from the assigned readings this week, review the following article: Sharma, S. K

Question

from the assigned readings this week, review the following article:

Sharma, S. K., Kumar, S., Saha, P. K., George, N., Arora, S. K., Gupta, D., . . . Vashisht, R. P. (2011). Prevalence of multidrug-resistant tuberculosis among Category II pulmonary tuberculosis patients. Indian Journal of Medical Research, 133(3), 312–315. (Web of Science Accession Number: WOS: 000289322400013)

Write a 3–5-page paper in Microsoft Word format that addresses the following:

Explain the significance of monitoring the prevalence of MDR-TB among Category II pulmonary tuberculosis patients.

Describe the methodology of the study in the above journal article and how the study sample was selected.

Analyze the study’s findings as they relate to the effective management of tuberculosis.

Summarize the results of the study

Justify how the results of the study can improve rapid detection of MDR-TB.

Explanation / Answer

Significance of monotoring the prevalence of MDR-TB:

Multi-drug resistance TB,abbreviated as MDR-TB,is that category of TB in which the causative organism becomes resistant to two of the most important TB drugs namely, rifampicin and isoniazid.And the patients who have undergone previous anti-tuberculosis therapy are the most prone ones to get infected by this MDR-TB.These patients comprise of the category II pulmonary TB group who have failed the category I TB treatment,relapsed after treatment or defaulted during previous treatment.The WHO report says that there were 10.4 million new cases of TB in 2016 out of which more than 6 lakhs were reported to be drug resistant.So it is extremely important that the prevalence of MDR-TB amongst category II pulmonary TB patients are monitored.This way we can prevent the TB from becoming an epidemic.

Methodology and Sample selection:

This study involved category II sputum-positive pulmonary TB patients,aged between 18-60 years excluding those with-

The methodology followed protocols approved by ethics committee of the concerned institute.

Step 1-Letter of consent were taken from each patient involved in the study.

Step2- Sputum-smear microscopy for detecting acid-fast bacteria and chest radiography of all patients at the time of enrollment.

Step 3-Culture of sputum specimen on Lowenstein-Jensen slopes by Petroff's method,followed by n0 iacin test,catalase test and para-nitrobenzoic acid test to identify the isolated mycobacteria.

Step 4-Positive cultures were evaluated for drug susceptibility pattern carried out by economic variant of 1% proportion method and the sensitivity tests were done with inoculum prepared from the growth of selected positive slopes.

H37Rv was taken as the standard strain.

Step 5-The inoculated slopes were evaluated for growth after 28 and 42 days of inocubation.

Results and Findings:

Amongst the final 196 category II pulmonary TB patients included in the study, 40 were diagnosed with MDR-TB with mean age of 18-55 years.

Of these 40, 29 had relapse,3 had treatment failure and 8 were defaulters.9 patients were female.

36 patients showed resistance to rifampicin and isoniazid and 4 showed resistance to streptomycin in addition to both.

This is how the prevalence of MDR-TB amongst the category II pulmonary TB patients was 20.4% which was almost 3% higher than the WHO global project report published on the prevalence of MDR-TB among the previously treated cases in India.

This study was very significant as very little or scarce data were available from the on the statistics of MDR-TB detected patients.Moreover, drug resistance is dynamic in nature, so it is necessary to monitor it periodically and this study was a prospective one carried out over a period of three years.Although there were certain limitations of this study mainly in case of screening of patients and exclusion which will not be applicable to real-life situations,still it gave the statistics and showed that the prevalence of MDR-TB among the category II pulmonary TB patients were high and these patients were prone to be affected by XDR-TB(extensively drug resistance).

This study shows that observation of TB patients are required at the primary care level across the country to get a clear picture about the statistics of the MDR-TB affected patients.Further,all category II pulmonary TB patients should be screened for MDR-TB using rapid diagnostic tests such as the line probe assays.This might facilitate the early detection and treatment of MDR-TB that can prevent it from becoming an epidemic.Also,monitoring of drug resistance patterns at regular intervals is necessary to check for the efficacy of the current interventions in curbing the TB epidemic.

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