568. A Pilot Study on Epidemiology of Drug Resistant Tuberculosis Among in Sub-Himalayan Valley of Himachal Pradesh, India – A Large Unmet Gap
Session: Poster Abstract Session: TB: Multidrug Resistant TB
Thursday, October 8, 2015
Room: Poster Hall
Background: Tuberculosis (TB) is a major public health problem in India. The data on actual burden of TB and drug resistance from the rural sub-Himalayan valley in India is limited. This is the first hospital based study conducted to describe the epidemiology and burden of drug resistant tuberculosis in Manali town of Himachal Pradesh, India.

Methods: This is an observational retrospective cohort study done at Lady Willingdon Hospital (LWH), 50 bedded, not-for-profit, secondary care hospital. All adult TB cases from 1st January 2012 to 31st May, 2014 were included. Drug susceptibility testing was done on solid culture medium. Paired t-test and chi-square with 95%CI have been used to assess the statistical significance at the level of ɑ <0.05.

Results: 247 adult patients were enrolled. Clinical characteristics are outline in table 1. Incidence of PTB was significantly higher among males than females (70% versus 53%, P<0.009, OR=2.0). The mean age of EPTB group was significantly lower than PTB group (41.9 ±17.2 years and 32.8 ± 13.3 years, 95%CI 5.1 – 13.3). Drug susceptibility testing on 11 cases showed resistance to INH + Rifampicin and INH + Rifampicin + Ethambutol + Aminoglycoside were 9.1% and 18.2% respectively. All patients received once daily anti-tubercular therapy. 

Conclusion: There is a large burden of pulmonary tuberculosis especially among young males in this sub-Himalayan valley. The possibility of high prevalence of multi-drug resistant tuberculosis cannot be excluded. Hence there is an urgent need for implementation of point-of-care rapid molecular based testing and patient-centered counseling to improve adherence.

 

Characteristics

Sputum +ve TB

(N=104)

Sputum –ve PTB

(N=49)

EPTB

(N=94)

Age (yrs)

42.6 (17.9)

40.7 (15.8)

32.8 (28.5)

Weight (Kg)

46.6 (8.9)

47.9 (8.9)

50.6 (10.9)

Gender

Male

64 (61.5)

27 (55.1)

39 (41.5)

Female

40 (38.5)

22 (44.9)

55 (58.5)

Duration of treatment

Up to 6 months

54 (52.9)

32 (66.7)

64 (69.6)

6-12 months

40 (39.2)

13 (27.1)

23 (25)

>12 months

8 (7.8)

3 (6.2)

5 (5.4)

Treatment regimen

HRZE

62 (59.6)

35 (72.9)

74 (78.7)

HRZES

22 (21.2)             

6 (12.5)

11 (11.7)

Other

20 (19.2)

7 (14.6)

9 (9.6)

Outcome

Cured

67 (64.4)

31 (63.3)

53 (56.4)

Lost to follow up

27 (26.0)

17 (34.7)

31 (33.0)

Transferred out

4 (3.8)

1 (2.0)

10 (10.6)

Expired

6 (2.5)

0

0

Shubhanker Mitra, MD - Medicine1, Pradeep Zechariah, MBBS2, Philip Alexander, MS - Surgery3 and Anna Alexander, MD - Medicine3, (1)Medicine, Christian Medical College, Vellore, Vellore, India, (2)Medicine, Lady Willingdon Hospital, Kullu, India, (3)Lady Willingdon Hospital, Kullu, India

Disclosures:

S. Mitra, None

P. Zechariah, None

P. Alexander, None

A. Alexander, None

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