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Deepa D.,State Tuberculosis Training and Demonstration Center | Achanta S.,World Health Organization | Jaju J.,World Health Organization | Rao K.,State Tuberculosis Training and Demonstration Center | And 4 more authors.
PLoS ONE | Year: 2013

Background:Multi drug resistant and rifampicin resistant TB patients in India are treated with the World Health Organization (WHO) recommended standardized treatment regimens but no guidelines are available for the management of isoniazid (INH) resistant TB patients. There have been concerns that the standard eight-month retreatment regimen being used in India (2H3R3Z3E3S3/1H3R3Z3E3/5H3R3E3; H-Isoniazid; R-Rifampicin; Z-Pyrazinamide; E-Ethambutol; S-Streptomycin) may be inadequate to treat INH resistant TB cases and leads to poor treatment outcomes. We aimed to assess if INH resistance is associated with unfavorable treatment outcomes (death, default, failure and transferred out) among a cohort of smear positive retreatment TB patients registered in three districts of Andhra Pradesh, India.Methods:We conducted a retrospective record review of all smear positive retreatment TB patients without rifampicin resistance registered during April-December 2011.Results:Of 1,947 TB patients, 1,127 (58%) were tested with LPA-50 (4%) were rifampicin resistant, 933 (84%) were sensitive to INH and rifampicin and 144 (12%) were INH resistant. Of 144 INH resistant cases, 64 (44%) had poor treatment outcomes (25 (17%) default, 22 (15%) death, 12 (8%) failure and 5 (3%) transfer out) as compared to 287 (31%) among INH sensitive cases [aRR 1.46; 95%CI (1.19-1.78)].Conclusion:Our study confirms that INH resistance is independently associated with unfavorable treatment outcomes among smear positive retreatment TB patients, indicating that the current treatment regimen may be inadequate. These findings call for an urgent need for randomized controlled trials to discover the most effective treatment regimen for managing INH resistant TB. © 2013 deepa et al.

Nagaraja S.B.,Office of the WHO Representative in India | Satyanarayana S.,International Union Against Tuberculosis and Lung Diseases The Union | Chadha S.S.,International Union Against Tuberculosis and Lung Diseases The Union | Kalemane S.,Impact Health Solutions | And 13 more authors.
PLoS ONE | Year: 2011

Setting: Seven districts in Andhra Pradesh, South India Objectives: To a) determine treatment outcomes of patients who fail first line anti-TB treatment and are not placed on an multi-drug resistant TB (MDR-TB) regimen, and b) relate the treatment outcomes to culture and drug susceptibility patterns (C&DST). Design: Retrospective cohort study using routine programme data and Mycobacterium TB Culture C&DST between July 2008 and December 2009. Results: There were 202 individuals given a re-treatment regimen and included in the study. Overall treatment outcomes were: 68(34%) with treatment success, 84(42%) failed, 36(18%) died, 13(6.5%) defaulted and 1 transferred out. Treatment success for category I and II failures was low at 37%. In those with positive cultures, 81 had pan-sensitive strains with 31(38%) showing treatment success, while 61 had drug-resistance strains with 9(15%) showing treatment success. In 58 patients with negative cultures, 28(48%) showed treatment success. Conclusion: Treatment outcomes of patients who fail a first-line anti-TB treatment and who are not placed on an MDR-TB regimen are unacceptably poor. The worst outcomes are seen among category II failures and those with negative cultures or drug-resistance. There are important programmatic implications which need to be addressed. © 2011 Burugina Nagaraja et al.

Sureshbabu R.,Karpagam University | Sureshbabu R.,State Tuberculosis Training and Demonstration Center | Lakshmi Murali A.,State Tuberculosis Training and Demonstration Center | Palaniswamy M.,Karpagam University
International Journal of Pharma and Bio Sciences | Year: 2016

To diagnose the multi-drug resistant Mycobacterium tuberculosis by using molecular methods from pulmonary specimens of presumptive TB suspects belonging to the districts of Tamil Nadu. Two thousand three hundred and thirty five (2335) clinical specimens of presumptive MTB patients were collected from 23 districts of Tamil Nadu between the period of January and March 2015. Smear microscopy was performed by LED fluorescent microscopy. All smear positive samples were tested using Line Probe Assay (LPA) and smear negative samples were tested by Xpert MTB/RIF (Xpert) to detect the percentage of drug resistance pattern and to identify MTB complex. Among 1235 smear positives subjected to LPA method; 116 (9.4%) MTB was not detected and 3 (0.2%) showed invalid result; 1116 (90.4 %) strains showed MTB positive; 896 (80.3 %) were sensitive for both rifampicin (RIF) and isoniazid (INH) drugs; 128 (11.5 %) were resistance for INH; 18 (1.6 %) resistant for RIF and58 (5.2 %) were resistance for RIF and INH and smear negative specimens were subjected to Xpert, Out of 1090 specimens; 647 (59.4 %) MTB was not detected; 30 (2.8 %) showed an invalid/error results; 413 (37.9 %) strains showed MTB positive of which 379 (91.8 %) were sensitive for RIF, 24 (5.8 %) showed resistant for RIF and 09 (2.2 %) showed MTB detection and RIF Indeterminate. LPA and Xpert molecular technology are the rapid, feasible and reliable methods for the detection of multi drug resistant (MDR) mutation.

PubMed | Centers for Disease Control and Prevention, World Health Organization, Regional Office for South East Asia, Bhopal Memorial Hospital and Research Center and 3 more.
Type: Journal Article | Journal: Public health action | Year: 2015

This cross-sectional multi-centric study compared the yield of and potential benefit for detecting smear-positive pulmonary tuberculosis (PTB) by bleach sedimentation (2% sodium-hypochlorite) versus direct microscopy under programme conditions in India. Among 3168 PTB suspects, 684 (21.6%) were detected by bleach sedimentation vs. 625 (19.7%) by direct microscopy, with a proportional overall agreement of 96% ( = 0.88). While 594 patients were smear-positive with both methods, 31 patients detected by direct microscopy were missed and an additional 90 patients were detected by bleach sedimentation. Overall, bleach sedimentation increased the yield of smear-positive TB detection; however; it also increased the time to results.

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