Pakistan Journal of Medical Research (Jul 2020)
Factors Responsible for Relapse Among the Cured Tuberculosis Patients and Frequency of Drug Resistance Among Them
Abstract
Background: Tuberculosis (TB) is considered as one of the major disease responsible for the morbidity and mortality. Pakistan is ranked 5th in terms of disease burden of TB which is very alarming for the worldwide. Patients who are diagnosed with TB gets registered with TB control program for the treatment. Major factors responsible for the rise in TB patients includes delayed or missed diagnosis. We planned to examine and investigate the predictors of relapse TB in patients who had successfully completed the TB treatment amid a unit of sputum smear-positive pulmonary tuberculosis (PTB) patients. Prevalence of drug resistance among these patients was also determined. Objective: To identify the factors associated with relapse among cured patients under DOTS program and determine the frequency of drug resistance among the relapsed cases of cured TB patients. Study type settings & duration: This cross sectional, descriptive study was conducted in collaboration with Pakistan Health Research Council (PHRC) TB research center and Institute of Chest Medicine, King Edward Medical University, Mayo Hospital Lahore and PHRC CRC NIH Islamabad from April 2017 to October 2018 Methodology: Two hundred cases of TB were selected for the research purpose who had relapse of TB, and were previously declared as cured for the TB. The cases were subjected to Ziehel Neelsen (ZN) smear microscopy and later on LJ culture. Two sputum specimens from each subject was collected for ZN smear microscopy, GeneXpert and culture for Mycobacterium Tuberculosis (MTB) detection on Lowenstein-Jensen media. Those found positive on culture were then tested for drug susceptibility for first and second line drugs by standard drug proportion method on LJ medium. A semi-structured questionnaire was used to collect the information. Data was analyzed by using the SPSS. Results: A total of 200 patients of relapse were included in the study and a total of 84 (42%) cured patients were found with relapse. The major factors for the relapse were addiction history 35 (42%), non-adherence to previous treatment 50 (59.5%), co-morbidity with diabetes 22 (26.2%) and hypertension 20 (24.8%). With respect to the frequency of drug resistance Isoniazid and Rifampicin resistance was very high in proportions of 44% and 37% respectively. The Multi-Drug Resistance (MDR) status was found to be positive among 30 (36%) cases of relapse. Conclusion: TB is a menace that needs to be eradicated. From the study it is fairly concluded that critical factors including addiction, non-adherence, diabetes and hypertension were responsible for relapse of TB. We recommend more studies with larger sample sizes for further evaluation at a larger prospective. Such studies would definitely provide key solutions for TB control agencies in the future.
