Drug resistance of mycobacterium tuberculosis with comparison of diagnostic methods for TB cases

مقدم أطروحة جامعية

al-Kinani, Ikhlas Atiyyah Khalaf

مشرف أطروحة جامعية

Mankhi, Ahmad Asmir
al-Muzayini, Muhammad Abd al-Imam

أعضاء اللجنة

Sharif, Ali A.
Mukhlif, Haydar A.
Hamim, Sad Salman

الجامعة

جامعة البصرة

الكلية

كلية العلوم

القسم الأكاديمي

قسم علوم الحياة

دولة الجامعة

العراق

الدرجة العلمية

ماجستير

تاريخ الدرجة العلمية

2014

الملخص الإنجليزي

The study included (169) specimens of TB patients that attended to Specialized Chest and Respiratory Disease Center/ National Reference Laboratory for Tuberculosis (NRL) in Baghdad, during the period from 1/10/2012- 1/8/2013.

These specimens included (147) sputum specimens of pulmonary TB patients and (22) Extra-pulmonary specimens.

Most of the subjected cases (169) in the study had belonged to the age group (25-34) years with percentage of (28.99%), while the lowest age group was (5-14) years with a percentage of (0.59%), without statistically difference (p=0.9222, p>0.05).The males (111 patients) were more predominant among all age groups than the females (58 patients).

TB cases which received from patients of Baghdad (51.47%) were more than patients from all other governorates (48.53%).

The pulmonary TB specimens included (112) specimens that belonged to re-treated TB patients (old case), and (35) specimens belonged to new TB patients.

(88) specimens (66 of sputum and 22 Extra-pulmonary TB specimens) had been comparatively investigated by different laboratory diagnostic methods, 66 sputum specimens were isolated from two hundred specimens by solid media; first step was the Zhiel-Nelseen staining, cultivation on solid media using (Lowenstein- Jensen media), and the sputum isolates were taken only from positive cultured on L-J media as standard and to complete other identifications on isolates.

In addition to cultivation in liquid media Middle Brook 7H9 in MGIT tube of advanced technology of culture in liquid media (Bactec MGIT 960 system) and by using molecular assay (Gene Xpert MTB/RIF) that achieved the highest percentage of detection rate which were (97.14%) in pulmonary TB specimens and (90.91%) in Extra-pulmonary TB specimens, while the lowest detection rate were by using Z-N staining (53.03%) in pulmonary TB specimens and (9.09%) in Extra-pulmonary TB أ specimens.

The Bactec MGIT 960 detection rate in pulmonary TB was (86.36%), were also higher than it in Extra-pulmonary (50%).

Statistically there were significant differences among the results of pulmonary samples (p-value=0.000002671,p<0.05).

There were only six specimens among 22 Extra-pulmonary samples that showed growth on solid media (27.27%) , and no one exposed growth on (Stone-brink) media.

On the other hand, all specimens (pulmonary and Extra-pulmonary TB) were subjected to drug susceptibility test by using (Indirect 1%proportion method) to evaluate the drug resistance of Tuberculosis patients.

The acquired drug resistance for 112 old TB patients were (87.5%) and the primary resistance for 35 new TB patients (5.71%).

while the new TB cases 33/35 were sensitive to all drugs at (94.28%) and the sensitivity of re-treated TB Patients were (12.5%), with significant differences (P˂0.001, P˂0.05).

The majority of resistant cases were resistant to four drugs at (30.61%), used in the first line TB treatment; Isoniazid (INH), Rifampicin (RMP), Streptomycin (SM), and Ethambutol (EMB), and the percentages of other resistance were 2.04% for one drug , 9.52% to two drug , and 28.85% to three drug with significant differences (P=0.000001, P<0.05).

For total resistance of each drug ,the study revealed the INH and RMP were the high resistant drugs had been resisted among old TB patients at percentage (63.26%) for INH , and (64.62%) for RMP, while EMB was lowest in comparing with other drugs (39.45%), without statistically differences (P=0.39, P>0.05).

The study also showed that high percentage of MDR-TB (93%) among resistant old TB patients ,whereas the poly drug-resistance were (4%).

The majority of old cases were from defaulter categories (32.43%).

Concerning the results of drug susceptibility test in Extra-pulmonary TB specimens, all of them were sensitive according to proportion method and أ Gene Xpert except one specimens that was diagnosed as Rifampicin resistant by using Gene Xpert.

Seventy-four of pulmonary TB isolates were subjected comparatively between proportion method and an advanced method of antimicrobial susceptibility test of liquid culture (AST of BACTEC MGIT 960 system) , There were high levels of agreement in the results of these two methods concerning INH, RIF drugs results, with simple differences for SM, EMB results, without statistically significant differences (P-value=0.9 , P>0.05) , also there were high agreement between the results of Gene Xpert that revealed 30/34 isolates were resistance to rifampicin at percentage (88.24%) whereas the percentage (82.35%) for the same isolates according to proportion method.

For identification and typing of acid fast bacilli, six biochemical typing tests were used in the study ; growth on stone-brink media , growth on Para-nitro benzoic acid media (PNB), growth on Thiophene -2-Carboxyl acid hydrazine (TCH) media, in addition to catalase test, niacin test, and nitrate reduction test.

These tests showed the high percentage (90.91%) of results representing strains belonged to M.tuberculosis, and (9.09%) represent the percentage of non agreed results with the species M.tuberculosis.

التخصصات الرئيسية

الأحياء

عدد الصفحات

124

قائمة المحتويات

• APA
• MLA
• AMA

لغة النص

الإنجليزية

نوع البيانات

رسائل جامعية

رقم السجل

BIM-743635