Analysis of drug resistance among difficult-to-treat tuberculosis patients in Ghana identifies several pre-XDR TB cases

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Abstract

Background

Resistance to tuberculosis (TB) drugs has become a major threat to global control efforts. Early case detection and drug susceptibility profiling of the infecting bacteria are essential for appropriate case management. The objective of this study was to determine the drug susceptibility profiles of difficult-to-treat (DTT) TB patients in Ghana.

Methods

Sputum samples obtained from DTT-TB cases from health facilities across Ghana were processed for rapid diagnosis and detection of drug resistance using the Genotype MTBDR plus and Genotype MTBDR sl. v2 from Hain Life science.

Results

A total of 298 (90%) out of 331 sputum samples processed gave interpretable bands out of which 175 (58.7%) were resistant to at least one drug (ANY ^r); 16.8% (50/298) were isoniazid-mono-resistant (INH ^r), 16.8% (50/298) were rifampicin-mono-resistant (RIF ^r), and 25.2% (75/298) were MDR. 24 (13.7%) of the ANY ^r were additionally resistant to at least one second line drug: 7.4% (2 RIF ^r, 1 INH ^r, and 10 MDR samples) resistant to only FQs and 2.3% (2 RIF ^r, 1 INH ^r, and 1 MDR samples) resistant to AMG drugs kanamycin (KAN), amikacin (AMK), capreomycin (CAP), and viomycin (VIO). Additionally, there were 4.0% (5 RIF ^r and 2 MDR samples) resistant to both FQs and AMGs. 81 (65.6%) out of 125 INH-resistant samples including INH ^r and MDR had katG-mutations (MT) whereas 15 (12%) had inhApro-MT. The remaining 28 (22.4%) had both katG and inhA MT. All the 19 FQ-resistant samples were gyrA mutants whereas the 10 AMGs were rrs (3), eis (3) as well as rrs, and eis co-mutants (4). Except for the seven pre-XDR samples, no sample had eis MT.

Conclusion

The detection of several pre-XDR TB cases in Ghana calls for intensified drug resistance surveillance and monitoring of TB patients to, respectively, ensure early diagnosis and treatment compliance.

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Most cited references 28

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Fluoroquinolone resistance in Mycobacterium tuberculosis and mutations in gyrA and gyrB.

Carolina da Silva, Anandi Martin, Juan Carlos Palomino … (2009)

This study evaluated cross-resistance of Mycobacterium tuberculosis strains to ofloxacin, moxifloxacin, and gatifloxacin and investigated the presence of mutations in gyrA and gyrB. Fluoroquinolone susceptibilities were determined for 41 M. tuberculosis strains by the proportion method on 7H11, and MICs were determined by the resazurin microtiter assay. Forty strains shared the same resistance results for the three fluoroquinolones. However, one strain, with an Asn-533 --> Thr mutation in gyrB, was susceptible to ofloxacin but resistant to moxifloxacin and gatifloxacin.

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Author and article information

Contributors

Isaac Darko Otchere: URI : http://loop.frontiersin.org/people/637753/overview

Portia Abena Morgan: URI : http://loop.frontiersin.org/people/1516025/overview

Prince Asare: URI : http://loop.frontiersin.org/people/884714/overview

Stephen Osei-Wusu: URI : http://loop.frontiersin.org/people/930930/overview

Samuel Yaw Aboagye: URI : http://loop.frontiersin.org/people/1145947/overview

Abdul Basit Musah: URI : http://loop.frontiersin.org/people/1486709/overview

Theophilus Afum: URI : http://loop.frontiersin.org/people/1301949/overview

Adwoa Asante-Poku: URI : http://loop.frontiersin.org/people/891085/overview

Sebastien Gagneux: URI : http://loop.frontiersin.org/people/167038/overview

Dorothy Yeboah-Manu: URI : http://loop.frontiersin.org/people/479427/overview

Journal

Journal ID (nlm-ta): Front Microbiol

Journal ID (iso-abbrev): Front Microbiol

Journal ID (publisher-id): Front. Microbiol.

Title: Frontiers in Microbiology

Publisher: Frontiers Media S.A.

ISSN (Electronic): 1664-302X

Publication date (Electronic): 12 January 2023

Publication date Collection: 2022

Volume: 13

Electronic Location Identifier: 1069292

Affiliations

[1] ¹Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana , Accra, Ghana

[2] ²Institute for Environment and Sanitation Studies, College of Basic and Applied Sciences, University of Ghana , Accra, Ghana

[3] ³Eastern Regional Hospital , Koforidua, Ghana

[4] ⁴Chest Department, 37 Military Hospital , Accra, Ghana

[5] ⁵National Tuberculosis Control Program, Ghana Health Service , Accra, Ghana

[6] ⁶Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, University of Basel , Basel, Switzerland

Author notes

Edited by: Maria Rosalia Pasca, University of Pavia, Italy

Reviewed by: Okon Okwong Kenneth, Federal Medical Centre Makurdi, Nigeria; Uma Devi Ranganathan, National Institute of Research in Tuberculosis (ICMR), India

*Correspondence: Isaac Darko Otchere, iotchere@ 123456noguchi.ug.edu.gh

This article was submitted to Antimicrobials, Resistance and Chemotherapy, a section of the journal Frontiers in Microbiology

Article

DOI: 10.3389/fmicb.2022.1069292

PMC ID: 9878308

PubMed ID: 36713197

SO-VID: 54d5cb13-14a7-44f8-97c3-e0026834a408

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 13 October 2022

Date accepted : 28 December 2022

Page count

Figures: 2, Tables: 5, Equations: 0, References: 31, Pages: 9, Words: 5149

Funding

This study was funded by the Swiss-African Research Cooperation (SARECO) grant SA_IO110 to IO and the WANETAM-2 funded by EDCTP.

Analysis of drug resistance among difficult-to-treat tuberculosis patients in Ghana identifies several pre-XDR TB cases

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Abstract

Background

Methods

Results

Conclusion

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Wiley: Novel Coronavirus COVID-19

Most cited references 28

COVID-19 as the Leading Cause of Death in the United States

Global Tuberculosis Report 2020.

Fluoroquinolone resistance in Mycobacterium tuberculosis and mutations in gyrA and gyrB.

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