Antitubercular Agents ; pharmacology ; therapeutic use ; Child ; Drug Resistance, Multiple, Bacterial ; Drug Therapy, Combination ; Humans ; Tuberculosis, Multidrug-Resistant ; drug therapy ; microbiology

Antitubercular Agents/therapeutic use* ; China/epidemiology* ; Drug Resistance, Multiple, Bacterial ; Extensively Drug-Resistant Tuberculosis ; Humans ; Kanamycin Resistance ; Microbial Sensitivity Tests ; Mycobacterium tuberculosis ; Ofloxacin/pharmacology* ; Tuberculosis, Multidrug-Resistant/epidemiology*

OBJECTIVETo explore the correlation between Beijing genotype (Beijing family) strains of Mycobacterium tuberculosis (MTB) and drug resistance.

METHODSA computer retrieval of Medline, Embase, SCI, EBSCO, CNKI, Weipu and Wanfang databases from 1990 to 2010 was conducted. A total of 525 articles exploring the relationship of Beijing genotype of MTB and drug resistance were found through literature search. Following the inclusion and exclusion criteria, a Meta-subgroup analysis was conducted in Beijing genotype of MTB and drug resistance.

RESULTSA total of 38 articles were selected, including 22 articles on isoniazid resistance, 24 articles on rifampin resistance, 19 articles on ethambutol resistance, 18 articles on ethambutol resistance, 26 articles on multi-drug resistance (MDR). Meta-subgroup analysis showed that in China, there was an association between Beijing genotype and resistance to rifampin, ethambutol and MDR: rifampin (OR = 1.62, 95%CI: 1.13 - 2.31), ethambutol (OR = 1.67, 95%CI: 1.16 - 2.40), MDR (OR = 1.79, 95%CI: 1.20 - 2.68); in Russia, there was an association between Beijing genotype and resistance to isoniazid, rifampin, ethambutol and MDR: isoniazid (OR = 4.82, 95%CI: 3.19 - 7.29), rifampin (OR = 4.84, 95%CI: 3.84 - 6.10), ethambutol (OR = 3.32, 95%CI: 2.51 - 4.40), MDR (OR = 5.42, 95%CI: 3.36 - 8.74); in Vietnam, there was an association between Beijing genotype and resistance to isoniazid, rifampin, ethambutol and MDR: isoniazid (OR = 2.12, 95%CI: 1.55 - 2.91), rifampin (OR = 4.71, 95%CI: 3.01 - 7.36), ethambutol (OR = 3.78, 95%CI: 1.63 - 8.77), MDR (OR = 4.21, 95%CI: 1.58 - 11.18); in other countries, there was an association between Beijing genotype and resistance to isoniazid, rifampin, ethambutol and MDR: isoniazid (OR = 1.69, 95%CI: 1.19 - 2.42), rifampin (OR = 2.48, 95%CI: 1.92 - 3.19), ethambutol (OR = 3.04, 95%CI: 2.13 - 4.33), MDR (OR = 2.36, 95%CI: 1.52 - 3.68).

CONCLUSIONBeijing genotype of MTB was positively associated with three kinds of first-line anti-tuberculosis drugs (isoniazid, rifampin, ethambutol) and MDR, and the relationship intensity was different in different countries.

Antitubercular Agents ; pharmacology ; China ; DNA, Bacterial ; Drug Resistance, Multiple, Bacterial ; Genotype ; Humans ; Mycobacterium tuberculosis ; drug effects ; genetics ; isolation & purification ; Russia ; Tuberculosis, Multidrug-Resistant ; genetics ; microbiology ; Vietnam

Humans ; Isoniazid/pharmacology* ; Mycobacterium tuberculosis/genetics* ; Rifampin/pharmacology* ; Antitubercular Agents/pharmacology* ; Mutation ; Microbial Sensitivity Tests ; Tuberculosis, Multidrug-Resistant/microbiology* ; Drug Resistance, Multiple, Bacterial/genetics* ; Bacterial Proteins/genetics*

OBJECTIVETo evaluate microscopic observation drug susceptibility (MODS) for mycobacterium tuberculosis drug susceptibility in smear-positive sputum.

METHODSDrug susceptibility of mycobacterium tuberculosis in 275 smear-positive sputum samples collected from TB patients were detected directly by MODS. The susceptibility of seven antimicrobials including streptomycin, isoniazid, rifampicin, ethambutol, levofloxacin, amikacin and capromycin were detected MODS. At the same time the sputum sample were cultured in MGIT 960 tube and the positive isolates were tested for drug susceptibility by MGIT 960 system. The results of MODS were analyzed and compared with that of MGIT 960.

RESULTSOf 275 smear-positive sputum, MODS detected 235 (85.45%). Results of MODS were obtained in a median time of 18 days (5 - 39 d). For the 235 MODS-positive samples, the compliance rates of MODS to MGIT of 7 drugs were 90.21% (212/235), 88.09% (207/235), 93.62% (220/235), 87.23% (205/235), 92.34% (217/235), 88.51% (208/235) and 86.81% (204/235) respectively. The sensitivity of MODS method were 83.33% (90/108), 85.11% (120/141), 90.74% (98/108), 85.71% (78/91), 86.73% (85/98), 76.92% (40/52) and 77.08% (37/48). The specificities of MODS method were 96.06% (122/127), 92.55% (87/94), 96.06% (122/127), 88.19% (127/144), 96.35% (132/137), 91.80% (168/183) and 89.30% (167/187) respectively.

CONCLUSIONMODS is an optimal alternative method for direct and rapid drug susceptibility of sputum with high accuracy in a timely and affordable way in resource-limited settings.

Antitubercular Agents ; pharmacology ; Drug Resistance, Multiple, Bacterial ; Humans ; Microbial Sensitivity Tests ; methods ; Microscopy ; Mycobacterium tuberculosis ; drug effects ; isolation & purification ; Sputum ; microbiology ; Tuberculosis, Multidrug-Resistant ; microbiology

Antitubercular Agents ; economics ; therapeutic use ; Directly Observed Therapy ; Drug Resistance, Multiple, Bacterial ; Humans ; Singapore ; epidemiology ; Tuberculosis, Multidrug-Resistant ; drug therapy ; economics

OBJECTIVETo evaluate the effects of microscopic observation drug susceptibility (MODS) in detecting susceptibility of Mycobacterium tuberculosis (MTB) onto four first line anti-tuberculosis drugs.

METHODThe 24-hole cell culture plates were used to test drug susceptibility of MTB on liquid medium, and the best detecting condition of MODS assay was probed; 66 clinical isolates susceptibility to streptomycin (S), isoniazid (H), rifampin (R) and ethambutal (E) were evaluated by using MODS assay and Lowenstein-Jensen (L-J), thereafter, all the inconcordance of isolates between MODS and L-J were tested for the minimal inhibitory concentrations (MIC).

RESULTSConcordance rate of the susceptibility to S, H, R and E in 66 clinical isolates detected by MODS and L-J was 97.0%, 90.9%, 95.5% and 86.4% respectively. If the results obtained by L-J were taken as a golden standard, the sensitivity, specificity, positive and negative predictive value (PPV and NPV) as well as accuracy of susceptibility test to S detected by MODS was 96.0%, 97.6%, 96.0%, 97.6% and 97.0%; 100%, 85.4%, 81.0%, 100% and 90.9% to H; 96.2%, 95%, 92.6%, 97.4% and 95.5% to R; 73.7%, 91.5%, 77.8%, 89.6% and 86.4% to E. There were 20 inconsistent results of 16 isolates by comparing MODS with L-J, and MIC yielded 16 results of those 14 isolates showing identical results with those of the MODS, while 4 results of other 4 isolates identical with L-J.

CONCLUSIONMODS method simultaneously provides drug susceptibility to S, H, R and E. MODS might be one of the rapid tools to diagnosing multidrug-resistant tuberculosis as it is rapid, simple, inexpensive and has high concordance with L-J drug susceptibility test.

Bacteriological Techniques ; methods ; Drug Resistance, Multiple, Bacterial ; Microbial Sensitivity Tests ; methods ; Mycobacterium tuberculosis ; drug effects ; Predictive Value of Tests ; Sensitivity and Specificity ; Tuberculosis, Multidrug-Resistant ; microbiology

Objective: Drug-resistant tuberculosis (TB) may be resistant to one or multiple anti-TB drugs. We used generalized estimation equations to analysis the risk factors of drug-resistant TB and provide information for the establishment of a warning model for these non-independent data. Methods: The drug susceptibility test and questionnaire survey were performed in sputum positive TB patients from 30 anti TB drug-resistance surveillance sites in Zhejiang province. The generalized estimation model was established by the GENMOD module of SAS, with resistance to 13 kinds of anti-TB drugs as dependent variables and possible influencing factors, such as age, having insurance, HBV infection status, and history of anti-TB drug intake, as independent variables. Results: In this study, the probability of drug resistance at baseline level was 20.26%. Age, insurance, whether being co-infected with HBV, and treatment history or treatment withdrawal were statistically significantly correlated with anti-TB drug resistance. The prediction equation was established according to the influence degree of the factors mentioned above on drug resistance. Conclusion: The generalized estimation equations can effectively and robustly analyze the correlated binary outcomes, and thus provide more comprehensive information for drug resistance risk factor evaluation and warning model establishment.
Antitubercular Agents/therapeutic use* ; Drug Resistance, Multiple, Bacterial ; Humans ; Models, Statistical ; Mycobacterium tuberculosis/drug effects* ; Risk Factors ; Sputum/microbiology* ; Surveys and Questionnaires ; Tuberculosis/epidemiology* ; Tuberculosis, Multidrug-Resistant

Acute transverse myelitis (TM) is a neurological syndrome caused by inflammation of the spinal cord. TM is rare but is frequently caused by viral or bacterial infections. TM caused by tuberculosis (TB) is extremely rare and there are no reports of TM caused by multidrug-resistant TB (MDR-TB). We report a case of acute TM due to MDR-TB in a 40-year-old man. The patient had been diagnosed with pulmonary TB and was started on the first-line anti-TB treatment. However, the chest radiographic findings were aggravated and neurological symptoms such as weakness in both lower extremities, sensory changes, and voiding difficulty were newly developed. The T2-weighted magnetic resonance image of the spine showed diffusely increased signal intensity in the spinal cord, particularly at the lower cervical and upper thoracic levels, without any definite evidence of myeloradicular compression, which is consistent with a diagnosis of TM. A drug susceptibility test revealed MDR and second-line anti-TB drugs were prescribed. The chest radiographic findings showed improvement after treatment, the mycobacterial culture converted to negative, the MRI findings improved, and there was partial improvement in the low extremity weakness. The patient has been prescribing second-line anti-TB medications for 14 months.
Adult ; Bacterial Infections ; Diagnosis ; Drug Resistance, Multiple ; Extremities ; Humans ; Inflammation ; Lower Extremity ; Magnetic Resonance Imaging ; Mycobacterium tuberculosis ; Myelitis, Transverse* ; Radiography, Thoracic ; Spinal Cord ; Spine ; Tuberculosis ; Tuberculosis, Multidrug-Resistant*

OBJECTIVETo investigate the prevalence of primary drug-resistant tuberculosis (TB) and associated risk factors in China. We also explored factors contributing to the transmission of multidrug-resistant tuberculosis (MDR-TB).

METHODSA total of 2794 representative, Mycobacterium tuberculosis isolates from treatment-naive patients were subjected to drug susceptibility testing, and risk factors for drug-resistant TB were analyzed. We also analyzed MDR-TB strain sublineages, drug-resistance-conferring mutations, and risk factors associated with clustered primary MDR strains.

RESULTSAmong 2794 Mycobacterium tuberculosis isolates from treatment-naive patients, the prevalence of any resistance to first-line drugs was 33.2% and the prevalence of MDR-TB was 5.7%. We did not find any risk factors significantly associated with resistance to first-line drugs. The 93 primary MDR-TB isolates were classified into six sublineages, of which, 75 (80.6%) isolates were the RD105-deleted Beijing lineage. The largest sublineage included 65 (69.9%) isolates with concurrent deletions of RD105, RD207, and RD181. Twenty-nine (31.2%) primary MDR strains grouped in clusters; MDR isolates in clusters were more likely to have S531L rpoB mutation.

CONCLUSIONThis study indicates that primary drug-resistant TB and MDR-TB strains are prevalent in China, and multiple measures should be taken to address drug-resistant TB.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; China ; epidemiology ; Drug Resistance, Multiple, Bacterial ; genetics ; Female ; Humans ; Male ; Middle Aged ; Prevalence ; Risk Factors ; Tuberculosis, Multidrug-Resistant ; epidemiology ; transmission ; Young Adult