High prevalence of rifampin-resistant tuberculosis in mountainous districts of India.
High prevalence of rifampin-resistant tuberculosis in mountainous districts of India.
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DOI：
10.1016/j.ijtb.2019.08.005
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发表时间：
2020-01
期刊：
影响因子：
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通讯作者：
Kaushal, Kailash C
中科院分区：
文献类型：
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作者：
Dorjee, Kunchok;Sadutshang, Tsetan D;Rana, Ravinder S;Topgyal, Sonam;Phunkyi, Dawa;Choetso, Tsering;Chodon, Tenzin;Parmar, Malik;Singla, Rupak;Paster, Zorba;Chaisson, Richard E;Kaushal, Kailash C
印度占全球耐利福平/耐多药结核病 (RR/MDR-TB) 的四分之一。关于地区一级耐多药结核病的危险因素和分布的知识有限。研究印度喜马偕尔邦丘陵地区结核病患者耐多药结核病的患病率和危险因素。 2012 年 7 月至 2013 年 6 月期间，康格拉和乌纳地区根据修订后的国家结核病控制计划登记的疑似耐多药结核病患者被地区结核病办公室转介至达兰萨拉德勒克医院进行 Xpert® MTB/RIF 检测。在 378 名入组患者中（中位年龄：45 岁；85% 为男性），18% (n=68) 对利福平耐药。在 Xpert 阳性 (n=305) 中，RR-TB 的分布为： 接受结核病治疗 <2 个月的复发病例为 10% (n=9/89)，新发病例 (n=9/59) 或复发病例 (n=5/34) 在治疗 2-4 个月期间仍涂片呈阳性，各为 15%，治疗失败为 36% (n=41/113)，40% (n=2/5) 失访。在痰涂片阳性者中，15% (n=51/338) Xpert 阴性。在私营部门寻求治疗与较高的 RR-TB 风险相关（OR：1.85；95% CI：0.87-3.9）。在喜马偕尔邦山区疑似耐多药结核病患者中，利福平结核病的患病率普遍较高。治疗早期阶段的高患病率可能表明耐药结核病的原发传播。普遍的药敏测试和创新的病例发现策略将使生活在医疗服务不足的山区的患者受益。痰涂片阳性但 Xpert 阴性病例比例较高可能是由于非结核分枝杆菌疾病所致。
India accounts for quarter of global rifampin-resistant/multi-drug resistant-tuberculosis (RR/MDR-TB). Knowledge on risk-factors and distribution of MDR-TB at district level is limited. Study prevalence and risk factors of MDR-TB in tuberculosis patients in hilly districts of Himachal Pradesh, India. Between July 2012-June 2013, TB patients registered under the Revised National Tuberculosis Control Program in Kangra and Una districts suspected of MDR-TB were referred for Xpert® MTB/RIF testing at the Delek Hospital, Dharamsala by the district TB Office. Of 378 patients enrolled (median age: 45 years; 85% males), 18% (n=68) were rifampin-resistant. Among Xpert positives (n=305), distributions of RR-TB were: 10% (n=9/89) for recurrent cases who had received TB treatment for <2-months, 15% each for new (n=9/59) or recurrent cases (n=5/34) remaining smear positive between 2–4 months of treatment, 36% (n=41/113) for treatment failures, and 40% (n=2/5) for loss to follow-ups. Of the sputum-smear positives, 15% (n=51/338) were Xpert negative. Seeking care in the private sector was associated with higher risk of RR-TB (OR:1.85; 95% CI:0.87–3.9). Prevalence of RR-TB is generally high in patients suspected of MDR-TB in the hilly districts of Himachal Pradesh. High prevalence during early phase of treatment can suggest primary transmission of DR-TB. Universal drug susceptibility testing and innovative case finding strategies will benefit patients living in mountain districts with inadequate access to healthcare. The high proportion of sputum-smear positive but Xpert negative cases may be due to non-tubercular mycobacterial disease.