Estimation of First Line Anti-Tubercular Drugs resistance and their genetic analysis by Geno Type MTBDRplus assay from an Intermediate Reference Laboratory in Eastern Uttar Pradesh, India

Abstract

Globally, drug-resistant tuberculosis is major public health issue. Multidrug-resistant tuberculosis (MDR-TB), especially resistant to first line drugs (isoniazid [INH] and rifampicin [RMP]), is one of the serious health concerns in India. As per annual India TB report 2022, 2.7% of total TB patients were infected with MDR-TB. Line probe assay (LPA)/GenoTypeMTBDRplus technique based on polymerase chain reaction is a rapid method for the detection of RMP and INH simultaneously. This cross-sectional prospective study includes 405 samples from suspected TB patients from 30.12.2021 to 13.05.2022. Samples were received from linked districts with Intermediate Reference Laboratory (IRL) for fluorescent microscopy (FM) and LPA testing through proper cold-chain under NTEP program and then subjected to FM. Only smear positive sample were subjected to LPA as per manufacturer instructions. Out of 405, a total of 261 samples were smear positive (64.4%). Among 261 samples processed for LPA, 255(97.7%) showed valid result and 6(2.3%) were found invalid. In LPA result, 227 (89.01%) were susceptible to both INH and RMP, 9(3.5%) had MDR-TB, 18(7.05%) shows INH mono resistance and 1(0.3%) shows RMP mono resistance. Patients with MDR-TB were prominent in younger age group (Mean±S.D; 29.6±5.7 vs. 36.6±17.8 years, p value = 0.004). Prevalence of MDR-TB cases is higher in our study than cases reported in annual TB report (2022) of India. LPA is proved highly accurate in rapid detection RMP resistant/MDR-TB cases. Early diagnosis may potentially enable earlier commencement of appropriate TB drugs and the reduction of transmission of MDR-TB and may possibly leading to the complete eradication of TB in India.