Drug resistance of Mycobacterium tuberculosis in Malawi: a cross-sectional survey

Abouyannis, Michael ORCID: https://orcid.org/0000-0003-4856-4334, Dacombe, Russell ORCID: https://orcid.org/0000-0002-6705-1537, Dambe, Isais, Mpunga, James, Faragher, Brian, Gausi, Francis, Ndhlovu, Henry, Kachiza, Chifundo, Suarez, Pedro, Mundy, Catherine, Banda, Hastings T, Nyasulu, Ishmael and Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038 (2014) 'Drug resistance of Mycobacterium tuberculosis in Malawi: a cross-sectional survey'. Bulletin of the World Health Organization, Vol 92, Issue 11, pp. 773-848.

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Abstract

Objective
To document the prevalence of multidrug resistance among peoplenewly diagnosed with – and those retreated for – tuberculosis in Malawi.

Methods
We conducted a nationally representative survey of people with sputum-smear-positive tuberculosis between 2010 and 2011. For all consenting participants, we collected demographic and clinical data, two sputum samples and
tested for human immunodeficiency virus (HIV).The samples underwent resistance testing at the Central Reference Laboratory in Lilongwe, Malawi. All Mycobacterium tuberculosis isolates found to be multidrug-resistant were retestedfor resistance to first-line drugs – and tested for resistance to second-line drugs – at a Supranational Tuberculosis Reference Laboratory in South Africa.

Findings
Overall, M. tuberculosis was isolated from 1777 (83.8%) of the2120 smear-positive tuberculosis patients. Multidrug resistance was identified infive (0.4%) of 1196 isolates from new cases and 28 (4.8%) of 581 isolates from people undergoing retreatment. Of the 31 isolates from retreatment cases who had previously failed treatment, nine (29.0%) showed multidrug resistance. Althoughresistance to second-line drugs was found, no cases of extensive drug-resistanttuberculosis were detected. HIV testing of people from whom M. tuberculosis isolates were obtained showed that 576 (48.2%) of people newly diagnosed and 386 (66.4%) of people undergoing retreatment were positive.

Conclusion
The prevalence of multidrug resistance among people with smear-positive tuberculosis was low for sub-Saharan Africa –probably reflecting the strength of Malawi’s tuberculosis control programme. The relatively high prevalence of such resistance observed among those with previous treatment
failure may highlight a need for a change in the national policy for retreating this subgroup of people with tuberculosis.

Item Type:	Article
Subjects:	QW Microbiology and Immunology > Bacteria > QW 125 Actinibacteria, Actinomycetales. WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WC Communicable Diseases > Infection. Bacterial Infections > Other Bacterial Infections. Zoonotic Bacterial Infections > WC 302 Actinomycetales infections. Mycobacterium infections WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General) WF Respiratory System > Tuberculosis > WF 360 Drug therapy
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.2471/BLT.13.126532
Depositing User:	Helen Rigby
Date Deposited:	07 Nov 2014 15:02
Last Modified:	21 Nov 2019 13:56
URI:	https://archive.lstmed.ac.uk/id/eprint/4478

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