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 ~  Abstract
 ~  Materials and Me...
 ~  Results
 ~  Discussion
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ORIGINAL ARTICLE
Year : 2002  |  Volume : 20  |  Issue : 2  |  Page : 76-78
 

Drug susceptibility profiles of mycobacterium tuberculosis isolates at Jaipur


Dept. of Microbiology, Central JALMA Institute of Leprosy, Agra - 282 001, India

Correspondence Address:
Dept. of Microbiology, Central JALMA Institute of Leprosy, Agra - 282 001, India

 ~ Abstract 

PURPOSE: To find prevalence of drug resistance in Mycobacterium tuberculosis isolated from patients attending SMS Medical College, Jaipur during 1997-99. METHODS: Sputum samples from 164 patients with pulmonary tuberculosis were processed and cultured on Lowenstein Jensen medium and M.tuberculosis isolates were tested for drug sensitivity. RESULTS: M. tuberculosis was isolated in 122/164 (74.3%) samples and comprised 97.6% (122/125) of mycobacterial isolates. There were only three isolates of nontuberculous mycobacteria -one each of M.kansasii, M.avium and M.fortutium. Primary drug resistance in M.tuberculosis was estimated to be 3/44 (6.8%) to rifampicin, 6/44 (13.6%) to isoniazid and 2 strains (4.5%) were multi drug resistant i.e. resistant to both rifampicin and isoniazid. Among the isolates from cases with previous history of treatment of varying duration (acquired drug resistance) resistance to rifampicin was estimated to be 28.2% and for isoniazid to be 39.7%. 24.3% strains of these drug resistant isolates were multi drug resistant. CONCLUSIONS: While this information may not reflect true prevalence of drug resistance in the region this may help in further planning long term surveillance studies to know the trend of drug resistance in this area.

How to cite this article:
Malhotra B, Pathak S, Vyas L, Katoch V M, Srivastava K, Chauhan D S, Singh D, Sharma V D, Das R, Singh H B. Drug susceptibility profiles of mycobacterium tuberculosis isolates at Jaipur. Indian J Med Microbiol 2002;20:76-8


How to cite this URL:
Malhotra B, Pathak S, Vyas L, Katoch V M, Srivastava K, Chauhan D S, Singh D, Sharma V D, Das R, Singh H B. Drug susceptibility profiles of mycobacterium tuberculosis isolates at Jaipur. Indian J Med Microbiol [serial online] 2002 [cited 2019 Dec 7];20:76-8. Available from: http://www.ijmm.org/text.asp?2002/20/2/76/8351


Tuberculosis is one of the most common preventable infectious diseases of the world and it has been estimated that about 30% of the tuberculosis patients reside in India.1 Due to emergence of multidrug resistant tuberculosis (MDR-TB) the situation has become alarming. The MDR-TB is increasing not only in the developing countries[2],[3] but in developed countries as well.[4],[5] Major concern over drug resistance is a fear of spread of drug resistant organisms and ineffectiveness of chemotherapy in patients infected with them.[6] Limited data is available on the trends of prevalence of drug resistance in Jaipur.[7] The present study was undertaken to find prevalence of drug resistance in Jaipur during the years 1997-1999.

 ~ Materials and Methods Top

The present study was conducted on patients attending SMS and attached group of hospitals in Jaipur during 1997 - 1999. Cases were classified as primary or acquired drug resistance as per the standard definition based on prior history of drug intake. Primary resistance was defined as presence of drug resistance in a tuberculosis patient who did not have any history of having received prior treatment with anti-tubercular drugs whereas acquired resistance was defined as resistance occurring in cases who had prior history of treatment and had not shown proper response or had relapsed.
Sputum samples from 164 patients of pulmonary tuberculosis, which were acid fast bacilli (AFB) positive by Ziehl Neelsen method, were decontaminated by modified Petroff's method using 4% NaOH8 inoculated on to slants of Lowenstein Jensen's (LJ) medium and incubated for 8 weeks. The positive growths were characterized using standard array of biochemical tests as per Center for Disease Control Manual.[9] The M.tuberculosis isolates were further subjected to in vitro drug susceptibility testing by minimum inhibitory concentration method using Lowenstein Jensen media(LJ).[10],[11] The cut off value for rifampicin was 64 g/mL and for isoniazid (INH) 1 g/mL. The drug bases were obtained from Novartis India Ltd. and M.tuberculosis H37Rv was used as control strain.

 ~ Results Top

Mycobacteria were grown in 125/164 (76.2%) samples, and 122/125 (97.6%) of these were identified as M.tuberculosis, whereas 3/125 were identified as atypical mycobacteria (one each of M.kansasi, M.avium, and M.fortuitum). Pattern of primary drug resistance obtained with M.tuberculosis is given in [Table - 1]. Seven of the isolates (15.9%) showed primary drug resistance whereas 34/78 (43.5%) of the isolates were of acquired drug resistance type. Among the isolates from primary drug resistance cases [Table - 1] the resistance to rifampicin was detected in 3/44 (6.8%); to INH in 6/44 (13.6%) and to rifampicin and INH (MDR) together in 2/44 (4.5%). Acquired drug resistance was detected in 22/78 (28.2%) to rifampicin, in 31/78 (39.7%) to INH and in 19/78 (24.3%) for both.

 ~ Discussion Top

Increasing drug resistance to commonly used drugs rifampicin and INH in isolates of M. tuberculosis is a major cause of concern. Because of these trends it is important to know the rate of primary and acquired drug resistance in an area at regular intervals. The trends in the primary and acquired drug resistance to major anti TB drugs rifampicin (R) and INH (H) are detailed in [Table - 2] and [Table - 3] respectively.
Primary drug resistance to isoniazid in the present study was 13.6% which is lower than that found at several other centers in India, such as 17.4% at Bangalore and 32.8% at Kolar.12 But it is similar or only marginally higher than 10% reported at Jaipur in 1988-917 and 10.6% at Madras in 1976.[13]
On the other hand, primary drug resistance to rifampicin in these isolates was observed to be 6.8% which is higher as compared to other centers, such as 2.3% at Bangalore. A rising trend in rifampicin resistance has been recorded at Jaipur from 3% in 1988-91[7] to 6.8% in 1997-99. As some of the patients may have concealed history of previous treatment or were unaware of it, and as the sample size is also small it may not be a true indicator of the trends of drug resistance in the community in Jaipur area. The rate of primary multi drug resistance i.e. strains resistant to both the drugs was 4.5% which is similar to that at Kolar 3.2%.[12] But a rising trend is seen in Jaipur of primary multi drug resistance from 0.7% in 1991 to 4.5% in 1997 -1999. This indicates the need of starting well organised prospective surveillance in this area.
Acquired drug resistance to isoniazid in our study was 39.7% which is comparable to several reports elsewhere in India, varying from 15% in Bombay[14] to 67% in North Arcot.[15] Acquired drug resistance to rifampicin in the present study was 28.2% which is similar to that reported from Gujarat 37.3% [2]and New Delhi 33.7%,[3] though Bombay reports a very high incidence of rifampicin resistance of 66.8%. 24.3% of our strains had acquired multi drug resistance which is lower than 33.8% at Gujarat and 33.7% at New Delhi.
The increase in incidence of drug resistance may be due to, easy accessibility of the drugs to the patients, indiscriminate use of rifampicin, inadequate treatment received, poor patient compliance because of nausea and vomiting and improper treatment regimens practiced in the past / being practiced by medical personnel. These figures do not however indicate the efficacy of the regimens as these failures represent only a fraction of all cases being treated with different regimens. The pattern of drug resistance varies from place to place and at different periods of time. For a drug regimen to be effective it is important to know the drug resistance pattern in that area, therefore, there is a need to conduct periodic surveys of antibiotic drug resistance and also to establish a continuous drug resistance surveillance program. As several of the studies cited in the presentation including our present study may have flaws of proper sampling, carefully planned long term studies with sufficient quality assurance are required. 

 ~ References Top

1.Pathania V, Almeida J, Kochi A. TB patients and private for profit health care providers in India. WHO \TB\97 1997;223.   Back to cited text no. 1    
2.Trivedi SS, Desai SC. Primary antituberculosis drug resistance and acquired rifampicin resistance in Gujarat -India. Tubercle 1988;69:37-42.  Back to cited text no. 2    
3.Jain NK, Chopra KK, Prasad G. Initial and acquired INH and rifampicin resistant to Mycobacterium tuberculosis and its implication for treatment. Indian J Tub 1992;39:180- 186.  Back to cited text no. 3    
4.Snider Jr. DE, Cauthen GM, Lawrence SF, et al. Drug resistant tuberculosis. Am Rev Respir Dis 1991;144:732.   Back to cited text no. 4    
5.Chawla PK, Klapper PJ, Kamholz SL, et al. Drug resistant tuberculosis in an urban population including patients at risk for Human immunodeficiency virus infection Am Rev Respir Dis 1992;146:280-284.   Back to cited text no. 5    
6.Neville K, Bromberg A Bromberg R, Bonk S, Hanna BA, Rom WN. The third epidemic - multi drug resistant tuberculosis. Chest 1994;105:45-48.  Back to cited text no. 6    
7.Gupta PR, Singhal B, Sharma TN, Gupta RB. Prevalence of initial drug resistance in tuberculosis patients attending a chest hospital. Indian J Med Res 1993;97:102-103.   Back to cited text no. 7    
8.Katoch VM, Katoch K,Ramu G, et al. In vitro methods for determination of viability of Mycobacteria: Comparison of ATP content, morphological index and FDA -EB fluorescent staining in M. leprae. Lepr Rev 1988;59:137-143.  Back to cited text no. 8    
9.Vestal AL. Procedure for the isolation and identification of mycobacteria. (US Deptt of Health, Education and Welfare Pub No (CDC) 77-8230. Centre for Disease Control, Atlanta Georgia) 1977:159.  Back to cited text no. 9    
10.Canetti G, Fox W, Khomenko A. Advances in techniques of testing Mycobacterial drug sensitivity and the use of sensitivity tests in tuberculosis control programmes. Bull World Health Org 1969;31:21-43 .  Back to cited text no. 10    
11.Paramasivan CN, Chandrasekaran V, Santha T, Sudarsanam NM, Prabhakar R. Bacteriological investigations for short course chemotherapy under the tuberculosis programme in two districts in India .Tub Lung Dis 1993;74:23-27.  Back to cited text no. 11    
12.Chandrasekaran S, Chauhan MM, Rajalakshmi R, Chaudhari K, Mahadev B. Initial drug resistance to antituberculosis drugs in patients attending an urban district tuberculosis center. Indian J Tub 1990;37:215-216 .  Back to cited text no. 12    
13.Krishnaswamy KV, Rahim MA. Primary drug resistance in pulmonary tuberculosis. Indian J Chest Dis 1976;28:233-337.  Back to cited text no. 13    
14.Chowgule RV, Deodhar L. Pattern of secondary acquired drug reistance to antituberculosis drug in Mumbai, India -1991-1995. Indian J Chest Dis Allied Sci 1998;40:23-31.  Back to cited text no. 14  [PUBMED]  
15.Datta M, Radhamani MP, Selvaraj R, Parmasivan CN, Gopalan BN, Sudeendra CR, Prabhakar R. Critcal assessment of smear-positive pulmonary tuberculosis patients after chemotherapy under district tuberculosis programme. Tub Lung Dis 1993;74:180.  Back to cited text no. 15    
16.Parmasivan CN, Bhaskaran K, Venkataraman P, Chaandrasekaran V, Narayanan PR. Surveillance of drug resistance in Tuberculosis in the state of Tamil Nadu. Ind J Tub 2000;47:27-33.  Back to cited text no. 16    
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