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Drug resistance of Mycobacterium tuberculosis in Malawi: a cross-sectional survey.

Abouyannis M, Dacombe R, Dambe I, Mpunga J, Faragher B, Gausi F, Ndhlovu H, Kachiza C, Suarez P, Mundy C, Banda HT, Nyasulu I, Squire SB - Bull. World Health Organ. (2014)

Bottom Line: Although resistance to second-line drugs was found, no cases of extensive drug-resistant tuberculosis were detected.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Centre for Applied Health Research & Delivery, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England .

ABSTRACT

Objective: To document the prevalence of multidrug resistance among people newly diagnosed with - and those retreated for - tuberculosis in Malawi.

Methods: We conducted a nationally representative survey of people with sputum-smear-positive tuberculosis between 2010 and 2011. For all consenting participants, we collected demographic and clinical data, two sputum samples and tested for human immunodeficiency virus (HIV).The samples underwent resistance testing at the Central Reference Laboratory in Lilongwe, Malawi. All Mycobacterium tuberculosis isolates found to be multidrug-resistant were retested for resistance to first-line drugs - and tested for resistance to second-line drugs - at a Supranational Tuberculosis Reference Laboratory in South Africa.

Findings: Overall, M. tuberculosis was isolated from 1777 (83.8%) of the 2120 smear-positive tuberculosis patients. Multidrug resistance was identified in five (0.4%) of 1196 isolates from new cases and 28 (4.8%) of 581 isolates from people undergoing retreatment. Of the 31 isolates from retreatment cases who had previously failed treatment, nine (29.0%) showed multidrug resistance. Although resistance to second-line drugs was found, no cases of extensive drug-resistant tuberculosis were detected. HIV testing of people from whom M. tuberculosis isolates were obtained showed that 577 (48.2%) of people newly diagnosed and 386 (66.4%) of people undergoing retreatment were positive.

Conclusion: The prevalence of multidrug resistance among people with smear-positive tuberculosis was low for sub-Saharan Africa - probably reflecting the strength of Malawi's tuberculosis control programme. The relatively high prevalence of such resistance observed among those with previous treatment failure may highlight a need for a change in the national policy for retreating this subgroup of people with tuberculosis.

No MeSH data available.


Related in: MedlinePlus

Flowchart to determine multidrug resistance in people diagnosed with tuberculosis in Malawi, 2010–2011
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Figure 1: Flowchart to determine multidrug resistance in people diagnosed with tuberculosis in Malawi, 2010–2011

Mentions: During the study period, 2120 smear-positive individuals consented to participate. Five were excluded as their baseline data were missing, another 1347 were classified as newly diagnosed with tuberculosis and the remaining 768 were classified as retreatment cases (Fig. 1). M. tuberculosis was isolated from 1196 (88.8%) of the new cases. There was no difference in the distribution of age, sex, region or HIV status between these and new cases from which M. tuberculosis was not isolated. M. tuberculosis was isolated from 581 (75.7%) of people undergoing retreatment. Those in whom M. tuberculosis was not isolated were older than the other retreatment cases, with mean ages of 40.7 and 36.4 years, respectively.


Drug resistance of Mycobacterium tuberculosis in Malawi: a cross-sectional survey.

Abouyannis M, Dacombe R, Dambe I, Mpunga J, Faragher B, Gausi F, Ndhlovu H, Kachiza C, Suarez P, Mundy C, Banda HT, Nyasulu I, Squire SB - Bull. World Health Organ. (2014)

Flowchart to determine multidrug resistance in people diagnosed with tuberculosis in Malawi, 2010–2011
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4221759&req=5

Figure 1: Flowchart to determine multidrug resistance in people diagnosed with tuberculosis in Malawi, 2010–2011
Mentions: During the study period, 2120 smear-positive individuals consented to participate. Five were excluded as their baseline data were missing, another 1347 were classified as newly diagnosed with tuberculosis and the remaining 768 were classified as retreatment cases (Fig. 1). M. tuberculosis was isolated from 1196 (88.8%) of the new cases. There was no difference in the distribution of age, sex, region or HIV status between these and new cases from which M. tuberculosis was not isolated. M. tuberculosis was isolated from 581 (75.7%) of people undergoing retreatment. Those in whom M. tuberculosis was not isolated were older than the other retreatment cases, with mean ages of 40.7 and 36.4 years, respectively.

Bottom Line: Although resistance to second-line drugs was found, no cases of extensive drug-resistant tuberculosis were detected.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Centre for Applied Health Research & Delivery, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England .

ABSTRACT

Objective: To document the prevalence of multidrug resistance among people newly diagnosed with - and those retreated for - tuberculosis in Malawi.

Methods: We conducted a nationally representative survey of people with sputum-smear-positive tuberculosis between 2010 and 2011. For all consenting participants, we collected demographic and clinical data, two sputum samples and tested for human immunodeficiency virus (HIV).The samples underwent resistance testing at the Central Reference Laboratory in Lilongwe, Malawi. All Mycobacterium tuberculosis isolates found to be multidrug-resistant were retested for resistance to first-line drugs - and tested for resistance to second-line drugs - at a Supranational Tuberculosis Reference Laboratory in South Africa.

Findings: Overall, M. tuberculosis was isolated from 1777 (83.8%) of the 2120 smear-positive tuberculosis patients. Multidrug resistance was identified in five (0.4%) of 1196 isolates from new cases and 28 (4.8%) of 581 isolates from people undergoing retreatment. Of the 31 isolates from retreatment cases who had previously failed treatment, nine (29.0%) showed multidrug resistance. Although resistance to second-line drugs was found, no cases of extensive drug-resistant tuberculosis were detected. HIV testing of people from whom M. tuberculosis isolates were obtained showed that 577 (48.2%) of people newly diagnosed and 386 (66.4%) of people undergoing retreatment were positive.

Conclusion: The prevalence of multidrug resistance among people with smear-positive tuberculosis was low for sub-Saharan Africa - probably reflecting the strength of Malawi's tuberculosis control programme. The relatively high prevalence of such resistance observed among those with previous treatment failure may highlight a need for a change in the national policy for retreating this subgroup of people with tuberculosis.

No MeSH data available.


Related in: MedlinePlus