Mono- and polyresistant tuberculosis at TB focal point, Helen Joseph Hospital
Date
2015-09-04
Authors
Van Blydenstein, Sarah Alexandra
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Abstract
Drug resistant (DR) tuberculosis (TB) is a rapidly emerging health problem in the Republic of South Africa (RSA). Multidrug resistant TB attracts a great deal of scientific attention not only worldwide but also in RSA, however, mono- and polyresistant TB is a relatively under studied disease entity. This study explored the demographics and characteristics of the types of mono- and polyresistant TB groups, and tried to determine if there were any associations between type of TB resistance and treatment outcome. The cohort studied consisted of 194 patients who had attended the Helen Joseph Hospital TB Focal Point. There were five major types of DR TB identified, including rifampicin (RIF) monoresistant (34%, 66 patients), isoniazid (INH) monoresistant (32.5%, 63 patients), INH polyresistant (20.1%, 39 patients), RIF polyresistant (4.6%, 9 patients) and phenotypically sensitive TB (8.9%, 17 patients).
A concerning figure of 86.6% of the DR TB cohort tested HIV positive, compared to the national population where 10.2% are reported HIV positive. The median CD4 was 67 cells/mm3, and 30.4% of the HIV positive patients had a CD4 count of less than 50 cells/mm3. Only 36.6% of the HIV positive patients were on antiretroviral therapy at time of DR TB diagnosis. Neither serum albumin nor haemoglobin were found to be significant markers for the prediction of outcome in DR TB, and no significant differences in DR TB type nor outcome were found when looking at age groups and gender. Although the numbers were small RIF monoresistant TB emerged as the most common type of DR TB (34%), and as such represents a clinical entity that should be considered separately from MDR TB. Unfortunately due to small sample sizes, no significant interpretation could be made regarding the various subgroups of DR TB and the genetic mutations to understand if there are differences in clinical presentation, mortality and morbidity predictors and outcome, and this is a field that requires further investigation.
Description
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Master of Medicine in Internal Medicine
Johannesburg 2015