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Multi drug Resistant Tuberculosis

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MDR-TB, defined as resistance to the two most important drugs, isoniazid (INH) ... one is treated for culture on Lowenstein Jensen media and stone brink media. ... – PowerPoint PPT presentation

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Title: Multi drug Resistant Tuberculosis


1
Multi drug Resistant Tuberculosis
National Tuberculosis Control Programme
2
Multi drug Resistant Tuberculosis
MDR-TB, defined as resistance to the two most
important drugs, isoniazid (INH) and rifampicin
(RMP), is a potential threat to tuberculosis
control. Patients infected with strains resistant
to multiple drugs are extremely difficult to
cure, and the necessary treatment is much more
toxic and expensive.
3
Drug resistance survey, Egypt (Pilot phase March
2000) (Extension phase March 2001)
4
Drug resistance survey, Egypt
  • Technical Steps
  • At the Peripheral lab.
  • 3 samples are taken from each patient.
  • Prepare and examine 2 samples after straining
    with Z.N.
  • The samples should be identified on the container
    as well as the cover and the code number of the
    patient is written on the containers.
  • Code number governorate/ Chest clinic /No. on
    the special register of the survey.
  • 2 samples from each positive case are sent to the
    intermediate lab with the questionnaire and
    special request form for culture.

5
Drug resistance survey, Egypt
  • At the Intermediate lab.
  • A Z.N film from each sputum sample is examined
  • One of sample is kept in the refrigerator and the
    second one is treated for culture on Lowenstein
    Jensen media and stone brink media.
  • Positive cultures are sent to the C.L in ice box
    with the questionnaire and request for
    sensitivity test.

6
Drug resistance survey, Egypt
  • At the Central Lab
  • Questionnaire is checked for the previous items.
  • All the samples are registered in the Lab.
    register serially.
  • Identification of the isolate is done using
    niacin test by strips and catalase test.
  • Sensitivity tests is done by proportional method
  • External quality control, all resistant strains
    and percentage of sensitive strains (10-15) are
    sent to the SRL.

7
Drug resistance survey, Egypt (Pilot phase March
2000)
  • WHO Recommended methodology
  • Duration survey March 2000-July 2000
  • Sample site Chest Clinics Cairo and Giza
  • Validation patient category questionnaire
    (before start treatment)
  • Culture Identification Susceptibility
  • Quality control with international reference lab

8
Results table -1-
9
Results table -2-
10
Drug resistance survey, Egypt (Extension phase
March 2001)
Aim This study aims at assessing the magnitude
of Multi Drug Resistant(MDR) Problem as a step to
put a strategy to overcome this problem
11
Drug resistance survey, Egypt (Extension phase
March 2001)
  • Objectives
  • Identification of the prevalent resistant types
    of bacilli.
  • Epidemiological features of MDR cases.
  • To update the intermediate lab.Capabilities both
    equipment and personnel to be able to identify
    strains

12
Drug resistance survey, Egypt (Extension phase
March 2001)
  • Methodology
  • 18 governorates have been selected on basis of
    number of new smear ve cases attending the
    clinics en each governorates(the number of
    attendants should not be les than 100
    patients/year)
  • It expected that the Central Lab.to handle
    1500-1800 sensitivity tests during 12months of
    continuous work
  • The first 100 new smear ve case in each
    governorate will be enrolled in the study.

13
Drug resistance survey, Egypt (Extension phase
March 2001)
14
Drug resistance survey, Egypt (Extension phase
March 2001)
New Cases
Old Cases
15
New Cases
Total Number Tested 389 Total Sensitivity
286 73.5 Resistance to one drug
16
New Cases
Multiple drug Resistance
17
Chronic Cases
Total Number Tested 149 Total Sensitivity
41 27.5 Resistance to one drug
18
Old Cases
Multiple drug Resistance
19
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