Clinical and mutational profile of extensively drug resistant tuberculosis cases in northern India

Abstract

Introduction: Insight into the clinical characteristics and mutational profile of XDR TB cases is essential to reduce the incidence and effectively treat the cases of XDR TB, which has remained a challenge.

Aim: To identify the clinical and mutational profile in cases of extensively drug resistant tuberculosis.

Objectives: ·       To identify the clinical profile in cases of XDR TB. To identify the mutations and drug-resistance pattern as detected by First and Second-Line Line Probe Assay in cases of XDR TB.

Methodology: 53 patients newly diagnosed with XDR TB referred to nodal DR-TB Centre KGMU, Lucknow from the period of 1st May 2019 to 30th April 2020 were enrolled. A comprehensive oral and documented history was used to determine the clinical history and prior treatment details. The results of Line Probe Assays(GenoType MTBDRplus(ver2) and GenoType MTBDRsl(ver2)) were analysed for mutation pattern and interpreted for drug resistance.

Results & Conclusion: The patients had a median symptom duration of 14 months. An anti-tubercular regimen was being initiated for a median of 3rd time, with a 13 month median duration of previous ATT intake, second-line drugs being consumed for a median of 7 months. The most prevalent mutations conferring resistance to rifampicin, isoniazid, fluoroquinolones and second-line injectables were rpoB S531L, katG S315T1, gyrA D94G, and rrs a1401g respectively. In addition to being resistant to rifampicin, isoniazid, levofloxacin and kanamycin, 52.83%, 75.47%, 91.30% and 17.39% were resistant to high dose moxifloxacin, amikacin/capreomycin, high dose isoniazid and ethionamide respectively.