Rate of Treatment Failure among Tuberculosis Patients

Rate of Treatment Failure among Tuberculosis Patients swipeTreatment ruin in patient roles with pulmonary tuberculosis (PTB) poses a vast danger to the global effort in come across of tuberculosis. This study evaluated preponderance of slightnessment disaster among PTB patients at a tertiary cargon educational activity hospital in Pakistan. Consecutive patients of derogate constructive PTB patients man matured between February 2011 to October 2013 at the directly observed therapy (Tuberculosis) unit of our hospital were enrolled for the study. Sputum specimens were collected from apiece patient at entry for Acid Fast Bacilli microscopic trial run and repeated at the end of 2nd (in course I cases only), tertiary (in category II cases only), fifth and 7th month of give-and-take. Of the 144 patients recruited, 124 patients consisting of 53 (42.74%) males and 71 (57.26%) females aged 14-85 stratums completed the study. Ninety three (75 %) of the patients were unsanded (category I) at entry term 31 (25%) were Retreatment cases (category II). Among 124 smear verificatory patients at baseline, 22 (17.74%), 6(4.84%) and 6(4.84%) patients remained positive after 2nd (in category I patients only) and third (in category II cases only), 5th and 7th month of treatment respectively. In conclusion, there is considerable treatment loser browse (4.84%) among our smear positive TB patients and this poses a great danger to wellness worry personnel and determination contacts in the community.Key words Pulmonary tuberculosis, prevalence, treatment failure.INTRODUCTION round dickens billion or nearly a third of the humans population is infected with mycobacterium tuberculosis.(1) The global prevalence of TB was an estimated 14 million, with 9.4 million incident cases and 1.3 million deaths among HIV-negative cases for the year 2009. (2) Eighty-five percent of the 9 million people infected with TB each year live in the ontogenesis countries. (2) Whereas mo re women of child bearing age die of Tuberculosis than from all causes of maternal mortality combined.(3) TB incidence has tripled in high HIV prevalence countries in the last two decades with a slight decline in 2009. Globally, in people upkeep with AIDS, one out of every four deaths is due to TB globally 380,000 people died of HIV associated TB in 2009. Persons co-infected with TB and HIV argon 20-30 times more likely to develop active TB affection than persons without HIV. Globally, 440,000 MDR TB cases were estimated in 2009 (8). thither are 27 high MDR TB shoot d avow countries contributing 86% of the MDR TB case burden. Pakistan falls on number 4 among these high MDR TB burden countries.(2) Currently Pakistan stands 5th amongst the 22 high TB burden countries which account for about 81 % of all estimated TB cases just about the globe. (4) Pakistan contributes about 63% of tuberculosis burden in the Eastern Mediterranean Region. According to WHO, the incidence of languor po sitive TB cases in Pakistan is 97/100,000 per year and for all types it is 231/100,000 or around 420,000 new cases each year. The prevalence of the disease is much higher and is estimated at 373/100,000 population or 670,000 cases.(5) TB is responsible for 5.1 percent of the total theme disease burden in Pakistan. The impact of TB on socio sparing status is substantial.(6) Sputum smear-positive patients are the most potent sources of infection and, without chem separateapy, sport poor outcomes, as about two-thirds of them die within 2-3 historic period of developing disease. (Ten years case fatality rate of HIV negative untreated smear positive pulmonary tuberculosis is 70%, while that for smear negative cases is 20%). (7)Non- consummation of treatment has serious consequences, including ongoing infectiousness and development of do drugs-resistant Mycobacterium tuberculosis. The problem of confrontation results from treatment that is inadequate, often because of an irregular dru g supply, conflicting regimens, or poor compliance. Drug resistance is a potential little terror to tuberculosis-control programs throughout the world. (8)Materials and methodsThe study was carried out in a tertiary care teaching hospital inPakistan. The research proposal was approved by the Ethics and Review Committee of the hospital. Informed consent was obtained from the patients. The hospital has a TB clinic which is supported by the content Tuberculosis Control design Pakistan. Laboratory services for sputum microscopy and the drug regimens are provided according to National Tuberculosis Control Programme protocol.Consecutive patients who presented at the TB clinic of the hospital with smear positive pulmonary tuberculosis were enrolled. Sociodemographic information such as age, sex, marital status and occupation were recorded. Patients of age less than 5 years were excluded.Before enrolling into the study, the patients were well informed about the consequences and potenti al predictors of treatment failure such as treatment compliance. Pretreatment sputum specimens were collected from each patient for acid fast bacilli (AFB) examination. Patients were categorized as New cases (category I) and Retreatment cases (category II) on the background of history of previous anti TB treatment. All patients were followed up to completion of eight months TB treatment. Sputum examinations were repeated at 2nd month (in case of category I only), 3rd month (in case of category II only), 5th month and 7th month of treatment. Data were entered and canvas using SPSS 16.0 version.ResultsA total of 144 patients were recruited during the study period (between February 2011 and October 2013). xx patients were either transferred out or lost to follow up. One 100 and twenty four patients who completed their treatment at the centre were evaluated. There were 93(75%) New cases (category I) and 31(25%) Retreatment cases (category II). There were 71 (57.26%) females and 53(4 2.74%) males aged between 14 and 85 years. Majority of the patients (47.58%) were aged supra 45 years with 6 patients above 80 years. Table 2 shows the age group distribution of sputum positive pulmonary TB patients on entry.Repeat sputum AFB results in study participants are presented in figure 1. Of the 124 patients who were sputum positive at baseline, 6 (4.84%) patients were AFB smear positive after 5 months therapy revealing the prevalence of treatment failure in these patients. Our study showed that TB affects mainly the mall and elderly age in our environment (47.58% of the patients managed were above age 45 years). This finding is also observed in some studies from the actual countries (9), temporary hookup in developing countries it affects mainly the young age group. (10) One fence may be the changing circumstances in the less developed countries and further large scale studies may highlight the issue. Greater parting of our study population was females which again is different from studies in our region. (10,11) Treatment failure rate among our patients was 4.84%. Though this is lower tthan describe in many studies we simmer down need to further improve it (The repossess rate of tuberculosis among kinsperson I patients in our study was more than the cure rate reported by studies from Bangalore (65.7%) and Tamil Nadu (75%). (12,13) The World Health Organization guidelines have recommended achieving cure rate of 85%. The smear positive TB patients pose a significant risk to members of the public, close relatives, and health care staff who treat these patients. They are the focus for infection control measures, and contact investigations. This type of patient must be isolated because of risk of transmitting microbes. Treatment failure increases the risk further. These are the cases where there are much chances of drug resistance including multidrug resistance and extended drug resistance. ((((All 3 failure patients who underwent DST testing had MDR-TB, while 3 of 22 of relapse patients and 0 of 5 default patients tried and true did. While these DST results were only available for three failure patients and, therefore, not representative, these data and those from other studies suggest that MDR risk is not uniform among retreatment subgroups, with increased prevalence of MDR among patients with initial treatment failure. (14-16) Drug resistance is a global health concern and effective programmatic therapy of the smear positive cases is one of the cornerstones in its prevention. Facilities for rapid detection of rifampicin resistance are being make available throughout the country which can help in early detection of drug resistant cases. Physicians involved in TB management need to be involved in its programmatic management and timely referrals for testing resistance in appropriate cases. Taken together, these findings support use of DST in all retreatment patients, anterior DST testing in those with clinical and microb iological indications of impending treatment failure, and use of second-line drugs for retreatment of patients with initial treatment failure until DST results are known.(17) Recently, total drug-resistant tuberculosis has been described in which some patients with TB infection were completely unresponsive to all TB drugs. This is a big blow to the global effect in control of TB. On the other hand, additional burdens of isolation and stigmatization on the patients are enormous. (18) Noncompliance to treatment, deficient patient knowledge/health education, drug quality, and other comorbidities like diabetes mellitus and HIV infection had been identified as major predictors of treatment failure in patients with TB. These factors were not considered in our study participants. According to observations made in many countries, only directly observed therapy is capable of amend treatment outcomes. (19-22) The effectiveness of the DOTS strategy is also confirmed by our own studies.In conc lusion, there is still considerable treatment failure rate among TB patients managed in our tuberculosis clinic. There is need for provision of quickness for sputum culture for detection of patients with drug resistant TB cases. Policies on the management of tuberculosis need to be reviewed and strengthened in rear to reduce open TB cases in the community.