Abstrakti
Background: Information on TB drug resistance profiles and its’ associated risk factors are scarce in Nigeria despite the large burden of disease in the country. The study was designed to report drug resistance profiles of new- and previously treated patients with pulmonary tuberculosis (TB) in Ibadan, Nigeria.
Method: Sputum from consenting pulmonary TB patients were collected and cultured for Mycobacterium tuberculosis (Mtb) at the TB laboratory of the University College Hospital, Ibadan, Nigeria using standard method. Mtb were stored and sent for drug susceptibility testing against first and second-line anti-TB drugs at the MRC Unit, The Gambia and at the Institute of Tropical Medicine, Antwerp, Belgium using BACTEC MGIT 960 and proportion method on solid medium respectively.
Results: Of 238 Mtb collected, 124 (52.1%) were viable, 102 (59.65%) non-viable while 12 (7.02%) were contaminated. About half (58.87%) of the Mtb were from previously treated patients, 40 (32.26%) were from new patients while treatment history of 11 (8.87%) were unknown. Forty-seven (37.90%) of the 124 Mtb tested were multidrug resistant (MDR) out of which, 40 (85.10%) were from previously treated patients. HIV prevalence was 8.69%. Of the 17 MDR-TB from previously treated cases tested for second-line drugs, four (23.53%) were resistant to fluoroquinolones or injectable agents, 13 (76.47%) were susceptible while none was resistant to both of these classes of drugs.
Conclusion: MDR-TB in Ibadan already demonstrates resistance to second line anti-TB drugs hence management of MDR-TB patients should be strengthened to prevent emergence of extensively drug-resistant TB (XDR-TB).
Keywords: Pulmonary tuberculosis, drug resistance, new, previously treated, Ibadan, Nigeria
Résumé
Contexte: Les informations sur les profils de résistance aux médicaments antituberculeux et ses facteurs de risque associés sont rares au Nigeria malgré la grandecharge de cette maladie dans le pays. L’étude a été conçue pour rendre compte des profils de résistance aux médicaments des patients nouveaux et préalablement traités atteints de tuberculose pulmonaire (TB) à Ibadan, Nigeria.
Méthode: Les crachatsprovenant de patientsatteints de tuberculose pulmonaireconsentants ont été prélevés et cultivés pour Mycobactérietuberculoses (Mtb) au laboratoire TB duCollège HospitalierUniversitaire, Ibadan, Nigeria en utilisant la méthode standard. Mtb ont été stockés et envoyés pour des tests de sensibilité aux médicaments contre la première et la deuxième ligne de médicaments anti-TB à l’unité MRC, la Gambie et à l’Institut de Médecine Tropicale, Anvers, Belgique en utilisant BACTEC MGIT 960 et la méthode des proportions sur milieu solide, respectivement.
Résultats: Sur 238 Mtb recueillis, 124 (52,1%) étaient viables, 102 (59,65%) non-viable alors que 12 (7,02%) ont été contaminés. Environ la moitié (58,87%) desMtb provenaient de patients précédemment traités, 40 (32,26%) provenaient de nouveaux patients tandis que l’histoire de traitement de 11 (8,87%) étaient inconnus. Quarante-sept (37,90%) des 124 Mtb testés étaient multi résistants (MDR), dont 40 (85,10%) provenaient de patients précédemment traités. La prévalence du VIH était de 8,69%. Sur les 17 casde MDR-TB traités auparavant testés pour les médicaments de deuxième ligne, quatre (23,53%) étaient résistants aux fluoro-quinolones ou agents injectables, 13 (76,47%) étaient sensibles alors qu’aucun n’était résistant à ces deux classes de médicaments.
Conclusion: MDR-TB à Ibadan montrent déjà une résistance à la seconde ligne anti-médicaments antituberculeux par conséquent la gestion des patients atteints de
MDR-TB doit être renforcée pour prévenir l’émergence de la tuberculose extensivement résistante aux médicaments (XDR-TB).
Mots-clés: Tuberculose pulmonaire, résistance aux médicaments, nouveau, préalablement traité, Ibadan, Nigeria
Correspondence: Dr. Aderemi Kehinde, TB Unit, Department of Medical Microbiology Parasitology, College of Medicine, University of Ibadan, Nigeria. E-mail: aokehinde@yahoo.com
Lähdeviitteet
World Health Organization. Global tuberculosis control: surveillance, planning and financing. WHO report. WHO, Geneva, 2010. WHO/HTM/TB/2010.7
World Health Organization. Global tuberculosis control: surveillance, planning and financing. WHO report. WHO, Geneva, 2013. WHO/HTM/TB/2013.11
World Health Organization. Global tuberculosis control: surveillance, planning and financing. WHO report. WHO, Geneva, 2014. WHO/HTM/TB/2014.08
Kehinde A O, Obaseki F A, Ishola O C and Ibrahim K D. Multidrug resistance to Mycobacterium tuberculosis in a tertiary hospital. Journal of the National Medical Association 2007. 99 (10): 1185-1189
Osman E, Daniel O, Ogiri S, et al. Resistance of Mycobacterium tuberculosis to first and second line antituberculosis drugs in South West, Nigeria. J Pulmon Resp Med 2012. S6 001. DOI: 10.4172/2161-105X.S6-001
Federal Republic of Nigeria Official Gazette. Legal Notice of Publication of 2006 Census Final Results. Abuja, Nigeria Federal Government of Nigeria 2009. 2, 38-39.
Narvais de Kantor I. Laboratory services in tuberculosis control. Part III: Culture. Geneva, World Health Organization,1998. WHO/TB/98.258
Barrow G I and Feltham R K A. Characters of Gram positive bacteria. In: Cowan and Steel’s manual for the identification of medical bacteria (3rd edn). Cambridge, UK: Cambridge University Press, 1995. 91-93
Ardito F, Posteraro B, Sanguinetti M, Zanetti S, Fadda G. Evaluation of BACTEC Mycobacteria Growth Indicator Tube (MGIT 960) automated system for drug susceptibility testing of Mycobacterium tuberculosis. J Clin Microbiol. 2001. Dec 39(12):4440-4444.
World Health Organization. The Stop TB Department. Policy guidance on drug-susceptibility testing (DST) of second-line antituberculosis drugs. 2008
Nathanson E, Nunn P, Uplekar M, et al. MDR tuberculosis- Critical steps for prevention and control. N Engl J Med 2010. 363 (11), 1050-1058
Erhabor G E, Adebayo R A, Omodara J A, et al. Ten year review of pattern of presentation and outcome of pulmonary tuberculosis in OAUTHC, Ile-Ife, Nigeria. Nig J of Health Sciences 2003. 3: 34-37
Ige O M, Sogaolu O M and Ogunlade O A. Pattern of presentation of tuberculosis and hospital prevalence of tuberculosis and HIV in University College Hospital, Ibadan, Nigeria: A review of five years (1998-2002). Afr J Med & Med sci 2005. 34:329-333
Ani A E, Idoko J, Dalyop Y B and Pitman S L. Drug resistance profile of Mycobacterium tuberculosis isolates from pulmonary tuberculosis patients in Jos, Nigeria. Transactions of the Royal Society of Tropical Medicine and Hygiene 2009. 103:67-71
Osagie E A D K, Shuaib A and Lawson L. Multidrug- resistant tuberculosis at the National Hospital, Abuja, Nigeria. African Journal of Respiratory Medicine 2008. 23:1-5
World Health Organization.Guidelines for surveillance of drug resistance in tuberculosis. 4th edition and (supplementary materials). WHO report. WHO, Geneva, 2009.WHO/HTM/TB/2009. 422
Lawn S and Churchyard G. Epidemiology of HIV associated tuberculosis. Curr Opin HIV/AIDS 2009; 325-333
Kehinde A O, Oladokun R E, Ige O M, Bakare R A and Osinusi K. Bacteriology of childhood tuberculosis in Ibadan, Nigeria: A five year review. Tropical Medicine & Health 2008. 36 (3): 127-130