Magnitude of Mycobacterium tuberculosis, drug resistance pattern, and associated factors among patients referred to St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.
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Date
2019-12
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Addis Abeba University
Abstract
Background: Tuberculosis (TB) is an infectious disease caused by strains belonging to the
Mycobacterium tuberculosis complex. Mycobacterium tuberculosis (M. tuberculosis) remains one
of the most significant causes of death from an infectious agent and a major public health problem
in the community. Drug development of drug resistance and its association with Human
immunodeficiency virus (HIV) by far the major cause of the current increase in tuberculosis
infection. Sub-Saharan Africa is endemic for both TB and HIV infection, and pulmonary
tuberculosis (PTB) in the HIV-affected countries of eastern and southern Africa, such as Ethiopia,
has increased rapidly in the past decades.
Objective:-To assess the magnitude of Mycobacterium tuberculosis, drug-resistance pattern ,and
associated factors among patients referred to St. Paul‘s Hospital Millennium Medical College,
Addis Ababa, Ethiopia.
Methods: A cross-sectional study was conducted at SPHMMC, Addis Ababa, Ethiopia from Jan to
July 2019. Socio-demographic data were collected by using structured questionnaire in face to face
interview with patients. Sputum and non-sputum samples were also collected from 436 presumptive
TB cases.
All sputum specimens collected underwent digestion and decontamination using the NaOH-NALC
method, whereas and extra pulmonary clinical samples were used directly without decontamination.
After centrifugation sputum samples, the sediments were examined using Ziehl-Neelsen technique,
analyzed with Gene X-pert MTB/RIF assay, and culture using Lowenstein-Jensen (LJ) and positive
culture results were tested for drug resistance pattern using Line probe Assay (LPA). The collected
data was entered to EPI info 2002 version 3.32 after data editing and cleaning, exported to SPSS
version 23 for analysis.
Results: The total of 436 respondents were included in the study, of this 223 (51%) were male. The
mean ±SD age the participants was 38±17years. Regarding marital status, 238 (54.6%) participants
were Julyried, and majority of the respondents 240(55%) urban resident, 214 (49 %) had monthly
income 100-1000 Ethiopian Birr, 278 (63.8%) used carbohydrate as a usually monthly food item.
Of the total, 374(85.8%) were diagnosed for pulmonary tuberculosis and 62(14.2%) were for extrapulmonary
tuberculosis, and from all 130 (30-%) were HIV positive individuals. Out of the total
participants, the overall LJ culture confirmed Mycobacterium tuberculosis was, 27 (6.2%), and
three isolates were resistant for either INH or RIF drug, while two of them were MDR-TB based on
line probe assays method. In a bivariate logistic regression analysis, having a previous TB-contact
history (COR=3.1; 95 % CI: 1.1, 8.7; P=0.03), patient weight loss (COR=3.6; 95 % CI: 1.5-8.8;
P=0.004), having pneumonia with chest X-ray diagnosis (COR=3; 95%CI:3, 33; P=0.02), and
having CD4
+
T-cells count 200-350/mm
3
of blood (COR=8.9; 95%CI:0.5, 0.9; p=0.049) were
significantly associated.
Conclusion: The magnitude of M. tuberculosis and MDR TB in this study highlights the need for
further extended early case detection and managing MDR TB cases to minimize transmission and
the suffering of patients.
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Keywords
M. tuberculosis, Resistance pattern, Lowenstein-Jensen and Line probe Assay.