Prevalence of Drug Resistance in Mycobacterium tuberculosis in a Teaching Hospital of Kanchipuram District, Tamilnadu, South India

V. Makeshkumar^1, , Radha Madhavan¹ and Sujatha Narayanan²

¹Department of Microbiology, SRM Medical College Hospital and Research Centre (SRM MCH & RC), SRM University, Potheri village, Kattankulathur, Kanchipuram District, Tamilnadu, India

²Department of Immunology, National Institute for Research in Tuberculosis [NIRT] (Formerly Tuberculosis Research Centre [TRC]), Indian Council of Medical Research (ICMR), Mayor V.R. Ramanathan Road, Chetpet, Chennai, Tamilnadu, India

Cite this paper:
V. Makeshkumar, Radha Madhavan and Sujatha Narayanan. Prevalence of Drug Resistance in Mycobacterium tuberculosis in a Teaching Hospital of Kanchipuram District, Tamilnadu, South India. American Journal of Microbiological Research. 2014; 2(1):35-40. doi: 10.12691/ajmr-2-1-5

Abstract

Objectives: To study the prevalence of drug resistance in Mycobacterium tuberculosis isolated from patients with pulmonary and extrapulmonary tuberculosis. Materials and Methods: A total of 178 extra pulmonary clinical specimens were collected from patients suspected with extrapulmonary tuberculosis (EPTB) and again 2,048 sputum samples from 1030 patients with clinical evidence of pulmonary tuberculosis (PTB) were collected in SRM Hospital and Research Centre of Kanchipuram District. Both pulmonary and extrapulmonary specimens were stained by Ziehl-Neelsen (ZN) method. All sputum AFB smear positive specimens and 178 extrapulmonay clinical specimens were cultured in Lowenstein Jensen (LJ) medium. All Mycobacterial isolates were identified by standard protocols and were tested by conventional drug susceptibility method using absolute concentration method. Results: Out of 1030 clinically suspected pulmonary tuberculosis patients, 125 (12.13%) patients were smear positive for AFB. Among these 125, 76 (54.4%) were positive for Mycobacterium species cultured on LJ medium. Out of 76 mycobacterial isolates, 68 (89.4%) were M. tuberculosis and 8 (10.52%) were non tuberculous mycobacteria (NTM). Of 178 extrapulmonary clinical specimens, 10 (5.6%) were direct AFB smear positive and 6 (3.37%) were positive for M. tuberculosis on LJ medium. All 74 M. tuberculosis isolates (68 pulmonary isolates and 6 extrapulmonary isolates) were tested for first line anti-TB drugs by conventional drug susceptibility method. Three (4.05%) M. tuberculosis isolates were resistant to rifampicin, isoniazid and ethambutol. All the three multidrug resistance tuberculosis (MDR-TB) strains were isolated from pulmonary tuberculosis patients. Conclusion: In this hospital area, 4.05 percentage of MDR-TB isolates were reported in culture positive PTB cases.

Keywords:
prevalence of drug resistance pulmonary and extra pulmonary tuberculosis absolute concentration method Middle brook 7H10 agar first line anti-tb drugs

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Munn P, Felten M. Surveillance of resistance to anti tuberculosis drugs in developing countries, Tuberc Lung Dis 1994; 75: 163-167.
[2]	Kochi A, Vareldzis B, Styblo K. Multidrug resistant tuberculosis and its control, Rex Microbiol 1993, 144: 104.
[3]	Kim SJ, Hong YF. Drug resistance to Mycobacterium tuberculosis in Korea, Tubercle & Lung Dis 1992, 73: 219.
[4]	Chandrasekaran S, Jagota P, Chaudhury K. Initial drug resistance to anti-tuberculosis drugs in urban and rural district tuberculosis programme, Ind J Tub 1992, 39: 171.
[5]	Frieden TR, Sterling T, Pablos-Mendes A, et al. The emergence of drug resistant tuberculosis in New York City, New Eng J Med 1993, 328: 521.
[6]	Van der Werf TS. High initial drug resistance in pulmonary tuberculosis in Ghana, Tubercle 1989, 70: 249.
[7]	Braun MM, Kilburn JO, Smithwick RW, et al. HIV infection and primary resistance to anti-tuberculosis drugs in Abidjan, Cote d`Ivoire. AIDS 1992; 6: 1327.
[8]	Paramasivan CN. An overview of drug resistant tuberculosis in India, Ind J Tub1998, 45: 73.
[9]	World Health Organization. Global tuberculosis control: surveillance, planning, financing: Geneva: the Organization: 2005.WHO/HTM/TB/2005.349.
[10]	Prasad R. Current MDR status. Ind J Tub.2005; 52: 121-31.
[11]	Iseman MD. Treatment of multi resistant tuberculosis, N Engl J Med 1993; 329 (11): 784-791.
[12]	Mitchison, DA. Drug resistance in mycobacteria. Br Med Bull 1984; 40: 84-90.
[13]	Snider DE, Jr, Kelley GD, Cauthen GM, Thompson NJ, Kilburn JO. Infection and disease among contacts of tuberculosis cases with drug resistant and drug susceptible bacilli, Am Rev Respir Dis 1985; 132: 125-32.
[14]	Aziz M, K. Ryszewska L, Blanc V, Vincent H, Getahun A Wright P, Nunn and Raviglione M. Expanding culture and drug susceptibility testing capacity in tuberculosis diagnostic services: the new challenge. Int. J. Tuberc. Lung Dis. 2007;11: 247-250.
[15]	Canetti, G., W. Fox, A. Khomenko, H. T. Mahler, N.K. Menon, D. A. Mitchison, N. Rist, and N. A. Smelev. Advances in techniques of testing mycobacterial drug sensitivity, and the use of sensitivity tests in tuberculosis control programmes, Bull. W.H.O 1969; 41: 21-43.
[16]	World Health Organization. Guideliness for drug susceptibility testing for second-line anti-tuberculosis drugs for DOTS-plus. 2001.
[17]	World Health Organization. 2007. Reduction of number of smears for the diagnosis of pulmonary TB. World Health Organization, Geneva, Switzerland. http://www.who.int/tb/dots/laboratory/policy/en/index2.html.
[18]	Kent PT and Kubic GP. Public health mycobacteriology a guide for the level III laboratory.U.S. Department of Health and Human Services. Public health service.CDC, Atlanta, Georgia; 1985.
[19]	Laszlo A, Rahman M, Espinal, M, and Raviglione M. Quality assurance programme for drug susceptibility testing of Mycobacterium tuberculosis in the WHO/IUALTD Supranational Reference Laboratory Network: five rounds of proficiency testing,1994-1998.Int J Tuberc Lung Dis,2002. 6: 748-756.
[20]	Laszlo A, Rahman M, Raviglione M, and Bustreo F. Quality assurance programme for drug susceptibility testing of Mycobacterium tuberculosis in the WHO/IUALTD Supranational Laboratory Network: first round of proficiency testing, 1994-1998. Int J Tuberc Lung Dis, 1997; 1: 231-238.
[21]	Grange JM. “Environmental mycobacteria”. In Greenwood, David; Slack, Richard; pietherer, John & Barer, Mike (Eds), Medical Microbiology 2007 (17th Ed). Pp. 221-227. Elsevier. ISBN 978-0-443-10209-7.
[22]	A B M Abdul wadud, A S M Matiur Rahman, Md Ruhul Amin Miah, Ahmed Abu Saleh. Drug Resistance Pattern of Mycobacterium tuberculosis isolated from Patients Attending a Referral Hospital. Bangladesh J Med Microbiol 2009; 03 (01): 13-17.
[23]	Tatar D, Senol G, Cosar D, Ozacar R, Halicolar H. Patterns of Drug resistance in pulmonary tuberculosis cases in the Izmir district, Turkey. New Microbiol 2009; 32: 31-7.
[24]	Nagaraja C, Shashibhushan BL, Sager C, Asif M, Manjunath PH. Resistance pattern in drug–resistant pulmonary tuberculosis. J postgradu Med 2011; 57: 181-3.
[25]	Ravidran C, James PT, and Jyothi E. Prevalence of initial drug resistance of mycobacterium tuberculosis in northern Kerala. Lung India 2006; 23: 106-8.
[26]	WHO, Geneva, Switzerland. Anti tuberculosis drug resistance in the world. The WHO/IUATLD project on antituberculosis drug resistance surveillance. WHO/CDS/ TB/2000.2000; 278: 4-5.
[27]	Singh MM. Tuberculosis: Triumphs and tragedy. Ind J Tub2000; 47: 129-32.
[28]	Santha T, Thomas A, Chandrashekaran V, Selvakumar N, et al. Initial drug susceptibility profile of M.tuberculosis among patients under TB programme in south India. Int J Tuberc Lung Dis 2006; 10 (1): 52-57.
[29]	Jain N K: Drug resistance in India, A tragedy in the making. Ind J tub 1992; 39: 145-148.
[30]	Pablos-Medoz A, Raviglione MC, Laszlo a et al. Global surveillance for tuberculosis drug resistance, 1994-1997. N Engl J Med 1998; 338: 1641-1649.
[31]	Lee JH, Chang JH. Drug resistance tuberculosis in a tertiary referral teaching hospital of Korea. Korean J Inter Med 2001; 16: 173-179.
[32]	Churchyard GJ, Corbett EL, Kleinschmidt I, Mulder D, Decock KM. Drug resistance tuberculosis in South African gold miners: Incidence and associated factors. Int J Tuberc Lung Dis 2000; 4: 433-440.
[33]	Dhingra VK, Rajpal S, Bhalla P, Yadav A, Jain SK, et al, Prevalence of initial drug resistance in new sputum positive revised national tuberculosis control programme (RNTCP) patients. J Commun Dis 2003; 35: 82-89.
[34]	Liaw YS, Hsueh PR, YU CJ, Wang SK, Yang PC, Luh KT. Drug resistance pattern of Mycobacterium tuberculosis in University hospital in Taiwan 1998-2008. J Formos Med Assoc 2004; 103: 671-677.
[35]	Hellen S, Juan D, Roy M, Sabine R, Dennis F, Ian S et al. Multidrug resistance in Central Asia. EmerInfec Dis 2004; 10: 1210-1215.
[36]	World Health Organization Guidelines for surveillance of drug resistance in tuberculosis. WHO/TB/96, 216.
[37]	Dooley, S.W, Simone, P.M. The extent and management of drug–resistant tuberculosis: the American experience. Clinical tuberculosis. London: Chapman & Hall 1994; 171-189.
[38]	International Union against Tuberculosis and Lung Disease. Antituberculosis regimens of chemotherapy. Bulletin IUALTD. 1988; 63: 64.
[39]	Huq AKMS, Khan ABMBR, Sabur SAMA, Azad A, and Miah NU. Study of case findings for pulmonary tuberculosis in out patient departments of general hospitals Bangladesh. Chest and Heart Bulletin 1995: 25-30.