July 15, 2011 : Islamabad
The government has established five reference laboratories in the country to ensure best diagnostic and treatment facilities for tuberculosis patients. According to official sources, around 982 microscopy centres are working throughout the country to provide free of cost diagnostic facility of tuberculosis.
They said more than 700,000 tuberculosis patients had been provided free treatment facilities while 100 per cent coverage of WHO-recommended treatment strategy for detection and treatment known as Directly Observed Treatment has been achieved in the country. They said external quality assurance for sputum microscopy was implemented in 40 districts of the country while training and health education materials had been developed with training of all health care providers.
They said TB was an infectious bacterial disease caused by mycobacterium tuberculosis, which most commonly affected the lungs.
They added the disease was transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease. They said in healthy people, infection with mycobacterium tuberculosis often caused no symptoms, since the person’s immune system acted to wall off the bacteria.
They said the symptoms of active TB of the lung were coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats. They added tuberculosis was treatable with a six-month course of antibiotics.
http://www.thenews.com.pk/TodaysPrintDetail.aspx?ID=57751&Cat=6&dt=7/15/2011
Showing posts with label Tuberculosis(Pakistan). Show all posts
Showing posts with label Tuberculosis(Pakistan). Show all posts
Sunday, 17 July 2011
Tuesday, 15 March 2011
TUBERCULOSIS: Fluoroquinolone-Resistant Mycobacterium tuberculosis, Pakistan, 2005–2009
Kauser Jabeen, Sadia Shakoor, Shazia Chishti, Afsheen Ayaz, and Rumina Hasan: Author affiliation: Aga Khan University Hospital, Karachi, Pakistan
To the Editor: Pakistan is 1 of 22 countries listed by the World Health Organization (WHO) as having a high incidence of tuberculosis (TB). We recently reported an increase in rates of multidrug-resistant (MDR) TB with emergence of extensively drug-resistant TB (1). Fluoroquinolone resistance is associated with worse outcome in patients with MDR TB (2). Recent evidence suggests emergence and increasing incidence of fluoroquinolone-resistant Mycobacterium tuberculosis from several countries, particularly in MDR strains (3). We present data from a tertiary care referral center laboratory in Pakistan to assess fluoroquinolone resistance in MDR TB strains during 2005–2009.
The Aga Khan University Hospital and its clinical laboratory have been accredited by the Joint Commission of International Accreditation and designated as a technical partner of the National TB Program. M. tuberculosis susceptibility testing is also periodically validated by the WHO Supranational Reference Laboratory network. The microbiology laboratory serves different cities across Pakistan with ≈180 peripheral collection units. Specimens for TB cultures are requested by physicians and received through passive collection and thus are not restricted to programmed surveys. All specimens received at each of the collection units are sent to the central laboratory in Karachi for culture and drug susceptibility testing (DST). Specimens reach the main laboratory within 24 hours after receipt.
During the past 4 years, the laboratory has received 12,000–15,000 specimens annually for M. tuberculosis culture; positivity rate has been 15%–20%. Culture and DST are performed at the laboratory in accordance with Clinical Laboratory Standards Institute and WHO recommendations, as described (4). During 2005–2008, fluoroquinolone susceptibilities for all MDR and polydrug-resistant isolates were determined by using ciprofloxacin (2 μg/mL). From 2009 onwards, fluoroquinolone susceptibilities were determined by using ofloxacin (2 μg/mL), and second-line DST was performed for all M. tuberculosis isolates.
During 2005–2009, a total of 11,263 cultures were reported positive for M. tuberculosis. Of these, 34.4% were MDR, and 50.1% were sensitive to all 4 first-line agents (isoniazid, rifampin, pyrazinamide, ethambutol). Because of inconsistencies in testing criteria for fluoroquinolones (fluoroquinolone testing being conducted primarily for MDR cases during 2005–2008), the overall fluoroquinolone-resistance rate could not be determined. However, for MDR strains, fluoroquinolone susceptibilities were consistently determined, and resistance rates increased from 17.41% in 2005 to 42.92% in 2009 (p<0.001, by χ2 test for trend analysis) (Table).
A progressive increase in fluoroquinolone use and its association with increase in resistance against organisms other than M. tuberculosis have been reported from Pakistan (5). We report a progressive increase in fluoroquinolone resistance rate in MDR M. tuberculosis isolates during a 5-year period. This finding is consistent with those of several studies reporting fluoroquinolone resistance from the region. Agrawal et al. have recently reported an exponential increase in fluoroquinolone resistance in India from 3% in 1996 to 35% in 2004 (6). A significant increase in fluoroquinolone resistance from 7.7% to 20% in MDR TB was also reported from Taiwan (7); the authors correlated this finding with the inappropriate use of fluoroquinolones for managing TB rather than with fluoroquinolone misuse in the community. Another study from the United States and Canada reported 4.1% fluoroquinolone resistance in MDR TB strains (8).
In addition to detecting increasing fluoroquinolone resistance in MDR isolates, we have also detected fluoroquinolone resistance in non-MDR, polydrug-resistant M. tuberculosis isolates. Moreover, in 2009, a total of 3.1% of isolates susceptible to all first-line agents were fluoroquinolone resistant.
Although our dataset includes samples from throughout Pakistan, sampling limitations prevent us from deriving definite conclusions and generalizing results to the entire population of the country. A referral bias attributable to passive sampling exists because cases referred to our laboratory tend to be more complicated. Moreover, treatment history was not available for patients in our dataset; therefore, increased fluoroquinolone resistance could not be correlated with prior fluoroquinolone use. However, our findings have implications for therapy with fluoroquinolones for TB and other infections.
Fluoroquinolones are freely available as over-the-counter medications to the general population (9), which creates potential for misuse of fluoroquinolones by the general population for TB and several other infections, such as enteric fever and genitourinary infections. Furthermore, because national guidelines for treating enteric fever and genitourinary infections do not exist, these drugs are also overprescribed by physicians. We propose control of over-the-counter availability of fluoroquinolones and judicious use of this class of drugs by physicians to prevent further escalation in resistance rates in Pakistan.
http://www.cdc.gov/eid/content/17/3/564.htm
To the Editor: Pakistan is 1 of 22 countries listed by the World Health Organization (WHO) as having a high incidence of tuberculosis (TB). We recently reported an increase in rates of multidrug-resistant (MDR) TB with emergence of extensively drug-resistant TB (1). Fluoroquinolone resistance is associated with worse outcome in patients with MDR TB (2). Recent evidence suggests emergence and increasing incidence of fluoroquinolone-resistant Mycobacterium tuberculosis from several countries, particularly in MDR strains (3). We present data from a tertiary care referral center laboratory in Pakistan to assess fluoroquinolone resistance in MDR TB strains during 2005–2009.
The Aga Khan University Hospital and its clinical laboratory have been accredited by the Joint Commission of International Accreditation and designated as a technical partner of the National TB Program. M. tuberculosis susceptibility testing is also periodically validated by the WHO Supranational Reference Laboratory network. The microbiology laboratory serves different cities across Pakistan with ≈180 peripheral collection units. Specimens for TB cultures are requested by physicians and received through passive collection and thus are not restricted to programmed surveys. All specimens received at each of the collection units are sent to the central laboratory in Karachi for culture and drug susceptibility testing (DST). Specimens reach the main laboratory within 24 hours after receipt.
During the past 4 years, the laboratory has received 12,000–15,000 specimens annually for M. tuberculosis culture; positivity rate has been 15%–20%. Culture and DST are performed at the laboratory in accordance with Clinical Laboratory Standards Institute and WHO recommendations, as described (4). During 2005–2008, fluoroquinolone susceptibilities for all MDR and polydrug-resistant isolates were determined by using ciprofloxacin (2 μg/mL). From 2009 onwards, fluoroquinolone susceptibilities were determined by using ofloxacin (2 μg/mL), and second-line DST was performed for all M. tuberculosis isolates.
During 2005–2009, a total of 11,263 cultures were reported positive for M. tuberculosis. Of these, 34.4% were MDR, and 50.1% were sensitive to all 4 first-line agents (isoniazid, rifampin, pyrazinamide, ethambutol). Because of inconsistencies in testing criteria for fluoroquinolones (fluoroquinolone testing being conducted primarily for MDR cases during 2005–2008), the overall fluoroquinolone-resistance rate could not be determined. However, for MDR strains, fluoroquinolone susceptibilities were consistently determined, and resistance rates increased from 17.41% in 2005 to 42.92% in 2009 (p<0.001, by χ2 test for trend analysis) (Table).
A progressive increase in fluoroquinolone use and its association with increase in resistance against organisms other than M. tuberculosis have been reported from Pakistan (5). We report a progressive increase in fluoroquinolone resistance rate in MDR M. tuberculosis isolates during a 5-year period. This finding is consistent with those of several studies reporting fluoroquinolone resistance from the region. Agrawal et al. have recently reported an exponential increase in fluoroquinolone resistance in India from 3% in 1996 to 35% in 2004 (6). A significant increase in fluoroquinolone resistance from 7.7% to 20% in MDR TB was also reported from Taiwan (7); the authors correlated this finding with the inappropriate use of fluoroquinolones for managing TB rather than with fluoroquinolone misuse in the community. Another study from the United States and Canada reported 4.1% fluoroquinolone resistance in MDR TB strains (8).
In addition to detecting increasing fluoroquinolone resistance in MDR isolates, we have also detected fluoroquinolone resistance in non-MDR, polydrug-resistant M. tuberculosis isolates. Moreover, in 2009, a total of 3.1% of isolates susceptible to all first-line agents were fluoroquinolone resistant.
Although our dataset includes samples from throughout Pakistan, sampling limitations prevent us from deriving definite conclusions and generalizing results to the entire population of the country. A referral bias attributable to passive sampling exists because cases referred to our laboratory tend to be more complicated. Moreover, treatment history was not available for patients in our dataset; therefore, increased fluoroquinolone resistance could not be correlated with prior fluoroquinolone use. However, our findings have implications for therapy with fluoroquinolones for TB and other infections.
Fluoroquinolones are freely available as over-the-counter medications to the general population (9), which creates potential for misuse of fluoroquinolones by the general population for TB and several other infections, such as enteric fever and genitourinary infections. Furthermore, because national guidelines for treating enteric fever and genitourinary infections do not exist, these drugs are also overprescribed by physicians. We propose control of over-the-counter availability of fluoroquinolones and judicious use of this class of drugs by physicians to prevent further escalation in resistance rates in Pakistan.
http://www.cdc.gov/eid/content/17/3/564.htm
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