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Drug-resistant tuberculosis in HIV-infected patients in a national referral hospital, Phnom Penh, Cambodia.

Walls G, Bulifon S, Breysse S, Daneth T, Bonnet M, Hurtado N, Molfino L - Glob Health Action (2015)

Bottom Line: There is significant resistance to first-line TB drugs amongst new and previously treated TB-HIV co-infected patients in Phnom Penh.Additional prevalence studies are needed.This study also illustrates the feasibility and utility of analysis of non-respiratory specimens in the diagnosis of TB, even in low-resource settings, and suggests that extra-pulmonary specimens should be included in TB diagnostic algorithms.

View Article: PubMed Central - PubMed

Affiliation: Médecins Sans Frontières (MSF) France, Phnom Penh, Cambodia; Department of Infectious Diseases, Middlemore Hospital, Auckland, New Zealand; genevieve.walls@middlemore.co.nz.

ABSTRACT

Background and objective: There are no recent data on the prevalence of drug-resistant tuberculosis (DR TB) in Cambodia. We aim to describe TB drug resistance amongst adults with pulmonary and extra-pulmonary TB and human immunodeficiency virus (HIV) co-infection in a national referral hospital in Phnom Penh, Cambodia.

Design: Between 22 November 2007 and 30 November 2009, clinical specimens from HIV-infected patients suspected of having TB underwent routine microscopy, Mycobacterium tuberculosis culture, and drug susceptibility testing. Laboratory and clinical data were collected for patients with positive M. tuberculosis cultures.

Results: M. tuberculosis was cultured from 236 HIV-infected patients. Resistance to any first-line TB drug occurred in 34.7% of patients; 8.1% had multidrug resistant tuberculosis (MDR TB). The proportion of MDR TB amongst new patients and previously treated patients was 3.7 and 28.9%, respectively (p<0.001). The diagnosis of MDR TB was made after death in 15.8% of patients; in total 26.3% of patients with MDR TB died. The diagnosis of TB was established by culture of extra-pulmonary specimens in 23.6% of cases.

Conclusions: There is significant resistance to first-line TB drugs amongst new and previously treated TB-HIV co-infected patients in Phnom Penh. These data suggest that the prevalence of DR TB in Cambodia may be higher than previously recognised, particularly amongst HIV-infected patients. Additional prevalence studies are needed. This study also illustrates the feasibility and utility of analysis of non-respiratory specimens in the diagnosis of TB, even in low-resource settings, and suggests that extra-pulmonary specimens should be included in TB diagnostic algorithms.

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TB cases amongst HIV-infected patients.
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Figure 0001: TB cases amongst HIV-infected patients.

Mentions: Between 1 November 2007 and 30 November 2009, 658 cases of TB were reported in the programme's cohort of 3,612 HIV-infected adult patients (18.2%) who received inpatient and outpatient care over the study period. M. tuberculosis infection was confirmed by culture in 236 patients (236/658 cases, 35.9%). Case definitions of the 236 culture-positive patients were as follows: 187 new cases (187/236, 79.2%) and 38 previously treated cases (38/236, 16.1%): 26 relapsed (26/38, 68.4%), 6 who had failed treatment (6/38, 15.8%) and 6 who had interrupted previous TB treatment (6/38, 15.8%). The remainder with either transferred in from another cohort or ‘other’ case definitions (Fig. 1).


Drug-resistant tuberculosis in HIV-infected patients in a national referral hospital, Phnom Penh, Cambodia.

Walls G, Bulifon S, Breysse S, Daneth T, Bonnet M, Hurtado N, Molfino L - Glob Health Action (2015)

TB cases amongst HIV-infected patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4306750&req=5

Figure 0001: TB cases amongst HIV-infected patients.
Mentions: Between 1 November 2007 and 30 November 2009, 658 cases of TB were reported in the programme's cohort of 3,612 HIV-infected adult patients (18.2%) who received inpatient and outpatient care over the study period. M. tuberculosis infection was confirmed by culture in 236 patients (236/658 cases, 35.9%). Case definitions of the 236 culture-positive patients were as follows: 187 new cases (187/236, 79.2%) and 38 previously treated cases (38/236, 16.1%): 26 relapsed (26/38, 68.4%), 6 who had failed treatment (6/38, 15.8%) and 6 who had interrupted previous TB treatment (6/38, 15.8%). The remainder with either transferred in from another cohort or ‘other’ case definitions (Fig. 1).

Bottom Line: There is significant resistance to first-line TB drugs amongst new and previously treated TB-HIV co-infected patients in Phnom Penh.Additional prevalence studies are needed.This study also illustrates the feasibility and utility of analysis of non-respiratory specimens in the diagnosis of TB, even in low-resource settings, and suggests that extra-pulmonary specimens should be included in TB diagnostic algorithms.

View Article: PubMed Central - PubMed

Affiliation: Médecins Sans Frontières (MSF) France, Phnom Penh, Cambodia; Department of Infectious Diseases, Middlemore Hospital, Auckland, New Zealand; genevieve.walls@middlemore.co.nz.

ABSTRACT

Background and objective: There are no recent data on the prevalence of drug-resistant tuberculosis (DR TB) in Cambodia. We aim to describe TB drug resistance amongst adults with pulmonary and extra-pulmonary TB and human immunodeficiency virus (HIV) co-infection in a national referral hospital in Phnom Penh, Cambodia.

Design: Between 22 November 2007 and 30 November 2009, clinical specimens from HIV-infected patients suspected of having TB underwent routine microscopy, Mycobacterium tuberculosis culture, and drug susceptibility testing. Laboratory and clinical data were collected for patients with positive M. tuberculosis cultures.

Results: M. tuberculosis was cultured from 236 HIV-infected patients. Resistance to any first-line TB drug occurred in 34.7% of patients; 8.1% had multidrug resistant tuberculosis (MDR TB). The proportion of MDR TB amongst new patients and previously treated patients was 3.7 and 28.9%, respectively (p<0.001). The diagnosis of MDR TB was made after death in 15.8% of patients; in total 26.3% of patients with MDR TB died. The diagnosis of TB was established by culture of extra-pulmonary specimens in 23.6% of cases.

Conclusions: There is significant resistance to first-line TB drugs amongst new and previously treated TB-HIV co-infected patients in Phnom Penh. These data suggest that the prevalence of DR TB in Cambodia may be higher than previously recognised, particularly amongst HIV-infected patients. Additional prevalence studies are needed. This study also illustrates the feasibility and utility of analysis of non-respiratory specimens in the diagnosis of TB, even in low-resource settings, and suggests that extra-pulmonary specimens should be included in TB diagnostic algorithms.

Show MeSH
Related in: MedlinePlus