Journal of AdvancedMedical and Dental Sciences Research

Background: Tuberculosis (TB) is a contagious disease caused by the bacillus Mycobacterium (M.) tuberculosis and occasionally by Mycobacterium bovis, and Mycobacterium africanum. There are cases of drug-resistant TB throughout the world. Resistance of M. tuberculosis to drugs is a man-made amplification of spontaneous mutations in the genes of the tubercle bacilli. The present study was to conducted to evaluate the resistance of combinations of isoniazid (INH), rifampicin (RMP), streptomycin (SM), and ethambutol (EMB) and four resistant modes, i.e. mono, double, triple and quadruple resistance among cases of pulmonary tuberculosis patients. Materials & Methods: This study was conducted in Directly Observed Treatment Short-course (DOTS) centre in year 2014. It consisted of 200 newly diagnosed Sputum smear positive (SS+) for acid fast bacilli (AFB) pulmonary tuberculosis patients of both sexes and between the age group of 15 to 60 years. AFB culture and drug susceptibility test were done. Drug resistance was expressed in proportion method, where a strain was considered to be drug resistant if the number of colonies that grew on a drug containing medium was 1% or more of the colonies. Chest radiographs were taken of all the patients at the time of diagnosis of TB at the end of six-month treatment. Patients were evaluated by judging the site of lesions, zone of involvement, nature of the lesion (visible cavitary and non-cavitary area) in both lungs. Results were tabulated and subjected for correct inferences. P value < 0.05 was considered significant. Results: Out of 40 patients, 110 were males and 90 were females. Age group 15-30 years had males (50) and females (40).  Age group 30-45 years had males (25) and females (35).  Age group 45-60 years had males (35) and females (15). Sputum positivity grade was 1+ (60), 2+ (40), 3+ (45) or scanty (55). The difference was non - significant (P > 0.05). Socio economic status of patients was upper (2), upper middle (4), lower middle (4), upper lower (150) and lower middle (40). The difference was significant (P < 0.05). Lesions were cavitatory (36) and non cavitatory (164). The difference was significant (P <0.05). Culture on LJ medium was growth of bacteria in 185 cases, myobacteria other than tuberculosis in 3 cases, contamination in 10 cases and no growth of mycobacteria in 2 cases. Number of sensitive strains of rifampicin was 195, isoniazide (160), streptomycin (190), ethambutol (189) and resistant strains of rifampicin was 5, isoniazide (40), streptomycin (10), ethambutol (11). The difference of sensitive strains among all 4 drugs was non - significant (P > 0.05). Four most frequent drug resistance patterns of 21.3% strains of M. tuberculosis from mono drug, double drug, triple drug and quadruple drug resistance were 5.9%, 10.7%, 2.4% and 2.4% respectively. MDR was observed in 4.7% isolates. Conclusion: Drug resistant tuberculosis cases are now increasing day by day. It poses challenge to the treatment. Identification of resistant strains helps in proper management of cases of tuberculosis.
Key words: Drug resistant, Rifampicin, Streptomycin, Tuberculosis 

Corresponding Author: Dr. Sanjay Singh, Associate Professor, Department of T.B. & Chest, Career Institute of Medical Sciences and Hospital, Lucknow, U.P, India

This article may be cited as: Singh S, Mishra LK. Drug resistance pattern among patients with tuberculosis- A clinical study. J Adv Med Dent Scie Res 2017;5(1):103-107.