|Year : 2006 | Volume
| Issue : 3 | Page : 106-108
Prevalence of initial drug resistance of mycobacterium tuberculosis in northern Kerala
C Ravidran, PT James, E Jyothi
Department of TB & Chest Diseases, Medical College, Calicut, Kerala., India
Department of TB & Chest Diseases, Medical College, Calicut, Kerala.
Source of Support: None, Conflict of Interest: None
| Abstract|| |
50 patients with sputum smear positive pulmonary tuberculosis were evaluated for initial drug resistance to 4 first line anti-tuberculous drugs using Lowenstein Jenson method.17.7% of patients showed initial drug resistance out of which 2 were resistant to INH alone and 4 having multidrug resistant tuberculosis.
Keywords: Initial drug resistance, Multidrug resistance
|How to cite this article:|
Ravidran C, James P T, Jyothi E. Prevalence of initial drug resistance of mycobacterium tuberculosis in northern Kerala. Lung India 2006;23:106-8
|How to cite this URL:|
Ravidran C, James P T, Jyothi E. Prevalence of initial drug resistance of mycobacterium tuberculosis in northern Kerala. Lung India [serial online] 2006 [cited 2020 Feb 20];23:106-8. Available from: http://www.lungindia.com/text.asp?2006/23/3/106/44401
| Introduction|| |
The advent of combination chemotherapy in 1952 triggered a revolution in the treatment of tuberculosis  . But soon it became apparent that resistance to individual drugs would develop at a predictable rate, if the drugs were used as single agent- an observation that became the basis for multidrug treatment programmes.
Drug resistance is defined as the temporary or permanent capacity of organism or their progeny to remain viable or multiply in the presence of the concentration of the drug that would normally destroy or inhibit the growth of their cells  .
| Objective|| |
To study the prevalence of initial drug resistance of Mycobacterium tuberculosis patients with pulmonary tubeculosis in the 5 northern districts of Kerala.
A prospective clinical study
One year from September 1999 to August 2000
Institute of Chest Diseases, Medical College, Calicut, Kerala
| Patients and Methods|| |
Patients attending outpatient clinics of the Department of Tuberculosis and Chest Diseases (Institute of Chest Diseases) of Calicut Medical College with sputum smear positive for acid fast bacilli during a period of one year were included in the study. All the patients were initially evaluated with detailed history including contact with tuberculosis, physical examination, X-ray chest PA view, Blood sugar estimation and HIV ELISA. A 24 hour sputum specimen was collected and culture for Mycobacterium tuberculosis was done by LJ method from the Department of Microbiolgy. All culture positive specimens were sent to National Tuberculosis Institute Bangalore for drug susceptibility test for INH, Rifampicin, Ethambutol and Streptomycin using proportion method. Exclusion criteria:
- Patients who has history of treatment for pulmonary tuberculosis in the past.
- Patients with history of treatment for pulmonary tuberculosis for more than for more than one month during the present illness.
| Observations|| |
Out of the 50 patients studied 48 had culture positivity for mycobacterium tuberculosis of which 3 samples were found to be contaminated on subculture.
These 3 patients were excluded from the study and the remaining 45 were subjected for drug susceptibility test [Table 1]
In the study group more females were found to be having drug resistance [Table 2]
Most of the drug resistant patients were in the age group of 15-45 years [Table 3]
Two patients were having drug resistance to INH alone [Table 4]. All others were resistant to multiple drugs [Table 5].
In this study it is observed that cavitary lesion in Chest X-ray and close contact with tuberculosis were found to be risk factors for development of drug resistance.
| Discussion|| |
Tuberculosis is a common infectious disease in our country. The emergence of drug resistant tuberculosis is a real threat to the community. In this study, resistance to at least one drug among patients with no prior history of antitubrculous treatment was present in 17.7% and multidrug resistance was present in 8.8%. Earlier study conducted in India showed 18.5% resistance to INH and 0.6% to rifampicin  . The global surveillance of drug resistant tuberculosis conducted by WHO and IUALTD between 1994 and 1997 showed a single drug resistance of 9.9% and multidrug resistance of 1.4%  .
In this study drug resistance was found to be more among females. The increased incidence of drug resistance in females may be due to the fact that in our country females seek medical attention at a very late stage, by then the disease may become extensive with higher number of drug resistant mutant bacilli. It was also observed that drug resistant tuberculosis is more common among young individuals-that is below 45 years. This shows that the problem of drug resistance is recently acquired and it mainly affect the reproductive age group. Close contact with drug resistant tuberculosis and presence of cavitary lesions in chest X-ray were found to be risk factor for the development of resistance. Cavitary tuberculosis are known to harbor a higher number of bacilli compared to noncavitary tuberculosis. This may be the reason for the increased incidence of drug-resistance in cavitary disease. In a previous study by Ben Dov et al it was found that persons with cavitary disease were four times as likely to harbor resistant organisms compared to persons with non-cavitary disease  .
| Conclusion|| |
Studies conducted worldwide shows an alarming increase in the rate of drug resistant tuberculosis  . This study shows that initial drug resistance is not uncommon in our community and this should be taken in to consideration while treating tuberculosis. Prevalence of initial Drug Resistance in northern districts of Kerala is found to be 17.7% as against 9.9% reported by WHO-IUATLD. Resistance to individual drugs parallel with other studies, even though resistance to INH and Rifampicin is slightly higher in this group.[Table 6]
| References|| |
|1.||Michel D Iseman. Treatment of multidrug resistant tuberculosis. N Engl J Med 1993; 329:784-791. |
|2.||Sudheendra Ghosh C . Cost effective management of drug resistace in pulmonary medicine. Pulmon 2001,3:49-52. |
|3.||Jain N K: Drug resistance in India, A tragedy in the making. Ind J tuberculosis 1992; 39:145-148. |
|4.||Pablos-Medoz A, Ranglione M C, Laszlo A et al. Global surveillance for tuberculous drug resistance, 1994-1997. N Engl J med 1998; 338:1641-1649. |
|5.||Abe C, Turano K et al. Resistance to mycobacterium tuberculosis to four first line antituberculous drugs in Japan. Int J Tuber Lung Dis 1997; 5(1): 46-51. |
|6.||Christopher R Braden, Ida M william N Rom & Stuart Garay (eds) Tuberculosis. 1st edition, 1996, Little Brown & Company. 85-97. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]