New Delhi Tuberculosis Center

New Delhi, India

New Delhi Tuberculosis Center

New Delhi, India
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Vashistha H.,New Delhi Tuberculosis Center | Vashistha H.,Jaipur National University | Hanif M.,New Delhi Tuberculosis Center | Chopra K.K.,New Delhi Tuberculosis Center | And 2 more authors.
Indian Journal of Tuberculosis | Year: 2017

Background: The GenoType MTBDR. plus, a commercial Line Probe Assay (LPA) kit from Hain Lifescience, Germany, is endorsed by India's RNTCP Program for diagnosis of DRTB cases among smear-positive sputum samples. Although the LPA has been studied in several laboratories, there is a wide variation in existing M. tuberculosis strains across the globe, and false results can occur due to the presence of unique genetic mutations in different settings. Aim and objective: An attempt was made to carry out band pattern analysis using LPA and also to observe uncommon mutations in MDR strains. Materials and methods: Sputum samples were collected from MDR suspects and transported to intermediate reference laboratory (IRL) at New Delhi Tuberculosis Centre in Delhi. Sputum decontamination, DNA extraction, amplification, hybridization, and band pattern analysis of Line Probe assay strips was performed as per manufacturer's instructions. Results: Among the 3000 samples with interpretable LPA strips, rifampicin drug resistance with or without isoniazid was observed in 600 samples. The most common mutation detected by LPA in the rpoB gene was Ser516Leu (29.0%). Novel mutations reported in this study include mutation from CAG (Gin) to CAT (His) at codon 517, AGC (Ser)-AGG (Arg) at codon 512, ACA (Thr) to GCA (Ala) at codon 526, TTG (Leu)-CTG (Leu)s at codon 524. Conclusion: High frequencies of uncommon mutations in rpoB gene by LPA were observed, highlighting possibility of those in-silico detected mutations that may not impart phenotypic resistance further. © 2017 Tuberculosis Association of India.


Arora S.K.,Sanjay Gandhi Memorial Hospital | Singh U.,All India Institute of Medical Sciences | Hanif M.,New Delhi Tuberculosis Center | Vashisht R.P.,New Delhi Tuberculosis Center
Indian Journal of Medical Research | Year: 2011

Background & objectives: Multidrug-resistant tuberculosis (MDR-TB) has emerged as a significant global health concern. The most important risk factor for the development of MDR-TB is previous anti-tuberculosis therapy. Category II pulmonary TB includes those patients who had failed previous TB treatment, relapsed after treatment, or defaulted during previous treatment. We carried out this study to ascertain the prevalence of MDR-TB among category II pulmonary TB patients. Methods: This was a cross-sectional, descriptive study involving category II pulmonary TB patients diagnosed between 2005 and 2008. All sputum-positive category II TB cases were subjected to mycobacterial culture and drug-susceptibility testing (DST). MDR-TB was defined as TB caused by bacilli showing resistance to at least isoniazid and rifampicin. Results: A total of 196 cases of sputum-positive category II pulmonary tuberculosis patients were included. Of these, 40 patients (20.4%) had MDR-TB. The mean age of MDR-TB patients was 33.25 ± 12.04 yr; 9 patients (22.5%) were female. Thirty six patients showed resistance to rifampicin and isoniazid; while 4 patients showed resistance to rifampicin, isoniazid and streptomycin. The prevalence of MDR-TB among category-II pulmonary tuberculosis patients was 20.4 per cent. Interpretation & conclusions: The prevalence of MDR-TB in category II TB patients was significant. However, nation-wide and State-wide representative data on prevalence of MDR-TB are lacking. We stress the importance of continuous monitoring of drug resistance trends, in order to assess the efficacy of current interventions and their impact on the TB epidemic.


Arora S.K.,Sanjay Gandhi Memorial Hospital | Singh U.,All India Institute of Medical Sciences | Hanif M.,New Delhi Tuberculosis Center | Vashisht R.P.,New Delhi Tuberculosis Center
Indian Journal of Medical Research | Year: 2011

Background & objectives: The prevalence of multidrug-resistant tuberculosis (MDR-TB) is increasing throughout the world. Although previous treatment for TB is the most important risk factor for development of MDR-TB, treatment-naïve patients are also at risk due to either spontaneous mutations or transmission of drug-resistant strains. We sought to ascertain the prevalence of MDR-TB among new cases of sputum-positive pulmonary TB. Methods: This was a prospective, observational study involving newly diagnosed cases of sputum-positive pulmonary tuberculosis diagnosed between 2008 and 2009 carried out in New Delhi, India. All sputum-positive TB cases were subjected to mycobacterial culture and first-line drug-susceptibility testing (DST). MDR-TB was defined as TB caused by bacilli showing resistance to at least isoniazid and rifampicin. Results: A total of 218 cases of sputum-positive pulmonary tuberculosis were enrolled between 2008 and 2009. Of these, 41 cases had negative mycobacterial cultures and DST was carried out in 177 cases. The mean age of the patients was 27.8 ± 10.2 yr; 59 patients (27%) were female. All patients tested negative for HIV infection. Out of 177 cases, two cases of MDR-TB were detected. Thus, the prevalence of MDR-TB among newly diagnosed pulmonary tuberculosis patients was 1.1 per cent. Interpretation & conclusions: MDR-TB prevalence is low among new cases of sputum-positive pulmonary TB treated at primary care level in Delhi. Nation-wide and State-wide representative data on prevalence of MDR-TB are lacking. Efforts should be directed towards continued surveillance for MDR-TB among newly diagnosed TB cases.


Chopra K.,New Delhi Tuberculosis Center | Chadha V.K.,National Tuberculosis Institute | Ramachandra J.,National Tuberculosis Institute | Aggarwal N.,New Delhi Tuberculosis Center
PLoS ONE | Year: 2012

Setting: Six selected districts in Northern India. Objectives: To find out the trend in Annual risk of tuberculous infection (ARTI) in north India. Study Design: Two rounds of community level surveys were conducted during 2000-2001 and 2009-10 respectively. Representative samples of children 1-9 years of age were tuberculin tested and maximum transverse diameter of induration was recorded in mm at about 72 hours. ARTI was computed from the estimated Prevalence of infection using mirror-image technique and anti-mode method. Results: ARTI was found to decline from 1.9% (confidence interval: 1.7-2.1) at round I to 1.1% (confidence interval: 0.8-1.3) at round II at the rate of 8% per year during the intervening period. Conclusion: A significant reduction in the risk of tuberculous infection among children was observed between two rounds of surveys carried out at an interval of about 9 years. © 2012 Chopra et al.


Singh M.,Jawaharlal Institute of Postgraduate Medical Education & Research | Sethi G.R.,Maulana Azad Medical College | Mantan M.,Maulana Azad Medical College | Khanna A.,Lok Nayak Hospital | Hanif M.,New Delhi Tuberculosis Center
International Journal of Tuberculosis and Lung Disease | Year: 2016

SETTING: A tertiary care teaching hospital in New Delhi, India. OBJECTIVE : To determine the sensitivity and specificity of the Xpertw MTB/RIF assay in paediatric pulmonary tuberculosis (PTB) using MGITTM culture as gold standard. METHODS : After ethical approval had been obtained, 50 patients aged 0-14 years with suspected PTB were enrolled. Sputum/induced sputum and gastric lavage from the participants were sent for direct smear, MGIT culture and Xpert testing. Chest X-ray and tuberculin skin test (TST) were also performed. PTB diagnosis was made without considering Xpert results according to the Revised National Tuberculosis Control Programme (RNTCP) algorithm. The sensitivity and specificity of Xpert were calculated using culture as gold standard. RESULT S : Of 50 individuals with suspected PTB, 23 (46%) were diagnosed with PTB based on the RNTCP algorithm. Sixteen children from the PTB group (69.5%) were Xpert-positive. None in the 'ñot PTB' group were Xpert-positive. With culture as gold standard, Xpert sensitivity and specificity were respectively 91.6% (95%CI 59.7-99.5) and 86.8% (95%CI 71.1-95.05). CONCLUS ION: In almost 70% of PTB cases, a definitive diagnosis could be made within 2 h using Xpert, establishing its role as a sensitive and specific point-ofcare test. © 2016 The Union.


PubMed | New Delhi Tuberculosis Center, Lok Nayak Hospital, Jawaharlal Institute of Postgraduate Medical Education & Research and Maulana Azad Medical College
Type: Journal Article | Journal: The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease | Year: 2016

A tertiary care teaching hospital in New Delhi, India.To determine the sensitivity and specificity of the Xpert() MTB/RIF assay in paediatric pulmonary tuberculosis (PTB) using MGIT culture as gold standard.After ethical approval had been obtained, 50 patients aged 0-14 years with suspected PTB were enrolled. Sputum/induced sputum and gastric lavage from the participants were sent for direct smear, MGIT culture and Xpert testing. Chest X-ray and tuberculin skin test (TST) were also performed. PTB diagnosis was made without considering Xpert results according to the Revised National Tuberculosis Control Programme (RNTCP) algorithm. The sensitivity and specificity of Xpert were calculated using culture as gold standard.Of 50 individuals with suspected PTB, 23 (46%) were diagnosed with PTB based on the RNTCP algorithm. Sixteen children from the PTB group (69.5%) were Xpert-positive. None in the not PTB group were Xpert-positive. With culture as gold standard, Xpert sensitivity and specificity were respectively 91.6% (95%CI 59.7-99.5) and 86.8% (95%CI 71.1-95.05).In almost 70% of PTB cases, a definitive diagnosis could be made within 2 h using Xpert, establishing its role as a sensitive and specific point-of-care test.


Chopra K.K.,New Delhi Tuberculosis Center
Indian Journal of Tuberculosis | Year: 2015

The emergence of M. tuberculosis strains resistant to at least, Isoniazid (INH) and Rifampicin (RIF), the two most potent drugs of first-line anti-TB therapy is termed multidrug drug-resistant TB (MDR-TB). This is a cause of concern to TB Control Programmes worldwide. When MDR-TB strains become resistant to the major second-line drugs, one of the fluouroquinolones and one of the three injectable drugs (Amikacin, Kanamycin and Capreomycin), it is defined as extensively drug resistant TB.1,2 MDR-TB is a manmade, costly and deadly problem. Rapid diagnosis of MDR-TB is essential for the prompt initiation of effective second-line therapy to improve treatment outcome and limit transmission of the disease. © 2015 Published by Elsevier B.V. on behalf of Tuberculosis Association of India.


Dhingra V.K.,New Delhi Tuberculosis Center | Khan S.,New Delhi Tuberculosis Center
Indian Journal of Tuberculosis | Year: 2010

Setting: The study was carried out at Delhi State, New Delhi. Objectives: 1. To assess the effect of social stigma in TB patient's treatment, their personality, emotions, feelings, changes in their thinking process and behaviour of their family members, friends. 2. To study the relationship of gender and to what extent social stigma affects their lives. Design: It was a prospective study. A total of 1977 newly diagnosed and registered cases under Revised National TB Control Programme for treatment during the period of March 2009 to May 2009 were included in the study. Out of a total population of 170 lacs, a proportion of 31 lacs of Delhi, distributed among five chest clinics of Delhi, comprised the study population. All the patients were interviewed according to a pre-designed & pre-tested questionnaire after taking informed consent of the patients. The data was collected and analysed after processing into MS excel sheets for statistical analysis. Results: There was an immense stigma observed at society level with 60% of the patients hiding their disease (p<0.05) from friends and neighbours. Stigma was observed more among middle and upper middle class when compared to lower middle class and lower class (p<0.05). Gender-wise further it was observed that stigma was more among females (p<0.05) than in males. Conclusion: The study has demonstrated that despite good performance of Revised National TB Control Programme the stigma in tuberculosis still remains a problem and we need to supplement the efforts in advocacy, communication and social mobalization for reducing the stigma problem among TB patients in effective control of tuberculosis.


PubMed | New Delhi Tuberculosis Center and State Tuberculosis Office
Type: Evaluation Studies | Journal: The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease | Year: 2016

In most developing countries, sputum smear microscopy for acid-fast bacilli remains the front line and often the only diagnostic tool for the diagnosis of tuberculosis (TB), making quality assurance of smear microscopy an important activity.To evaluate the results of a pilot study, where the random blinded rechecking for the entire state of Delhi was conducted at a reference laboratory.Slides from 25 Revised National Tuberculosis Control Programme designated districts (200 peripheral microscopy centres) in Delhi were re-read after proper coding by all the Senior Tuberculosis Laboratory Supervisors (STLS) at an intermediate reference laboratory under proper supervision.Of 12,162 re-read slides, 204 discrepant results were found. Of these, 150 (73.5%) errors were attributed to the peripheral microscopy centres and 54 (26.5%) to STLS. High false-positive errors were observed at a frequency of 12/150 (8%), and high false-negative errors at a frequency of 38/150 (25%). Minor errors, i.e., low false-negative, low false-positive and quantification errors, were observed at frequencies of respectively 68/150 (45.3%), 17/150 (11.3%) and 15/150 (10.0%).Greater stringency in the supervision of random blinded rechecking at the district level is essential to make smear rechecking more efficient and effective.


PubMed | New Delhi Tuberculosis Center
Type: Journal Article | Journal: The Indian journal of tuberculosis | Year: 2015

The emergence of M. tuberculosis strains resistant to at least, Isoniazid (INH) and Rifampicin (RIF), the two most potent drugs of first-line anti-TB therapy is termed multidrug drug-resistant TB (MDR-TB). This is a cause of concern to TB Control Programmes worldwide. When MDR-TB strains become resistant to the major second-line drugs, one of the fluouroquinolones and one of the three injectable drugs (Amikacin, Kanamycin and Capreomycin), it is defined as extensively drug resistant TB.(1,2) MDR-TB is a manmade, costly and deadly problem. Rapid diagnosis of MDR-TB is essential for the prompt initiation of effective second-line therapy to improve treatment outcome and limit transmission of the disease.

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