Clinico-demographic profile of pre-extensively drug-resistant pulmonary tuberculosis patients in India

Q3 Medicine

Indian Journal of Tuberculosis Pub Date : 2025-04-30 DOI:10.1016/j.ijtb.2025.04.012

Bella Devaleenal Daniel , Muthuvijayalakshmi M , Vikas Oswal , Chetan Kumar Jain , Neeta Singla , Santosh Kumar , Anuj Bhatnagar , Vikram Vohra , Jigna Dave , Namrata Kaur Bhui , Rajesh Solanki , Rathinam Sridhar , Parul Vadgama , Suryakant , Rathinam Prabhakaran , Paranchi Murugesan Ramesh , Bharathi Jeyadeepa , Shanmugapriya Kumaravadivelu , Balaji Ramraj , Jyoti Jaju , Chandrasekaran Padmapriyadarsini

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Abstract

Drug-resistant tuberculosis (DR TB) is a major public health problem and an important area of research. Identification of various risk factors is essential for its prevention and management. Adults weighing more than 30 kg, aged 18 years or more diagnosed with pre extensively drug resistant TB (pre-XDR TB) were initiated on bedaquiline and linezolid based regimens along with pretomanid/delamanid as part of two multicentric clinical trials in India. Pre-XDR TB was defined as patients infected with M. tb strains resistant to rifampicin (may or may not be resistant to isoniazid) with additional resistance to fluoroquinolones and/or second line injectable as per the existing World Health Organization (WHO) definitions during the trial period. We describe here the baseline demographic and clinical profile of patients with pre-XDR TB and enrolled in those two trials. Of 554 Pre-XDR TB patients, 297 (54 %) were males. Median age (IQR) was 27 years [22.0–36.3] and body mass index was 17.4 [15.7–20.1] kg/m². Of all, 326 (59 %) had BMI <18.5 kg/m². History of previous episodes of TB was reported by 415 (75 %) patients. Among them, 142 (34 %) had taken treatment more than once, 279 (67 %) had treatment failure during the previous episodes. Persons with a known history of diabetes were 67 (12 %). Cough, cough with expectoration, fever and weight loss were the presenting complaints in 539 (97 %) and 487 (88 %), 337 (61 %) and 314 (57 %) respectively. Sputum smear microscopy showed more than ++ acid-fast bacilli in 264 (48 %). Chest x-ray showed bilateral lung involvement in 329 (60 %) with more than two zones involvement in 304 (55 %) and presence of cavities in 264 (48 %) patients. Persons in the younger age group, those with malnutrition and previous history of TB treatment were observed to be more in these cohort of patients with PreXDR TB. High rates of treatment failure during the earlier episodes of TB with increased disease severity and drug resistance during the current episode is a matter of grave concern. Improved treatment success during the management of drug sensitive TB, addressing the nutritional challenges are some of key areas of focus in the prevention of DRTB burden.

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印度广泛耐药前肺结核患者的临床人口统计资料

耐药结核病是一个重大的公共卫生问题，也是一个重要的研究领域。识别各种风险因素对预防和管理至关重要。作为印度两项多中心临床试验的一部分，体重超过30公斤、年龄在18岁或以上、被诊断为广泛耐药前结核病（xdr前结核病）的成年人开始使用贝达喹啉和利奈唑胺为基础的方案以及pretomanid/delamanid。根据世界卫生组织（世卫组织）在试验期间的现有定义，广泛耐药前结核病定义为感染了对利福平耐药（可能对异烟肼耐药，也可能不耐药）的结核分枝杆菌菌株的患者，并对氟喹诺酮类药物和/或二线针剂具有额外耐药性。我们在这里描述了广泛耐药前结核病患者的基线人口统计学和临床概况，并参加了这两项试验。在554例xdr前结核病患者中，297例（54%）为男性。中位年龄（IQR）为27岁[22.0 ~ 36.3]，体重指数为17.4 [15.7 ~ 20.1]kg/m2。其中326人（59%）的BMI指数为2。415例（75%）患者报告有结核病既往病史。其中142例（34%）治疗过一次以上，279例（67%）既往治疗失败。有糖尿病史的67人（12%）。咳嗽、咳痰、发热和体重减轻分别为539例（97%）、487例（88%）、337例（61%）和314例（57%）。痰涂片镜检显示264例（48%）中有++个抗酸杆菌。胸部x线显示双侧肺受累329例（60%），超过两个区受累304例（55%），存在空腔264例（48%）。在这些PreXDR结核病患者队列中，观察到年轻年龄组、营养不良和既往结核病治疗史的人更多。结核病早期发作期间治疗失败率高，而当前发作期间疾病严重程度和耐药性增加，这是一个令人严重关切的问题。提高药物敏感性结核病管理期间的治疗成功率，解决营养挑战是预防耐药结核病负担的一些关键重点领域。

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来源期刊

Indian Journal of Tuberculosis Medicine-Infectious Diseases

CiteScore

2.80

自引率

0.00%

发文量

103

期刊介绍： Indian Journal of Tuberculosis (IJTB) is an international peer-reviewed journal devoted to the specialty of tuberculosis and lung diseases and is published quarterly. IJTB publishes research on clinical, epidemiological, public health and social aspects of tuberculosis. The journal accepts original research articles, viewpoints, review articles, success stories, interesting case series and case reports on patients suffering from pulmonary, extra-pulmonary tuberculosis as well as other respiratory diseases, Radiology Forum, Short Communications, Book Reviews, abstracts, letters to the editor, editorials on topics of current interest etc. The articles published in IJTB are a key source of information on research in tuberculosis. The journal is indexed in Medline