Outcome of anti-tubercular therapy on rifampicin sensitive non-HIV patients with tubercular cervical lymphadenopathy in Bangladesh

Authors

  • Mahmud Asif Rifat Department of Ear, Nose, Throat and Head Neck Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh
  • M. Salahuddin Al Azad Department of Ear, Nose, Throat and Head Neck Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh
  • M. Anwarul Haque 50 Bed Ashuganj Upazilla Health Complex, Ashuganj, Bangladesh
  • M. Asaduzzaman Liton Department of ENT and Head Neck Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh
  • Nahiduzzaman Department of Ear, Nose, Throat and Head Neck Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20240052

Keywords:

TB, RIF, Sensitive, Resistant, Multidrug resistant

Abstract

Background: Tuberculosis (TB) remains a significant public health concern, particularly in developing countries like Bangladesh. The study aims to evaluate the outcomes of a six-month anti-tubercular therapy in rifampicin (RIF)-sensitive, non-HIV patients with tubercular cervical lymphadenopathy (TCL), and to challenge the conventional wisdom of extended treatment durations.

Methods: This retrospective observational study was conducted at Dhaka medical college, Dhaka, Bangladesh, from July 2019 to July 2023. A total of 189 patients diagnosed with TCL were included, adhering to specific inclusion and exclusion criteria. Various socio-demographic characteristics, clinical presentations, and treatment outcomes were analyzed.

Results: The majority of the participants were aged 15-30 (71.43%) and were female (68.25%). Fever was the most common clinical presentation, affecting 66.67% of the participants. After six months of therapy, 33.86% showed a complete response, and various clinical presentations were observed, with neck pain being the most common (11.64%). Among the 64 with complete response after 6 months, only 7.81% showed relapse at follow-up.

Conclusions: Our study suggests that a six-month treatment regimen can yield significant responses in TB patients. It challenges the prevailing notion that extended treatment durations are universally necessary. Treatment plans should be individualized, taking into account the clinical conditions of each patient, and should be advised by a clinician or a respected doctor.

References

Global tuberculosis report. 2020. Available at: https://www.who.int/publications-detail-redirect/9789240013131. Accessed on 18 June, 2023.

Glaziou P, Floyd K, Raviglione MC. Global Epidemiology of Tuberculosis. Semin Respir Crit Care Med. 2018;39(3):271-85.

Paul S, Akter R, Aftab A, Khan AM, Barua M, Islam S et al. Knowledge and attitude of key community members towards tuberculosis: mixed method study from BRAC TB control areas in Bangladesh. BMC Publ Heal. 2015;15:52.

Banu S, Rahman MT, Uddin MKM, Khatun R, Ahmed T, Rahman MM et al. Epidemiology of Tuberculosis in an Urban Slum of Dhaka City, Bangladesh. PLoS One. 2013;8(10):e77721.

Broughan JM, Judge J, Ely E, Delahay RJ, Wilson G, Clifton-Hadley RS et al. A review of risk factors for bovine tuberculosis infection in cattle in the UK and Ireland. Epidemiol Inf. 2016;144(14):2899-926.

Lackey B, Seas C, Van der Stuyft P, Otero L. Patient Characteristics Associated with Tuberculosis Treatment Default: A Cohort Study in a High-Incidence Area of Lima, Peru. PLoS One. 2015;10(6):e0128541.

Costa-Veiga A, Briz T, Nunes C. Unsuccessful treatment in pulmonary tuberculosis: factors and a consequent predictive model. Eur J Public Health. 2018;28(2):352-8.

Zager EM, McNerney R. Multidrug-resistant tuberculosis. BMC Infect Dis. 2008;8:10.

Pradipta IS, Forsman LD, Bruchfeld J, Hak E, Alffenaar JW. Risk factors of multidrug-resistant tuberculosis: A global systematic review and meta-analysis. J Infect. 2018;77(6):469-78.

Mesfin EA, Beyene D, Tesfaye A, Admasu A, Addise D, Amare M et al. Drug-resistance patterns of Mycobacterium tuberculosis strains and associated risk factors among multi drug-resistant tuberculosis suspected patients from Ethiopia. PLoS One. 2018;13(6):e0197737.

Nezenega ZS, Perimal-Lewis L, Maeder AJ. Factors Influencing Patient Adherence to Tuberculosis Treatment in Ethiopia: A Literature Review. Int J Environ Res Public Health. 2020;17(15):5626.

Atif M, Syed Sulaiman SA, Shafie AA, Asif M, Sarfraz MK, Low HC, et al. Impact of tuberculosis treatment on health-related quality of life of pulmonary tuberculosis patients: a follow-up study. Health Qual Life Outcomes. 2014;12:19.

Roy SC, Khanam PA, Ahmed BN, Islam MA, Huq AF, Saha MR. Assessment of Treatment Outcomes of Multidrug-Resistant Tuberculosis in Bangladeshi Population: A Retrospective Cohort Study. J Armed Forces Med College, Bangladesh. 2022;18(1):57-60.

Sultana R, Rahman M, Rahman M. Epidemiology and factors of tuberculosis treatment outcome, Bangladesh, 2012-13. Int J Community Med Publ Heal. 2022;9(1):100-4.

Heysell SK, Mpagama SG, Ogarkov OB, Conaway M, Ahmed S, Zhdanova S et al. Pharmacokinetic-Pharmacodynamic Determinants of Clinical Outcomes for Rifampin-Resistant Tuberculosis: A Multisite Prospective Cohort Study. Clin Infect Dis. 2023;76(3):497-505.

Barman TK, Roy S, Hossain MA, Bhuiyan GR, Abedin S. Clinical Presentation of Adult Pulmonary Tuberculosis (PTB): A Study of 103 Cases from a Tertiary Care Hospital. Mymensingh Med J. 2017;26(2):235–40.

Adisa R, Ayandokun TT, Ige OM. Knowledge about tuberculosis, treatment adherence and outcome among ambulatory patients with drug-sensitive tuberculosis in two directly-observed treatment centres in Southwest Nigeria. BMC Public Health. 2021;21(1):677.

Chen TC, Lu PL, Lin WR, Lin CY, Lin SH, Lin CJ et al. Diagnosis and treatment of pulmonary tuberculosis in hospitalized patients are affected by physician specialty and experience. Am J Med Sci. 2010;340(5):367-72.

Podlekareva DN, Folkvardsen DB, Skrahina A, Vassilenko A, Skrahin A, Hurevich H et al. Tuberculosis Drug Susceptibility, Treatment, and Outcomes for Belarusian HIV-Positive Patients with Tuberculosis: Results from a National and International Laboratory. Tuberc Res Treat. 2021;2021:6646239.

Chen RY, Via LE, Dodd LE, Walzl G, Malherbe ST, Loxton AG et al. Using biomarkers to predict TB treatment duration (Predict TB): a prospective, randomized, noninferiority, treatment shortening clinical trial. Gates Open Res. 2017;1:9.

Agizew T, Boyd R, Mathebula U, Mathoma A, Basotli J, Serumola C et al. Outcomes of HIV-positive patients with non-tuberculous mycobacteria positive culture who received anti-tuberculous treatment in Botswana: Implications of using diagnostic algorithms without non-tuberculous mycobacteria. PLoS One. 2020;15(6):e0234646.

Aljayyoussi G, Jenkins VA, Sharma R, Ardrey A, Donnellan S, Ward SA et al. Pharmacokinetic-Pharmacodynamic modelling of intracellular Mycobacterium tuberculosis growth and kill rates is predictive of clinical treatment duration. Sci Rep. 2017;7(1):502.

Mollalign H, Chala D, Beyene D. Clinical Features and Treatment Outcome of Coronavirus and Tuberculosis Co-Infected Patients: A Systematic Review of Case Reports. Infect Drug Resist. 2022;15:4037-46.

Chumovatov NV, Chernyh NA, Saharova GM, Antonov NS, Romanov VV, Ergeshov AE. Individual approach in treating patients with pulmonary and tracheobronchial tuberculosis, with a long history of tobacco smoking and decompensated diabetes mellitus. Ural Medical J. 2022;21(6):110-8.

Adjobimey M, Behr MA, Menzies D. Individualized Treatment Duration in Tuberculosis Treatment: Precision versus Simplicity. Am J Respir Crit Care Med. 2021;204(9):1013-4.

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Published

2024-01-25

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Original Research Articles