Govind Narayan Srivastava

Prevalence of Mycobacterium tuberculosis Beijing genotype and its association with drug resistance in North India

The global presence and rapid dissemination of Beijing genotype of Mycobacterium tuberculosis, makes it an important issue of public health. Its presence and association with multi-drug resistance has been shown in many settings. In present study we tried to find its prevalence and association with drug resistance in North India. One hundred and twenty four M. tuberculosis isolates were analyzed with spoligotyping, further drug susceptibility testing was done by 1% proportional method. Out of these, 11 (8.9%) M. tuberculosis isolates were identified as Beijing and 113 (91.1%) as non-Beijing genotypes. While looking at their drug susceptibility patterns, 6 (54.5%) & 22 (19.5%) were found to be multi drug resistant (MDR) among Beijing and non-Beijing isolates respectively. Our study concluded that the Beijing strains were not so common in north India and these strains do not fully associate with MDR.

Primary and acquired drug resistance patterns of Mycobacterium tuberculosis isolates in India: A multicenter study

Tuberculosis is the most prevalent infection worldwide. The emergence of drug-resistant Mycobacterium tuberculosis (M. tuberculosis) isolates emphasizes that it is necessary to monitor drug resistance of the organism against anti-tubercular drugs. We analyzed 327 M. tuberculosis isolates from patients who were cared for at three different health care centers, hereinafter known as study areas (SAs), in North India. Of the 327 total M. tuberculosis isolates, 255 were from a tertiary health care center (Varanasi, Uttar Pradesh [SA-1]), 48 were from a District tuberculosis center (Sawai Madhopur, Rajasthan [SA-2]), and 24 were from a different District tuberculosis center (Buxar, Bihar [SA-3]). Drug susceptibility testing against first-line antibiotics (viz. isoniazid, rifampicin, streptomycin, and ethambutol) was conducted for all the isolates using 1% proportional method. We found that the rates of acquired resistance were consistently higher than the rates of initial drug resistance. In new, untreated cases, a higher degree of MDR-TB was observed at SA-1 (13.3%) and SA-3 (25.0%), whereas it was observed in only 7.1% of the isolates at SA-2. In previously treated patients, MDR cases were found in 35.7% of the isolates from SA-1, 66.6% of the isolates from SA-2, and 43.8% of the isolates from SA-3. Resistance to a single drug was found at a much lower rate, ranging from 0.0 to 6.3% in new cases as well as previously treated cases. In conclusion, the primary resistance of M. tuberculosis is low, but acquired drug resistance is slightly higher in North India.

Association of risk factors and drug resistance pattern in tuberculosis patients in North India

Context: India is one of the high tuberculosis (TB) burden countries in the world. Improper implementation in the guidelines for the management of TB and high rate of defaults on the part of the patients are most important risk factors for the development of multi-drug resistant TB. Aims: This study examines the drug resistance profile and the effect of demographic, clinical and behavioral risk factors on the prevalence of TB and multidrug resistance (MDR) in north India. Settings and Design: This was a prospective, observational study carried out from May 2012 to February 2014 in tertiary care hospital of Varanasi. Subjects and Methods: The study was performed on 721 pulmonary and extrapulmonary specimens of suspected TB patients based on history, was subjected for the Ziehl–Neelsen staining and culture on Lowenstein–Jensen (LJ) media. Statistical Analysis: The features of groups were compared by Chi-square (χ2) and odds ratio. Results: Out of 721 clinically suspected pulmonary and extrapulmonary TB patients, 222 (30.8%) patients were smear positive for acid-fast bacilli and 244 (38.3%) were positive for Mycobacterium species cultured on LJ medium. The prevalence of resistance to at least one anti-TB drug was 71.1% and MDR was 53.5%. Age, gender, HIV status, nature of TB, smoking, and alcohol consumption risk factors were significantly associated with TB prevalence; while prior history of TB infection, pervious household exposure, smoking, and alcohol consumption were significantly associated with MDR. Conclusion: This study showed a high prevalence of drug resistance TB in this region. It also provides evidence in our circumstance, of the role of prior history of TB infection, alcohol and smoking in increasing the risk of developing TB and MDR-TB. Therefore, it is necessary for the public health community to incorporate and strengthen alcohol and smoking nonparticipation interference in TB control program.

Abdominal tuberculosis: experience with RNTCP category III antitubercular therapy -

Background: Abdominal tuberculosis as such has been put in seriously ill category III regimen because the therapy of abdominal tuberculosis throws up many challenges, especially those presenting with immune compromised and malnourished state. To accommodate all the accompanying challenges, it is prudent to keep the regimen flexible. Objective: To study the 30- and 60-day efficacy of daily versus alternate-day self-administered therapy of abdominal tuberculosis in young adults with ileocecal tuberculosis (IC) and mesenteric tubercular lymphadenitis (ML). Materials and Methods: This study was conducted for a duration of 2 years, starting June 2013, in an outpatient setting of a tertiary referral center in north India. Patients identified during a study of causes of functional abdominal pain syndrome (FAPS) or “only pain” presentation in gastroenterology (GI) outpatient and diagnosed as IC or ML on the basis of contrast-enhanced computerized tomography (CECT) and/or colonoscopy with ileoscopy were given daily (weight based) versus alternate-day revised national tuberculosis control program (RNTCP) category III regimen therapy in a nonrandom manner. Result: Twelve patients of abdominal tuberculosis were identified: eight cases had IC with varying degrees of gastrointestinal disturbances whereas four had ML with no other organic disease explaining the symptoms. Groups prescribed daily versus alternate-day therapy did not differ significantly because of the presentation as FAPS in young adults. All patients received clinically significant improvement with antitubercular therapy. Four patients prescribed RNTCP category III regimen showed excellent clinical relief. Dyspepsia occurred significantly more with alternate-day therapy. Conclusion: Self-administered DOTS alternate-day therapy according to RNTCP category III regimen is equally efficacious to daily-weight-based regimen in young adults with abdominal tuberculosis.

Acute silicosis with bilateral pneumothorax.

We present a case of acute silicosis with bilateral pneumothorax of a 28-year-old man working at a stone crusher factory for 1 year. He presented to the emergency department with cough, respiratory distress and diffuse chest pain. The patient was managed with bilateral intercostal tube drainage under water seal, oxygen inhalation and conservative therapy. On follow-up he showed improvement of resting dyspnoea and was doing well. This case is being reported because of the rare complications of acute silicosis as bilateral pneumothorax.

Oesophago-pleuro-cutaneous fistula

We describe a case of oesophago-pleuro-cutaneous fistula occurring as a complication of tuberculous pyopneumothorax in a young adult.