A Prospective Study of Tuberculosis Drug Susceptibility in Sabah, Malaysia, and an Algorithm for Management of Isoniazid Resistance
Introduction. The burden of tuberculosis is high in eastern Malaysia, and rates of Mycobacterium tuberculosis drug resistance are poorly defined. Our objectives were to determine M. tuberculosis susceptibility and document management after receipt of...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2015-01-01
|
| Series: | Journal of Tropical Medicine |
| Online Access: | http://dx.doi.org/10.1155/2015/261925 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832562248273362944 |
|---|---|
| author | Muhammad Redzwan S. Rashid Ali Uma Parameswaran Timothy William Elspeth Bird Christopher S. Wilkes Wai Khew Lee Tsin Wen Yeo Nicholas M. Anstey Anna P. Ralph |
| author_facet | Muhammad Redzwan S. Rashid Ali Uma Parameswaran Timothy William Elspeth Bird Christopher S. Wilkes Wai Khew Lee Tsin Wen Yeo Nicholas M. Anstey Anna P. Ralph |
| author_sort | Muhammad Redzwan S. Rashid Ali |
| collection | DOAJ |
| description | Introduction. The burden of tuberculosis is high in eastern Malaysia, and rates of
Mycobacterium tuberculosis drug resistance are poorly defined. Our objectives were
to determine M. tuberculosis susceptibility and document management after receipt of
susceptibility results. Methods. Prospective study of adult outpatients with smear-positive
pulmonary tuberculosis (PTB) in Sabah, Malaysia. Additionally, hospital clinicians accessed the
reference laboratory for clinical purposes during the study. Results. 176
outpatients were enrolled; 173 provided sputum samples. Mycobacterial culture yielded M. tuberculosis in
159 (91.9%) and nontuberculous Mycobacterium (NTM) in three (1.7%). Among
outpatients there were no instances of multidrug resistant M. tuberculosis (MDR-TB).
Seven people (4.5%) had isoniazid resistance (INH-R); all were switched to an appropriate
second-line regimen for varying durations (4.5–9 months). Median delay to commencement
of the second-line regimen was 13 weeks. Among 15 inpatients with suspected TB, 2 had multidrug
resistant TB (one extensively drug resistant), 2 had INH-R, and 4 had NTM. Conclusions. Current
community rates of MDR-TB in Sabah are low. However, INH-resistance poses challenges, and NTM is an
important differential diagnosis in this setting, where smear microscopy is the usual diagnostic modality. To
address INH-R management issues in our setting, we propose an algorithm for the treatment of isoniazid-resistant PTB. |
| format | Article |
| id | doaj-art-22f7813bcf2b4579b8b66168e46fde81 |
| institution | Kabale University |
| issn | 1687-9686 1687-9694 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Tropical Medicine |
| spelling | doaj-art-22f7813bcf2b4579b8b66168e46fde812025-02-03T01:22:59ZengWileyJournal of Tropical Medicine1687-96861687-96942015-01-01201510.1155/2015/261925261925A Prospective Study of Tuberculosis Drug Susceptibility in Sabah, Malaysia, and an Algorithm for Management of Isoniazid ResistanceMuhammad Redzwan S. Rashid Ali0Uma Parameswaran1Timothy William2Elspeth Bird3Christopher S. Wilkes4Wai Khew Lee5Tsin Wen Yeo6Nicholas M. Anstey7Anna P. Ralph8Department of Respiratory Medicine, Queen Elizabeth Hospital, 88000 Kota Kinabalu, Sabah, MalaysiaInfectious Diseases Unit, Clinical Research Centre, Queen Elizabeth Hospital, 88000 Kota Kinabalu, Sabah, MalaysiaInfectious Diseases Unit, Clinical Research Centre, Queen Elizabeth Hospital, 88000 Kota Kinabalu, Sabah, MalaysiaInfectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, 88000 Kota Kinabalu, Sabah, MalaysiaInfectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, 88000 Kota Kinabalu, Sabah, MalaysiaLuyang Outpatient Clinic, 88000 Kota Kinabalu, Sabah, MalaysiaInfectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, 88000 Kota Kinabalu, Sabah, MalaysiaInfectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, 88000 Kota Kinabalu, Sabah, MalaysiaInfectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, 88000 Kota Kinabalu, Sabah, MalaysiaIntroduction. The burden of tuberculosis is high in eastern Malaysia, and rates of Mycobacterium tuberculosis drug resistance are poorly defined. Our objectives were to determine M. tuberculosis susceptibility and document management after receipt of susceptibility results. Methods. Prospective study of adult outpatients with smear-positive pulmonary tuberculosis (PTB) in Sabah, Malaysia. Additionally, hospital clinicians accessed the reference laboratory for clinical purposes during the study. Results. 176 outpatients were enrolled; 173 provided sputum samples. Mycobacterial culture yielded M. tuberculosis in 159 (91.9%) and nontuberculous Mycobacterium (NTM) in three (1.7%). Among outpatients there were no instances of multidrug resistant M. tuberculosis (MDR-TB). Seven people (4.5%) had isoniazid resistance (INH-R); all were switched to an appropriate second-line regimen for varying durations (4.5–9 months). Median delay to commencement of the second-line regimen was 13 weeks. Among 15 inpatients with suspected TB, 2 had multidrug resistant TB (one extensively drug resistant), 2 had INH-R, and 4 had NTM. Conclusions. Current community rates of MDR-TB in Sabah are low. However, INH-resistance poses challenges, and NTM is an important differential diagnosis in this setting, where smear microscopy is the usual diagnostic modality. To address INH-R management issues in our setting, we propose an algorithm for the treatment of isoniazid-resistant PTB.http://dx.doi.org/10.1155/2015/261925 |
| spellingShingle | Muhammad Redzwan S. Rashid Ali Uma Parameswaran Timothy William Elspeth Bird Christopher S. Wilkes Wai Khew Lee Tsin Wen Yeo Nicholas M. Anstey Anna P. Ralph A Prospective Study of Tuberculosis Drug Susceptibility in Sabah, Malaysia, and an Algorithm for Management of Isoniazid Resistance Journal of Tropical Medicine |
| title | A Prospective Study of Tuberculosis Drug Susceptibility in Sabah, Malaysia, and an Algorithm for Management of Isoniazid Resistance |
| title_full | A Prospective Study of Tuberculosis Drug Susceptibility in Sabah, Malaysia, and an Algorithm for Management of Isoniazid Resistance |
| title_fullStr | A Prospective Study of Tuberculosis Drug Susceptibility in Sabah, Malaysia, and an Algorithm for Management of Isoniazid Resistance |
| title_full_unstemmed | A Prospective Study of Tuberculosis Drug Susceptibility in Sabah, Malaysia, and an Algorithm for Management of Isoniazid Resistance |
| title_short | A Prospective Study of Tuberculosis Drug Susceptibility in Sabah, Malaysia, and an Algorithm for Management of Isoniazid Resistance |
| title_sort | prospective study of tuberculosis drug susceptibility in sabah malaysia and an algorithm for management of isoniazid resistance |
| url | http://dx.doi.org/10.1155/2015/261925 |
| work_keys_str_mv | AT muhammadredzwansrashidali aprospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance AT umaparameswaran aprospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance AT timothywilliam aprospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance AT elspethbird aprospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance AT christopherswilkes aprospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance AT waikhewlee aprospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance AT tsinwenyeo aprospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance AT nicholasmanstey aprospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance AT annapralph aprospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance AT muhammadredzwansrashidali prospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance AT umaparameswaran prospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance AT timothywilliam prospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance AT elspethbird prospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance AT christopherswilkes prospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance AT waikhewlee prospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance AT tsinwenyeo prospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance AT nicholasmanstey prospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance AT annapralph prospectivestudyoftuberculosisdrugsusceptibilityinsabahmalaysiaandanalgorithmformanagementofisoniazidresistance |