S Tahseen1, E Qadeer2, F M Khanzada1, A H Rizvi1, A Dean3, A Van Deun4, M Zignol3. 1. National Tuberculosis Control Programme and National Tuberculosis Reference Laboratory, Islamabad, Pakistan. 2. National Tuberculosis Control Program Pakistan, Islamabad, Pakistan. 3. Global TB Programme, World Health Organization, Geneva, Switzerland. 4. Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium.
Abstract
SETTING: The first national anti-tuberculosis drug resistance survey in Pakistan, a high tuberculosis (TB) and low human immunodeficiency virus (HIV) burden country. OBJECTIVE: To determine the proportion of patients with multidrug-resistant TB (MDR-TB) and to compare the performance of Xpert(®) MTB/RIF with conventional phenotypic drug susceptibility testing (DST). METHODS: Sputum samples were collected from 1972 consecutively enrolled pulmonary TB patients from 40 clusters. Phenotypic DST was performed in parallel with Xpert. RESULTS: The proportion of MDR-TB patients was 3.7% (95%CI 2.5-5.0) among new and 18.1% (95%CI 13.0-23.4) among previously treated cases. A valid rifampicin (RMP) testing result was available from substantially more cases with Xpert (n = 1809) than with phenotypic DST (n = 1592). Among strains with discordant results, rpoB sequencing revealed only one false-resistant result (new TB case) with Xpert and 7.7% (8/104) of RMP-resistant cases missed with Xpert against 3.8% (4/14) by phenotypic DST. This difference was not significant. CONCLUSIONS: This survey provides the first representative data for Pakistan on its MDR-TB burden. The Xpert assay had nearly 100% specificity, even in a low MDR-TB prevalence setting. The use of this assay greatly simplifies survey logistics, making it a feasible option for survey implementation, especially in resource-constrained settings.
SETTING: The first national anti-tuberculosis drug resistance survey in Pakistan, a high tuberculosis (TB) and low human immunodeficiency virus (HIV) burden country. OBJECTIVE: To determine the proportion of patients with multidrug-resistant TB (MDR-TB) and to compare the performance of Xpert(®) MTB/RIF with conventional phenotypic drug susceptibility testing (DST). METHODS: Sputum samples were collected from 1972 consecutively enrolled pulmonary TB patients from 40 clusters. Phenotypic DST was performed in parallel with Xpert. RESULTS: The proportion of MDR-TB patients was 3.7% (95%CI 2.5-5.0) among new and 18.1% (95%CI 13.0-23.4) among previously treated cases. A valid rifampicin (RMP) testing result was available from substantially more cases with Xpert (n = 1809) than with phenotypic DST (n = 1592). Among strains with discordant results, rpoB sequencing revealed only one false-resistant result (new TB case) with Xpert and 7.7% (8/104) of RMP-resistant cases missed with Xpert against 3.8% (4/14) by phenotypic DST. This difference was not significant. CONCLUSIONS: This survey provides the first representative data for Pakistan on its MDR-TB burden. The Xpert assay had nearly 100% specificity, even in a low MDR-TB prevalence setting. The use of this assay greatly simplifies survey logistics, making it a feasible option for survey implementation, especially in resource-constrained settings.
Authors: W Aslam; S Tahseen; C Schomotzer; A Hussain; F Khanzada; M Ul Haq; N Mahmood; R Fatima; E Qadeer; E Heldal Journal: Public Health Action Date: 2017-06-21
Authors: David J Horne; Mikashmi Kohli; Jerry S Zifodya; Ian Schiller; Nandini Dendukuri; Deanna Tollefson; Samuel G Schumacher; Eleanor A Ochodo; Madhukar Pai; Karen R Steingart Journal: Cochrane Database Syst Rev Date: 2019-06-07
Authors: Matteo Zignol; Anna S Dean; Natavan Alikhanova; Sönke Andres; Andrea Maurizio Cabibbe; Daniela Maria Cirillo; Andrei Dadu; Andries Dreyer; Michèle Driesen; Christopher Gilpin; Rumina Hasan; Zahra Hasan; Sven Hoffner; Ashaque Husain; Alamdar Hussain; Nazir Ismail; Mostofa Kamal; Mikael Mansjö; Lindiwe Mvusi; Stefan Niemann; Shaheed V Omar; Ejaz Qadeer; Leen Rigouts; Sabine Ruesch-Gerdes; Marco Schito; Mehriban Seyfaddinova; Alena Skrahina; Sabira Tahseen; William A Wells; Ya Diul Mukadi; Michael Kimerling; Katherine Floyd; Karin Weyer; Mario C Raviglione Journal: Lancet Infect Dis Date: 2016-07-07 Impact factor: 25.071
Authors: Matteo Zignol; Andrea Maurizio Cabibbe; Anna S Dean; Philippe Glaziou; Natavan Alikhanova; Cecilia Ama; Sönke Andres; Anna Barbova; Angeli Borbe-Reyes; Daniel P Chin; Daniela Maria Cirillo; Charlotte Colvin; Andrei Dadu; Andries Dreyer; Michèle Driesen; Christopher Gilpin; Rumina Hasan; Zahra Hasan; Sven Hoffner; Alamdar Hussain; Nazir Ismail; S M Mostofa Kamal; Faisal Masood Khanzada; Michael Kimerling; Thomas Andreas Kohl; Mikael Mansjö; Paolo Miotto; Ya Diul Mukadi; Lindiwe Mvusi; Stefan Niemann; Shaheed V Omar; Leen Rigouts; Marco Schito; Ivita Sela; Mehriban Seyfaddinova; Girts Skenders; Alena Skrahina; Sabira Tahseen; William A Wells; Alexander Zhurilo; Karin Weyer; Katherine Floyd; Mario C Raviglione Journal: Lancet Infect Dis Date: 2018-03-21 Impact factor: 25.071
Authors: Elisa Tagliani; Mohamed Osman Hassan; Yacine Waberi; Maria Rosaria De Filippo; Dennis Falzon; Anna Dean; Matteo Zignol; Philip Supply; Mohamed Ali Abdoulkader; Hawa Hassangue; Daniela Maria Cirillo Journal: Sci Rep Date: 2017-12-15 Impact factor: 4.379