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Tasra Bibi
Asim Aslam
Yasin Tipu
Tahir Yaqub
Gohar Iqbal
Adullah H Altemani
Adnan Alharbi
Mirza Rafiullah Baig
Amal K Sulaiman
Fiza Ayub
Tahir Mehmood Khan


Mycobacterium tuberculosis, Line probe assays (LPA), Gene X pert, rifampin, Resistance, fluoroquinolones.


Objective This study was aimed to detect the rate of positive cases in urban setting of Punjab along with MDR and XDR cases using LPA, GeneXpert and hematological profile.

Design: A cross-sectional study.

Setting: The study was conducted at the Punjab Aids Control Program. All sample were collected along with the socio-demographics characteristics of patients.

Main Outcome Measure: These samples undergo Microscopy, Culture, Gene X pert and LPA to confirmed microbiological status of patients. EDTA collected blood was tested for complete blood counts using hematology analyzer.

Results Out of 1335 positive samples confirmed by Culture, Microscopy, GeneXpert and LPA, 4.5% were resistant to rifampin and isoniazid while 3.5% were resistant to second line fluoroquinolones using LPA. 14.7% Neutropenia, 17% anemia and 5.54% thrombocytopenia were observed. ESR was high in all participants.

Conclusions: GeneXpert and LPA to be a fundamental diagnosis for the detection of MDR and XDR. LPA outperformed in detection of resistant of TB compared to GeneXpert. It is better than conventional culture in terms of resistance detection. Prevalence of anemia and neutropenia was high in patients with TB and other co-morbidity.

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1. Levinson, W. and E. Jawetz, Medical microbiology and immunology: examination and board review. 1996: Appleton & Lange.
2. Sotgiu, G., G. Sulis, and A. Matteelli, Tuberculosis—A world health organization perspective. Microbiology Spectrum, 2017. 5(1): p. 5.1. 25.
3. Migliori, G.B., et al., Clinical standards for the diagnosis, treatment and prevention of TB infection. The International Journal of Tuberculosis and Lung Disease, 2022. 26(3): p. 190-205.
4. Dua, K., et al., Multi-drug resistant Mycobacterium tuberculosis & oxidative stress complexity: Emerging need for novel drug delivery approaches. Biomedicine & Pharmacotherapy, 2018. 107: p. 1218-1229.
5. Christopher, P.M. and A. Widysanto, GeneXpert Mycobacterium tuberculosis/rifampicin assay for molecular epidemiology of rifampicin-Resistant Mycobacterium tuberculosis in an Urban Setting of Banten province, Indonesia. International journal of mycobacteriology, 2019. 8(4): p. 351.
6. Pradipta, I.S., et al., Risk factors of multidrug-resistant tuberculosis: A global systematic review and meta-analysis. 2018. 77(6): p. 469-478.
7. Ahmed, N., et al., Heavy Metal (Arsenic) Induced Antibiotic Resistance among Extended-Spectrum β-Lactamase (ESBL) Producing Bacteria of Nosocomial Origin. Pharmaceuticals, 2022. 15(11): p. 1426.
8. Rabaan, A.A., et al., Application of artificial intelligence in combating high antimicrobial resistance rates. Antibiotics, 2022. 11(6): p. 784.
9. Zeb, S., et al., Self-medication as an important risk factor for antibiotic resistance: a multi-institutional survey among students. Antibiotics, 2022. 11(7): p. 842.
10. Caminero, J.A., et al., Best drug treatment for multidrug-resistant and extensively drug-resistant tuberculosis. The Lancet infectious diseases, 2010. 10(9): p. 621-629.
11. Suárez, I., et al., The Diagnosis and Treatment of Tuberculosis. 2019. 116(43).
12. Janin, Y.L., Antituberculosis drugs: ten years of research. Bioorganic & medicinal chemistry, 2007. 15(7): p. 2479-2513.
13. Bahuguna, A. and D.S. Rawat, An overview of new antitubercular drugs, drug candidates, and their targets. Medicinal Research Reviews, 2020. 40(1): p. 263-292.
14. Sotgiu, G., E. Pontali, and G.B.J.E.R.J. Migliori, Linezolid to treat MDR-/XDR-tuberculosis: available evidence and future scenarios. 2015. 45(1): p. 25-29.
15. Salim, H., et al., Early and rapid microscopy-based diagnosis of true treatment failure and MDR-TB. The International Journal of Tuberculosis and Lung Disease, 2006. 10(11): p. 1248-1254.
16. Mechal, Y., et al., Evaluation of GeneXpert MTB/RIF system performances in the diagnosis of extrapulmonary tuberculosis. BMC infectious diseases, 2019. 19(1): p. 1-8.
17. Fitzgerald, D., T.R. Sterling, and D.W. Haas, Mycobacterium tuberculosis. 2005, Principles and practice of infectious diseases, 6th ed. Philadelphia ….
18. Acharya, B., et al., Advances in diagnosis of Tuberculosis: an update into molecular diagnosis of Mycobacterium tuberculosis. Molecular biology reports, 2020. 47(5): p. 4065-4075.
19. MacLean, E., et al., Advances in molecular diagnosis of tuberculosis. 2020. 58(10): p. e01582-19.
20. Rattan, A., A. Kalia, and N. Ahmad, Multidrug-resistant Mycobacterium tuberculosis: molecular perspectives. Emerging infectious diseases, 1998. 4(2): p. 195.
21. Morrison, J., M. Pai, and P.C.J.T.L.i.d. Hopewell, Tuberculosis and latent tuberculosis infection in close contacts of people with pulmonary tuberculosis in low-income and middle-income countries: a systematic review and meta-analysis. 2008. 8(6): p. 359-368.
22. Mahendradhata, Y., et al., Embedding operational research into national disease control programme: lessons from 10 years of experience in Indonesia. Global health action, 2014. 7(1): p. 25412.
23. Piatek, A.S., et al., GeneXpert for TB diagnosis: planned and purposeful implementation. Global Health: Science and Practice, 2013. 1(1): p. 18-23.
24. Gelaw, Y., et al., Anemia as a risk factor for tuberculosis: a systematic review and meta-analysis. 2021. 26(1): p. 1-15.
25. Abay, F., et al., Hematological abnormalities of pulmonary tuberculosis patients with and without HIV at the University of Gondar Hospital, Northwest Ethiopia: a comparative cross-sectional study. 2018. 2018.
26. Habib, S.S., et al., Gender-based differences in community-wide screening for pulmonary tuberculosis in Karachi, Pakistan: An observational study of 311 732 individuals undergoing screening. 2022. 77(3): p. 298-299.
27. Sudha, G., et al., Perceptions of gender and tuberculosis in a south Indian urban community. 2008. 55: p. 9-14.
28. Mphande-Nyasulu, F.A., et al., Prevalence of Tuberculosis (TB) including Multi drug resistant and Extensively resistant TB and underlying occupations, in Adults at Sirindhorn Hospital, Bangkok. 2022.
29. McLean, M.R., et al., An inflammatory story: antibodies in tuberculosis comorbidities. 2019. 10: p. 2846.
30. Alfaray, R.I., et al., Occupational Status and Educational Stage as a Valuable Factors Affecting Knowledge and Perception Level of Indonesian Tuberculosis Patient. 2021. 21(2).
31. Comstock, G.W.J.A.j.o.r. and c.c. medicine, Occupation and tuberculosis: questions that need answers. 1996. 154(3): p. 553-554.
32. Jagdish, R.K. and K.J.I.J.O.S.S. Samui, Assessment of Nutritional Status of Sputum Positive Pulmonary Tuberculosis Patients in a Medical College. 2019. 7(9): p. 41-47.
33. Zignol, M., et al., Global incidence of multidrug-resistant tuberculosis. 2006. 194(4): p. 479-485.
34. Khawbung, J.L., et al., Drug resistant tuberculosis: a review. 2021. 74: p. 101574.
35. Shibabaw, A., et al., The burden of pre-extensively and extensively drug-resistant tuberculosis among MDR-TB patients in the Amhara region, Ethiopia. 2020. 15(2): p. e0229040.
36. Demile, B., et al., Risk factors associated with multidrug-resistant tuberculosis (MDR-TB) in a tertiary armed force referral and teaching hospital, Ethiopia. 2018. 18(1): p. 1-10.
37. Abhimanyu, S., et al., The Role of Cartridge-Based Nucleic Acid Amplification Test (CBNAAT), Line Probe Assay (LPA), Liquid Culture, Acid-Fast Bacilli (AFB) Smear and Histopathology in the Diagnosis of Osteoarticular Tuberculosis. 2021. 55(1): p. 157-166.