Multidrug Resistant Tuberculosis in Punjab, Pakistan

Abstract

Background: Tuberculosis (TB) can be traced back to the beginning of the mankind. It is a bacterial infectious communicable disease. Globally, TB is the second major cause of death from infectious diseases. MDR-TB is a type of tuberculosis that is resistance to at least two first line anti-tuberculosis drugs Isoniazid (INH) and Rifampicin (RMP) with or without resistance to other drugs. Multidrug resistant TB (MDR-TB) caught attention, when it emerged in the USA in 1990. Globally 425,000 new cases emerge annually, which is almost 5% of the annual global TB burden. Pakistan is included in 27 high burden MDR-TB countries, with almost 2% to 3.2% for newly diagnosed and 35% for previously treated patients. The overall aim of this study was to assess the burden and the distribution of resistance for four anti-tuberculosis medications. Method: A cross sectional study design was used. Data was collected from the hospital records of microbiology department, for the patients between the duration of January 2008 to December 2011. Forms of 300 patients were collected and analyzed. Epi-data and SPSS software were used for analysis. An outcome variable was developed and analysed. Correlation of resistance was analysedwith different independent variables such as age, sex, residence (rural/urban), duration of disease, TB treatment history, smear reports and sensitivity results. Results: The results of this study showed the variation of resistance to four different drugs, but most resistance was found for rifampicin and lowest for Ethambutol. The resistance was found Isoniazid (49%), Streptomycin (52%), Rifampicin (68%), and Ethambutol (25%). Resistance between male/female and rural/urban was not prominently different. Among the different TB types, MDR-TB patients were found to be more resistant, with the highest resistance for Rifampicin (80%) and the lowest resistance for Ethambutol (31%). The extent of the lesion had no association with the resistance prevalence. Age was significantly associated with resistance. Previous ZN smear negative reported cases appeared to be more resistant. Conclusion: This study suggests for improvements in the early detection and treatment. Old test techniques such as ZN smear should also be replaced by more reliable and efficient laboratory techniques. There is also a need to improve the record keeping system in order to have complete information about the diseases and patients.