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. 2024 May 6;19(5):e0301210.
doi: 10.1371/journal.pone.0301210. eCollection 2024.

Drug-resistant Mycobacterium tuberculosis among Nepalese patients at a tuberculosis referral center

Arun Bahadur Chand  1   2   3 , Ajaya Basnet  2 , Bhagwan Maharjan  3 , Ganesh Rai  2 , Yadav Prasad Joshi  4 , Lok Raj Bhatt  1 , Bindu Sen  5 , Shiba Kumar Rai  2   6
Affiliations

Drug-resistant Mycobacterium tuberculosis among Nepalese patients at a tuberculosis referral center

Arun Bahadur Chand et al. PLoS One. .

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB), characterized by isoniazid and rifampicin resistance, is caused by chromosomal mutations that restrict treatment options and complicate tuberculosis management. This study sought to investigate the prevalence of pre-extensively drug-resistant (pre-XDR) and extensively drug-resistant (XDR) tuberculosis, as well as mutation pattern, in Nepalese patients with MDR/rifampicin-resistant (RR)-TB strains.

Methods: A cross-sectional study was conducted on MDR/RR-TB patients at the German Nepal Tuberculosis Project from June 2017 to June 2018. The MTBDRsl line probe assay identified pre-XDR-TB and XDR-TB. Pre-XDR-TB included MDR/RR-TB with resistance to any fluoroquinolone (FLQ), while XDR-TB included MDR/RR-TB with resistance to any FLQ and at least one additional group A drug. Mutation status was determined by comparing bands on reaction zones [gyrA and gyrB for FLQ resistance, rrs for SILD resistance, and eis for low-level kanamycin resistance, according to the GenoType MTBDRsl VER 2.0, Hain Lifescience GmbH, Nehren, Germany definition of pre-XDR and XDR] to the evaluation sheet. SPSS version 17.0 was used for data analysis.

Results: Out of a total of 171 patients with MDR/RR-TB, 160 had (93.57%) had MTBC, of whom 57 (35.63%) had pre-XDR-TB and 10 (6.25%) had XDR-TB. Among the pre-XDR-TB strains, 56 (98.25%) were FLQ resistant, while 1 (1.75%) was SLID resistant. The most frequent mutations were found at codons MUT3C (57.14%, 32/56) and MUT1 (23.21%, 13/56) of the gyrA gene. One patient had SLID resistant genotype at the MUT1 codon of the rrs gene (100%, 1/1). XDR-TB mutation bands were mostly detected on MUT1 (30%, 3/10) of the gyrA and rrs, MUT3C (30%, 3/10) of the gyrA, and MUT1 (30%, 3/10) of the rrs.

Conclusions: Pre-XDR-TB had a significantly higher likelihood than XDR-TB, with different specific mutation bands present in gyrA and rrs genes.

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Conflict of interest statement

The authors have declared that no competing interests exist

Figures

Fig 1
Fig 1. Age and gender based distribution of the patients infected with M.
tuberculosis complex. In 160 MTBC positive cases, 91(56.88%) were male and 69(43.13%) were female participants. The highest number of male participants belonged to age 20–29 years whereas the age range for females was 20–29 years and 30–39 years.
Fig 2
Fig 2. Diagram shows the distribution of pre-XDR-TB and XDR-TB drug resistance cases.
This pie chart shows the prevalence of drug resistance patterns observed in cases of pre-XDR-TB and XDR-TB.
Fig 3
Fig 3. Pattern for pre-XDR-TB and XDR-TB cases.
This line chart shows the pattern of pre-XDR-TB and XDR-TB across the provinces of Nepal, highlighting the provinces with the highest and lowest prevalence rates of pre-XDR-TB and XDR-TB.
See this image and copyright information in PMC

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