CASE PERSENTATION Dr Peter Adwok PCs conflicted copy 2015 06 26 (original) (raw)
Related papers
Clinical management of adults and children with MDR and XDR-TB
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2016
Globally there is a burgeoning epidemic of drug mono-resistant tuberculosis (TB), multi-drug-resistant TB (MDR-TB), and extensively drug-resistant TB (XDR-TB). Almost 20% of all TB strains worldwide are resistant to at least 1 major TB drug including isoniazid. In several parts of the world there is an increasing incidence of MDR-TB, and alarmingly almost a third of MDR-TB cases globally are resistant to either a fluoroquinolone or aminoglycocide. This trend cannot be ignored because DR-TB is associated with greater morbidity compared to drug-sensitive TB, it accounts for almost 25% of global TB mortality, is extremely costly to treat, consuming substantial portions of budgets allocated to national TB programmes in TB endemic countries, and is a major threat to healthcare workers who are already in short supply in resource-poor settings. Even more worrying is the growing epidemic of resistance beyond XDR-TB, resistant to newer drugs such as bedaquiline and delamanid, and the increas...
MDR and XDR-TB among suspected drug-resistant TB patients in a tertiary care hospital in India
Clinical Respiratory Journal, 2010
Aim: To study the anti-tubercular drug resistance pattern among suspected cases of drug-resistant TB.Materials and Methods: First and second line drug susceptibility data were retrospectively analysed for all suspected cases of drug-resistant tuberculosis (TB), presenting to the Pulmonary Medicine department of tertiary care hospital in South India from 2003 to 2007.Results and Discussion: Out of 177 cases of suspected drug-resistant TB, 103 (58.2%) cases were multi-drug-resistant tuberculosis (MDR-TB). Out of 75 cases of MDR-TB for whom second-line drug susceptibility test was performed, 45 (60.0%) cases met the criteria of extensively drug–resistant (XDR) TB, which is very high when compared with existing worldwide data on XDR-TB (6.6% cases of MDR-TB). In comparison with non-MDR-TB cases, MDR and XDR-TB cases had a history of significantly higher duration of anti-TB treatment (ATT) and significantly higher exposure to multiple ATT regimens. Past exposure to second-line anti-TB drugs was significantly high in XDR-TB cases than in MDR-TB and non MDR-TB cases.Conclusion: This study highlights the high burden of XDR- and MDR-TB among TB patients coming to tertiary care hospitals in India.Please cite this paper as: James P, Gupta R, Christopher DJ, Thankagunam B and Veeraraghavan B. MDR and XDR-TB among suspected drug resistant TB patients in a tertiary care hospital in India. Clin Respir J 2011; 5: 19–25.
A Very Serious New Disease - Extended Drug- Resistant Tuberculosis (XDR TB)
2011
Compared to germ sensitive tuberculosis (TB), in the case of multi-drug resistant (MDR TB) or extended drug-resistant tuberculosis (XDR TB) the prognosis is unfavourable, by prolonging therapy and its success is relatively limited. Early diagnosis and swift establishment of the target therapy according to the extended antibiogram are very important for the success of the therapy. Abandonment and improper therapy in most cases lead to therapeutic failure and premature death. This paper presents the case of a patient presenting primary resistance of XDR TB type, with therapeutic non-compliance and abandonment, evolution being unfavourable and resulted in premature death of the patient. Cuvinte cheie: tuberculoza, chimiorezistența extinsă, rezistenţa primară, noncomplianța Rezumat: In comparație cu tuberculoza (TB) cu germeni sensibili, in cazul tuberculozei multidrogrezistente (TB MDR) sau cu rezisten ță extinsă (TB XDR) prognosticul este dezavantajos, prin prelungirea duratei terapie...
Annals of King Edward Medical University, 2016
Multidrug resistant (MDR) tuberculosis (TB) is becoming more cumbersome especially in developing countries. Already supportive infrastructures are weak as compared to disease burden. Numerous diagnostic techniques for early diagnosis of TB and MDR TB have brought incremental improvements however; the technical intricacies of these assays and their reliance on enthusiastic laboratory infrastructure have restricted their implementation, particularly in low resource and high burden settings. Recently introduced GeneXpert MTB / RIF assay simultaneously detects the presence of MTB, and its susceptibility to the important first line drug rifampicin. Aim of this report is to understand the role of physician in prompt diagnosis and its control in spread of MDR TB and conversion of normal TB to MDR TB using available resources. Watchfulness of physician is an important factor in treating TB patients and early diagnosis of MDR TB using available resources. A good skilled team work is necessar...
STUDY OF 537 CASES OF DRUG RESISTANT TUBERCULOSIS (DR TB
Aims:- To study outcome of 537 DR TB patients. Settings and Design:- Prospective study (June 2011 to March 2016). Introduction:- Multidrug-resistant tuberculosis (MDR-TB) is an increasing global problem. Though therapy of DR TB is much longer and costlier than drug sensitive TB, injectable have to be taken for six months, incidence of adverse reactions is more, thus decreasing compliance, patients do improve and even are cured if the health care personnel and caregivers encourage them to adhere to treatment. Methods and Material:- All cases were confirmed to have drug resistance to INH and Rifampicin or Rifampicin alone before admission. After starting treatment in DR TB ward, they were referred to their respective TB Units. Follow up was kept through District Tuberculosis and City Tuberculosis Office, and patients who came for treatment or adverse drug reaction. Results:- Males (79.41%) outnumbered females (20.59%). 388 patients (72.25%) belonged to the age group of 15 to 44 years, 81 (16.01%) were cured, 43 (8.50%) completed treatment, 88 (17.39%) died, 80 (15.81%) defaulted, 23 were HIV positive. 34 patients (6.331%) were subsequently found to have XDR TB. Conclusions:- In this prospective study of 537 DR TB cases, 124 (24.54%) patients recovered. However 80 patients (15.81%) is a matter of serious concern. Improved compliance in sensitive cases will help to prevent drug resistance. CB NAAT has grossly decreased the time needed for diagnosing DR TB helping early initiation of treatment which can be lifesaving.
Dsouza et al High levels of MDR TB in Mumbai BMC
Background: India, China and Russia account for more than 62% of multidrug resistant tuberculosis (MDRTB) globally. Within India, locations like urban metropolitan Mumbai with its burgeoning population and high incidence of TB are suspected to be a focus for MDRTB. However apart from sporadic surveys at watched sites in the country, there has been no systematic attempt by the Revised National Tuberculosis Control Programme (RNTCP) of India to determine the extent of MDRTB in Mumbai that could feed into national estimates. Drug susceptibility testing (DST) is not routinely performed as a part of programme policy and public health laboratory infrastructure, is limited and poorly equipped to cope with large scale testing. we determined the extent of drug resistance in 724 {493 newly diagnosed, previously untreated and 231 first line treatment failures (sputum-smear positive at the fifth month after commencement of therapy)} cases of pulmonary tuberculosis drawn from the RNTCP in four suboptimally performing municipal wards of Mumbai. The observations were obtained using a modified radiorespirometric Buddemeyer assay and validated by the Swedish Institute for Infectious Disease Control, Stockholm, a supranational reference laboratory. Data was analyzed utilizing SPSS 10.0 and Epi Info 2002.
Outcome of Multidrug Resistant Tuberculosis at a Tertiary Care Hospital, Rahim Yar Khan
Journal of Sheikh Zayed Medical College, 2020
Background: In patients of Multi drug resistant (MDR) TB, proper counseling of MDR-TB patients, regarding adherence to therapy, monitoring side effects and controlling the comorbidities, lead to better out come. Objective: To determine the outcome of MDR-TB at a tertiary care hospital in Rahim Yar Khan. Methodology: This retrospective cohort study was carried out at Department of Pulmonology, Sheikh Zayed Hospital, Rahim Yar Khan. A total of 231 patients of pulmonary MDR, were included from May 2014 to December 2017, patients having age between 10 to 80 years of either sex. Extra pulmonary DR-TB, Poly drug resistant TB, XDR and patients on shorter regimen of DR-TB were excluded from the study. Treatment outcomes like cured, treatment complete, died, treatment failure and lost to follow up were defined according to WHO definitions. Data was then analyzed with SPSS version 22.0 Results: Out of 231 patients, 123 (57.1%) were male, with mean age of 36.13+ 16 years. Regarding treatment outcome, 115 (49.8%) patients cured, 1 (0.4%) completed, 67 (29.0%) patients died, 5 (2.2%) patients showed treatment failure, 6 (2.6%) patients lost to follow up, 27 (11.7%) patents are still under treatment and treatment of 10 (4.3%) patients not evaluated. Over all successful outcome (treatment completed and cured) was 50.2% while unsuccessful outcome (died, treatment failure, lost to follow up, painters still under treatment and treatment not evaluated) was 49.8%. Conclusion: Successful outcome was noted in half of the pulmonary MDR-TB patients which is close to WHO target success rate. Younger age groups showed significantly better outcome.