Correlation of Clinical, Radiological, Microbiological Features and Drug Resistance Pattern of Mycobacterium Tuberculosis in Patients with HIV Tuberculosis Co-Infection

Elakya, V (2015) Correlation of Clinical, Radiological, Microbiological Features and Drug Resistance Pattern of Mycobacterium Tuberculosis in Patients with HIV Tuberculosis Co-Infection. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: Drug Resistant Tuberculosis is a major challenge in tuberculosis high prevalent countries. This challenge becomes bigger where HIV TB coinfection is present. 24.6% of TB deaths occur among HIV positive cases. AIM OF THE STUDY: To determine the correlation between clinical, radiological, microbiological features and the drug resistance pattern of Mycobacterium tuberculosis in patients with HIV tuberculosis co infection. OBJECTIVES: 1. To determine the relationship between clinical presentation of HIV - pulmonary tuberculosis co infection and drug resistance pattern. 2. Compare each of the variables CD4 count, HIV staging, chest Xray features, sputum smear for AFB, LPA with drug resistance pattern. 3. Prevalence of MDR-TB in HIV TB co-infection. MATERIALS & METHODS: It is a prospective study done at Government Hospital of Thoracic medicine, during April 2013 to March 2014. Inclusion Criteria : All HIV seropositive patients with pulmonary TB, Age > 18 years. Exclusion Criteria: HIV patients with only extrapulmonary TB, Age < 18 years, Patients who are moribund, sick and unable to produce sputum, Patients who are not willing to participate in the study, Patients whose sputum showed no growth in LJ culture medium. Collection of clinical samples/data: Symptoms duration, HIV diagnosis and treatment history, Antituberculous treatment history, Height & Weight, Chest radiograph, Sputum for AFB staining, LPA, sputum Mtb culture, CD4 count. Allotting score for each of the variable. Predict MDR based on score. Comparing prediction with sensitivity results and analyse. OBSERVATION AND RESULTS: 230 patients were included in the study - 198 were male, 32 female. Mean age 39.5. totally 5.2% cases were MDR, 4.8% monoresistant to Rifampicin (R). Among new case, MDR 3.4%, monoresistants to R 2.7%. Among retreatment cases, MDR was 8.5% and monoresistant to R 8.5%. Odds ratio was 3.18 (95% CI 1.31 - 7.71) when Rif resistance is compared with TB case. 10% of disseminated TB cases are MDR. Association between disseminated TB & Rif Resistance is odds ratio of 2.71 (95% CI 1.07 – 6.09) P value of 0.56 (> 0.05) is obtained when symptoms duration is compared with rifampicin resistance. CD4 count compared with MDR - TB gives odds ratio of 7.30 (95% CI 0.92 – 57.71). Odds ratio is 2.59 (95% CI 1.08 – 6.03) where HIV stage is compared with rifampicin resistance. Drug sensitivity of 154 cases were obtained by LPA, rest were obtained by culture. 67% of MDR cases were detected using LPA. Odd’s ratio is 2.96 (95% CI 1.23 – 7.12) when score more than 4 compared with Rifampicin resistance. CONCLUSION: In summary, prevalence of MDR TB in this study is 2.2% in new cases and 8.5% in retreatment cases. Prevalence of Rifampicin resistance in new cases is 6.1% and that in retreatment cases is 19%. History of prior treatment of tuberculosis, HIV stage 4, disseminated TB were significantly associated with rifampicin resistance. In this study, CD4 count less than 200 was significantly associated with MDR TB and drug resistant TB. HIV treatment was not associated with drug resistance pattern. Duration of symptoms did not affect prevalence of MDR TB. There was no significant association between chest x ray lesions, cavitation with MDR TB. Sputum smear status had no significant relation with MDR TB. Sensitivity of line probe assay in this study is 67%. Scoring with 8 variables with score more than 4 was significantly associated with Rifampicin resistance. Since the study population is small, further studies with large study population will be helpful in validating this score.

Item Type: Thesis (Masters)
Uncontrolled Keywords: HIV ; Tuberculosis ; Drug Resistance ; Line Probe Assay.
Subjects: MEDICAL > Tuberculosis and Respiratory Medicine
Depositing User: Punitha K
Date Deposited: 06 May 2018 03:24
Last Modified: 06 May 2018 03:24

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