Drug Resistance in Mycobacterium Tuberculosis

Drug Resistance in Mycobacterium Tuberculosis

CHAPTER ONE

OBJECTIVES OF STUDY

• To determine the prevalence of Drug resistance in New smear sputum positive patients during study
• To determine the drug resistance to Rifampicin among them by using Cartridge Based Nucleic Acid Amplification Test (CB-NAAT) [GeneXpert] .
• To analyze the drug resistance of New smear sputum positive Patients to decide whether the DOTS PLUS regimen should start.

CHAPTER TWO

REVIEW OF LITERATURE

“I have no business to live this life if I cannot eradicate this scourge from mankind”-Robert Koch (Delivering a lecture at Berlin University on his discovery of tuberculosis bacilli, 1882)¹.

HISTORY

The ancient human strains shows the evidence of the tuberculosis infection were more than 9,000 B.C years old⁴ . Greek term phithisis known as tuberculosis, in around 460 BC, Hippocrates found that the phthisis⁵ was the dangerous disease of the times involving cough with blood and fever, it almost end with mortality². It is spreads from person to person via droplets or sputum from the people with the acute TB disease. It is also known as Koch’s disease, after the scientist Robert Koch¹. The bacteria causing TB, Mycobacterium tuberculosis, was identified and described on 24 March ( the day called as World TB Day) 1882 by Robert Koch⁶ . The first immunization for tuberculosis was developed from attenuated bovine-strain tuberculosis by Albert Calmette and Camille Guerin in 1906. It called as “BCG” (Bacillus of Calmette and Guerin)⁷ .

EPIDEMIOLOGY

TB is a major public health problem in our country⁹. TB is the commonest cause of mortality due to single infectious agent⁹. It nearly kills about the more than 100000 peoples including children each and every year¹⁰. Every second someone in the world infecting with tuberculosis⁸.

BASIC EPIDEMIOLOGICAL PRINCIPLES:

Measures of Tuberculous Infection

• Prevalence of infection
• Risk of infection
• Annual risk of infection
• Measures of Tuberculosis disease:
• Incidence of tuberculosis disease
• Prevalence of tuberculosis disease
• Risk of developing TB disease

₦3,000.00 – DOWNLOAD CHAPTERS 1-5 PROCEED TO DOWNLOAD Added to cart

 

CHAPTER THREE

MATERIALS AND METHODS SOURCE OF STUDY:

Data consists of primary data collected by the principal investigator directly from the patients who are admitted in the Government Medical College and Hospital.

DESIGN OF STUDY: Cross Sectional Study.

PERIOD OF STUDY: One year, July 2014 – June 2015.

SAMPLE SIZE: 100

INCLUSION CRETERIA:

1. Patients (Both Genders) diagnosed 100 numbers of new smear positive pulmonary tuberculosis patients at Coimbatore Medical College
2. Age above 18

EXCLUSION CRITERIA:

1. Presence of secondary immunodeficiency states- HIV,
2. Diabetes Mellitus
3. Cancer patients,
4. Patients on corticosteroids or cytotoxic drugs
5. Extra pulmonary TB
6. Pregnancy and lactation
7. Patients not capable of giving consent (psychiatric patients).
8. Patients not willing to participate in the study (who refused to consent)

METHODOLOGY

The study is will be undertaken on the patients attending medicine outpatient department and admitted in the Coimbatore Medical College and Hospital, Coimbatore during the study period (July 2014 to June 2014). A total of 100 patients of new smear positive pulmonary tuberculosis will be included in the study.

The list of the patients enrolled in the study is appended along with the dissertation. The study excludes minors, pregnant women, mentally-ill and non- volunteering patients, Presence of secondary immunodeficiency states- HIV, Diabetes, cancer patients, patients on corticosteroids or cytotoxic drugs, Extra pulmonary TB, Pregnancy and lactation, Hepatitis B or C infections.

The study is proposed to be conducted after obtaining informed signed consent from the patients. The duration of the study is one year from July 2014 to June 2015. The principal investigator, after obtaining informed signed consent from the patients to participate in the study, collects their baseline characteristic details, medical history details and physical examination details.

The clinical history includes all risk factors like close contact with known MDR-TB or with person who died of TB/ failed treatment, failure to improve on current TB treatment and association with HIV or other immuno suppressions.

CHAPTER FOUR

ANALYSIS OF RESULTS

DISCUSSION

This study was conducted in Coimbatore medical college hospital from July 2014 to July 2015.This is a cross sectional type of study. In this study total number of 122 patients were taken and 100 patients were studied. 22 patients were excluded based on the exclusion criteria. The clinical and diagnostic findings of this study are compared with our studies in literature here.

Out of 100 patients, 84 patients were male and remaining 16 were female. Majority of patients were in the age group of 41-50 (25%) followed by 31-40(23%). And about 69% of patients were labourers and followed by drivers. There were 35% of smokers.

Most common symptom was cough (100%), followed by Cough with expectoration(93%),haemoptysis (64%) and fever (39%)..

CHAPTER FIVE

SUMMARY AND CONCLUSION

SUMMARY

• 122 cases of new smear positive TB patients are taken up for this study attending Out patient department at Coimbatore Medical College, Out of which 100 cases are included for this study remaining are excluded as per criteria.
• Commonest age group involved in this study was 41-50 followed by 31-40.
• Males are most commonly affected(84%)
• Most commonly Laburers are commonly affected about 69%
• Cough(100%) followed by Expectoration, Haemoptysis and fever are the most common
• Most common finding in respiratory examination was crepitations about 69%.
• And this alone present about 40% of patients. Wheezes were seen in 27% and bronchial breath sounds were seen in 34% of patients.
• Renal function test are normal for almost all
• Totally 2 % of patients are having elevated Bilirubin, SGOT and SGPT
• Nearly 27% of patients are anemic.
• Most common finding in Chest X ray was infiltrations about 93%, total percent of cavitation was 38% and total percent of pleural effusion was 9%. And infiltration are most commonly seen in upper zone about 73% followed by mid zone involved about 56% and lower zone was 10%.
• Only 2% of patients sputum sample wee showing resistance to Rifampicin out of 100

CONCLUSION

1. In this study most common manifestations of New sputum pulmonary tuberculosis were cough with expectoration followed by fever, weight loss, Most commonly upper zone of the lungs were involved. Most of the patients showed decreased haemoglobin, white blood cells and increases ESR.
2. Possibility of drug resistance is seen new smear positive pulmonary
3. Resistance to Rifampicin were found in new sputum positive TB patients by using
4. Prevalence of Drug resistance to Rifampicin in our locality is about 2%. to compare with national and international prevalence it was
5. Multi Drug Resistance Tuberculosis (MDR-TB) is described as the resistance to anyone of the first-line TB drugs Rifampicin and
6. RIF resistance is the main indictor of MDR TB because the resistance to RIF mostly combined with the resistance for
7. Since, this is the indicator for prevalence of MDR-TB and all new smear positive patients should be screened for the same to early detection, prevention of spread and management of MDR-TB.

REFERENCES

1. Sakula A. Robert Koch (1843–1910): founder of the science of bacteriology and discoverer of the tubercle bacillus. A study of his life and work. Br J Dis Chest. 1979 Oct;73(4):389–394.
2. Gutierrez MC, Brisse S, Brosch R, Fabre M, Omais B, Marmiesse M et Ancient origin and gene mosaicism of the progenitor of Mycobacterium tuberculosis. PLoS Pathog 2005 Sep;1(1):e5.
3. Hershkovitz I, Donoghue HD, Minnikin DE, Besra GS, Lee OY, Gernaey AM et Detection and molecular characterization of 9000-year-old Mycobacterium tuberculosis from a neolithic settlement in the eastern mediterranean. PLoS ONE 2008;3(10):e3426.
4. Academic dictionaries and encyclopedias. [Online] 2006 [cited 2010 Sep 10]; Available from: URL:http://web.archive.org/web/20050211173218/http://classics.mit.edu/Hippocrates/aphorisms.mb.txt Aphorisms.
5. Al-Sharrah YA. The Arab Tradition of Medical Education and its Relationship withthe European Springer 2003;33(4):413-25.
6. Bonah C. The experimental stable of the BCG vaccine: safety, efficacy, proof, and standards, 1921–1933. Stud Hist Philos Biol Biomed Sci 2005;36(4):696-721.
7. Nobel Foundation. The Nobel Prize in Physiology or Medicine 1905. [cited 2010 Sep10]

₦3,000.00 – DOWNLOAD CHAPTERS 1-5 PROCEED TO DOWNLOAD Added to cart