Clinico-demographic profile of pre-extensively drug-resistant pulmonary tuberculosis patients in India

Abstract

Drug-resistant tuberculosis (DR TB) is a major public health problem and an important area of research. Identification of various risk factors is essential for its prevention and management. Adults weighing more than 30 kg, aged 18 years or more diagnosed with pre extensively drug resistant TB (pre-XDR TB) were initiated on bedaquiline and linezolid based regimens along with pretomanid/delamanid as part of two multicentric clinical trials in India. Pre-XDR TB was defined as patients infected with M. tb strains resistant to rifampicin (may or may not be resistant to isoniazid) with additional resistance to fluoroquinolones and/or second line injectable as per the existing World Health Organization (WHO) definitions during the trial period. We describe here the baseline demographic and clinical profile of patients with pre-XDR TB and enrolled in those two trials. Of 554 Pre-XDR TB patients, 297 (54 %) were males. Median age (IQR) was 27 years [22.0–36.3] and body mass index was 17.4 [15.7–20.1] kg/m2. Of all, 326 (59 %) had BMI <18.5 kg/m2. History of previous episodes of TB was reported by 415 (75 %) patients. Among them, 142 (34 %) had taken treatment more than once, 279 (67 %) had treatment failure during the previous episodes. Persons with a known history of diabetes were 67 (12 %). Cough, cough with expectoration, fever and weight loss were the presenting complaints in 539 (97 %) and 487 (88 %), 337 (61 %) and 314 (57 %) respectively. Sputum smear microscopy showed more than ++ acid-fast bacilli in 264 (48 %). Chest x-ray showed bilateral lung involvement in 329 (60 %) with more than two zones involvement in 304 (55 %) and presence of cavities in 264 (48 %) patients. Persons in the younger age group, those with malnutrition and previous history of TB treatment were observed to be more in these cohort of patients with PreXDR TB. High rates of treatment failure during the earlier episodes of TB with increased disease severity and drug resistance during the current episode is a matter of grave concern. Improved treatment success during the management of drug sensitive TB, addressing the nutritional challenges are some of key areas of focus in the prevention of DRTB burden