First Susceptibility Testing of Mycobacterium tuberculosis for Second-line Anti-tuberculosis Drugs in Ghana
Identifieur interne : 000509 ( Pmc/Corpus ); précédent : 000508; suivant : 000510First Susceptibility Testing of Mycobacterium tuberculosis for Second-line Anti-tuberculosis Drugs in Ghana
Auteurs : Tomoko Kato ; Kennedy Kwasi Addo ; Naomi Nartey ; Alexander Kwadwo Nyarko ; Frank Adae Bonsu ; Satoshi MitaraiSource :
- Tropical Medicine and Health [ 1348-8945 ] ; 2014.
Abstract
We performed drug susceptibility testing on first- and second-line drugs in
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DOI: 10.2149/tmh.2013-16
PubMed: 24808747
PubMed Central: 3965846
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">First Susceptibility Testing of <italic>Mycobacterium tuberculosis</italic> for Second-line Anti-tuberculosis Drugs in Ghana</title><author><name sortKey="Kato, Tomoko" sort="Kato, Tomoko" uniqKey="Kato T" first="Tomoko" last="Kato">Tomoko Kato</name><affiliation><nlm:aff id="aff1">Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Tokyo, Japan</nlm:aff></affiliation></author><author><name sortKey="Addo, Kennedy Kwasi" sort="Addo, Kennedy Kwasi" uniqKey="Addo K" first="Kennedy Kwasi" last="Addo">Kennedy Kwasi Addo</name><affiliation><nlm:aff id="aff2">Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana</nlm:aff></affiliation></author><author><name sortKey="Nartey, Naomi" sort="Nartey, Naomi" uniqKey="Nartey N" first="Naomi" last="Nartey">Naomi Nartey</name><affiliation><nlm:aff id="aff2">Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana</nlm:aff></affiliation></author><author><name sortKey="Nyarko, Alexander Kwadwo" sort="Nyarko, Alexander Kwadwo" uniqKey="Nyarko A" first="Alexander Kwadwo" last="Nyarko">Alexander Kwadwo Nyarko</name><affiliation><nlm:aff id="aff2">Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana</nlm:aff></affiliation></author><author><name sortKey="Bonsu, Frank Adae" sort="Bonsu, Frank Adae" uniqKey="Bonsu F" first="Frank Adae" last="Bonsu">Frank Adae Bonsu</name><affiliation><nlm:aff id="aff3">National Tuberculosis Programme, Ghana Health Service, Ghana</nlm:aff></affiliation></author><author><name sortKey="Mitarai, Satoshi" sort="Mitarai, Satoshi" uniqKey="Mitarai S" first="Satoshi" last="Mitarai">Satoshi Mitarai</name><affiliation><nlm:aff id="aff1">Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Tokyo, Japan</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24808747</idno><idno type="pmc">3965846</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3965846</idno><idno type="RBID">PMC:3965846</idno><idno type="doi">10.2149/tmh.2013-16</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000509</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000509</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">First Susceptibility Testing of <italic>Mycobacterium tuberculosis</italic> for Second-line Anti-tuberculosis Drugs in Ghana</title><author><name sortKey="Kato, Tomoko" sort="Kato, Tomoko" uniqKey="Kato T" first="Tomoko" last="Kato">Tomoko Kato</name><affiliation><nlm:aff id="aff1">Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Tokyo, Japan</nlm:aff></affiliation></author><author><name sortKey="Addo, Kennedy Kwasi" sort="Addo, Kennedy Kwasi" uniqKey="Addo K" first="Kennedy Kwasi" last="Addo">Kennedy Kwasi Addo</name><affiliation><nlm:aff id="aff2">Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana</nlm:aff></affiliation></author><author><name sortKey="Nartey, Naomi" sort="Nartey, Naomi" uniqKey="Nartey N" first="Naomi" last="Nartey">Naomi Nartey</name><affiliation><nlm:aff id="aff2">Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana</nlm:aff></affiliation></author><author><name sortKey="Nyarko, Alexander Kwadwo" sort="Nyarko, Alexander Kwadwo" uniqKey="Nyarko A" first="Alexander Kwadwo" last="Nyarko">Alexander Kwadwo Nyarko</name><affiliation><nlm:aff id="aff2">Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana</nlm:aff></affiliation></author><author><name sortKey="Bonsu, Frank Adae" sort="Bonsu, Frank Adae" uniqKey="Bonsu F" first="Frank Adae" last="Bonsu">Frank Adae Bonsu</name><affiliation><nlm:aff id="aff3">National Tuberculosis Programme, Ghana Health Service, Ghana</nlm:aff></affiliation></author><author><name sortKey="Mitarai, Satoshi" sort="Mitarai, Satoshi" uniqKey="Mitarai S" first="Satoshi" last="Mitarai">Satoshi Mitarai</name><affiliation><nlm:aff id="aff1">Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Tokyo, Japan</nlm:aff></affiliation></author></analytic><series><title level="j">Tropical Medicine and Health</title><idno type="ISSN">1348-8945</idno><idno type="eISSN">1349-4147</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>We performed drug susceptibility testing on first- and second-line drugs in <italic>Mycobacterium tuberculosis</italic> (<italic>M. tuberculosis</italic>) for the first time in Ghana to obtain preliminary data on drug-resistant tuberculosis. Of 21 isolates (4 new cases and 17 treated cases), 5 (23.8%) were multi-drug resistant tuberculosis (MDR-TB) and 19 (90.5%) were resistant to at least one drug, but no extensively drug-resistant TB (XDR-TB) was identified. Since the target patients were Category II, IV or smear positive at follow-up microscopy, it is understandable that there were many drug-resistant TB cases. Six isolates were resistant to one or two second-line drugs, but the second-line drugs were not approved in Ghana. It is considered that the bacilli were imported from abroad. Preventing the import of drug-resistant TB bacilli is probably one of best ways to control TB in Ghana.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Forson, A" uniqKey="Forson A">A Forson</name></author><author><name sortKey="Kudzawu, S" uniqKey="Kudzawu S">S Kudzawu</name></author><author><name sortKey="Kwara, A" uniqKey="Kwara A">A Kwara</name></author><author><name sortKey="Flanigan, T" uniqKey="Flanigan T">T Flanigan</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Zignol, M" uniqKey="Zignol M">M Zignol</name></author><author><name sortKey="Van Gemert, W" uniqKey="Van Gemert W">W van Gemert</name></author><author><name sortKey="Falzon, D" uniqKey="Falzon D">D Falzon</name></author><author><name sortKey="Sismanidis, C" uniqKey="Sismanidis C">C Sismanidis</name></author><author><name sortKey="Glaziou, P" uniqKey="Glaziou P">P Glaziou</name></author><author><name sortKey="Floyd, K" uniqKey="Floyd K">K Floyd</name></author><author><name sortKey="Raviglione, M" uniqKey="Raviglione M">M Raviglione</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Trop Med Health</journal-id><journal-id journal-id-type="iso-abbrev">Trop Med Health</journal-id><journal-id journal-id-type="publisher-id">TMH</journal-id><journal-title-group><journal-title>Tropical Medicine and Health</journal-title></journal-title-group><issn pub-type="ppub">1348-8945</issn><issn pub-type="epub">1349-4147</issn><publisher><publisher-name>The Japanese Society of Tropical Medicine</publisher-name><publisher-loc>Nagasaki, Japan</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24808747</article-id><article-id pub-id-type="pmc">3965846</article-id><article-id pub-id-type="publisher-id">tmh-2013-16</article-id><article-id pub-id-type="doi">10.2149/tmh.2013-16</article-id><article-categories><subj-group subj-group-type="heading"><subject>Short Communication</subject></subj-group></article-categories><title-group><article-title>First Susceptibility Testing of <italic>Mycobacterium tuberculosis</italic> for Second-line Anti-tuberculosis Drugs in Ghana</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kato</surname><given-names>Tomoko</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Addo</surname><given-names>Kennedy Kwasi</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Nartey</surname><given-names>Naomi</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Nyarko</surname><given-names>Alexander Kwadwo</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Bonsu</surname><given-names>Frank Adae</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Mitarai</surname><given-names>Satoshi</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib></contrib-group><aff id="aff1"><label>1</label>Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Tokyo, Japan</aff><aff id="aff2"><label>2</label>Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana</aff><aff id="aff3"><label>3</label>National Tuberculosis Programme, Ghana Health Service, Ghana</aff><author-notes><corresp id="cor1"><label>*</label>Corresponding author: Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, 3-1-24, Matsuyama, Kiyose, Tokyo 204-8533, Japan Tel: +81 42 493 5711 Fax: +81 42 492 4600 E-mail: dumbo22boko22@gmail.com</corresp></author-notes><pub-date pub-type="ppub"><month>3</month><year>2014</year></pub-date><pub-date pub-type="epub"><day>4</day><month>2</month><year>2014</year></pub-date><volume>42</volume><issue>1</issue><fpage>53</fpage><lpage>55</lpage><history><date date-type="received"><day>20</day><month>5</month><year>2013</year></date><date date-type="accepted"><day>24</day><month>9</month><year>2013</year></date></history><permissions><copyright-statement>© 2014 Japanese Society of Tropical Medicine</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access"><license-p>This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>We performed drug susceptibility testing on first- and second-line drugs in <italic>Mycobacterium tuberculosis</italic> (<italic>M. tuberculosis</italic>) for the first time in Ghana to obtain preliminary data on drug-resistant tuberculosis. Of 21 isolates (4 new cases and 17 treated cases), 5 (23.8%) were multi-drug resistant tuberculosis (MDR-TB) and 19 (90.5%) were resistant to at least one drug, but no extensively drug-resistant TB (XDR-TB) was identified. Since the target patients were Category II, IV or smear positive at follow-up microscopy, it is understandable that there were many drug-resistant TB cases. Six isolates were resistant to one or two second-line drugs, but the second-line drugs were not approved in Ghana. It is considered that the bacilli were imported from abroad. Preventing the import of drug-resistant TB bacilli is probably one of best ways to control TB in Ghana.</p></abstract><kwd-group><kwd>Ghana</kwd><kwd>Drug susceptibility testing</kwd><kwd>MDR/XDR-TB</kwd><kwd>second-line drugs</kwd></kwd-group></article-meta></front><body><sec sec-type="introduction"><title>Introduction</title><p>The Republic of Ghana is a west African country with a population of 23 million [<xref rid="B1" ref-type="bibr">1</xref>]. The incidence of tuberculosis (TB) declined from 231 in 2000 to 106 per 100,000 in 2010 [<xref rid="B2" ref-type="bibr">2</xref>]. Since human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) prevalence is not very high (89/100,000, 2007) [<xref rid="B1" ref-type="bibr">1</xref>], TB incidence has also remained low compared to other sub-Saharan African countries such as Nigeria and Kenya [<xref rid="B3" ref-type="bibr">3</xref>, <xref rid="B4" ref-type="bibr">4</xref>].</p><p>Drug resistant TB is difficult to treat. That is especially true for MDR-TB, which is resistant to isoniazid (INH) and rifampicin (RIF), the two major bactericidal anti-TB drugs. Any drug(s) to which the bacilli show resistance must be replaced to avoid creating further drug resistance and to ensure successful treatment results. Therefore, it is important to determine the susceptibility of <italic>M. tuberculosis</italic> to various anti-TB drugs.</p><p>Approval for the purchase and use of second-line drugs by the Green Light Committee was in the pipeline as of 2011, meaning that MDR-TB patients cannot readily receive treatment. The main concern is to implement proper measures to avoid the emergence of XDR-TB, which is defined as resistance of <italic>M. tuberculosis</italic> to INH and RIF as well as any fluoroquinolone and at least one of the injectable anti-TB drugs (such as amikacin (AMK), kanamycin (KM) and capreomycin (CPM)). One such measure to ensure is that the central TB laboratory has the capacity to perform second-line drug susceptibility testing.</p><p>In this study, therefore, we performed first- and second-line drug susceptibility testing on the isolates from previously treated TB patients to obtain preliminary data on MDR/XDR-TB.</p></sec><sec sec-type="materials|methods"><title>Materials and Methods</title><sec><title>Specimen collection</title><p>The targeted patients were under WHO category II regimen or smear positive in follow-up microscopy at 2, 4, 5, 6, 8 and 9 months, including some new TB patients with positive smear as a reference. The category classification was at the time of study. Sputum specimens were collected from Kaneshie Polyclinic (33 specimens), Korle-bu teaching hospital (24 specimens), La General Hospital (19 specimens), Nsawam Government Hospital (6 specimens), and one patient who came directly to the Noguchi Memorial Institute for Medical Research. Specimens were collected between 2008 and 2009. Collected specimens were stored in a refrigerator from 1–7 days and transported to the laboratory in a cooler box.</p></sec><sec><title>Isolation of <italic>M. tuberculosis</italic> and drug susceptibility testing</title><p>Sputum was collected in a 50-mL centrifuge tube and kept in a refrigerator until inoculation. It was decontaminated with 4% NaOH and inoculated on 2% Kudo medium. The recovered <italic>M. tuberculosis</italic> colonies were then sub-cultured in Middlebrook 7H9 (Becton Dickinson) broth to obtain the bacterial suspension at OD 0.2 (530 nm). Recovered bacilli were tested with Capilia TB (TOUNS, Numazu, Japan) to identify <italic>Mycobacterium tuberculosis</italic> complex (MTC). The drug susceptibility testing (DST) was performed by the standard proportion method on Lowenstein-Jensen (L-J) medium. In short, each bacterial suspension was diluted by 1/100 and inoculated on L-J medium containing each anti-tuberculosis drug. For control, bacilli diluted by 1/100 and 1/10,000 were inoculated on drug-free L-J medium. The drugs and concentrations used for DST were INH (0.2 µg/mL), RIF (40 µg/mL), streptomycin (SM) (4 µg/mL), ethambutol (EB) (2 µg/mL), KM (30 µg/mL), AMK (40 µg/mL), CPM (40 µg/mL), ethionamide (ETH) (20 µg/mL), para-aminosalicylic acid (PAS) (1 µg/mL), cycloserine (CS) (40 µg/mL) and levofloxacin (LVFX) (1 µg/mL). The initial reading was done after 4 weeks and the final at 6 weeks. The colonies were counted and determined as resistant when more colonies were observed on the drug-containing medium than on the 1/10,000 control.</p></sec><sec><title>Ethical consideration</title><p>The research protocol was approved by the Ethics Committee of the Noguchi Memorial Institute for Medical Research (NMIMR – IRB CPN 003/04-05). Each sputum specimen was collected after obtaining written informed consent from the patients.</p></sec></sec><sec sec-type="results"><title>Results</title><p>A total of 83 sputum specimens were collected from 62 males, 18 females and 3 people of unknown gender. The mean age was 42.0 ± 12.0 for males and 33.6 ± 16.6 for females. The number of specimens from WHO category I, II and IV were 60, 15 and 3, respectively.</p><p>Of the 83 specimens, 39 were culture positive (35 MTC and 4 non-tuberculous mycobacteria), 40 were culture negative and 4 were contaminated. Thirty-five culture positive MTC samples were then sub-cultured in Middlebrook 7H9 broth for DST. However, 14 samples did not grow sufficiently. Finally, 21 isolates were subjected to DST.</p><p>The DST results are shown in Table <xref ref-type="table" rid="T1">1</xref>. Of 21 <italic>M. tuberculosis</italic> complex isolates, 5 (23.8%) were MDR-TB, 19 (90.5%) were resistant to at least one drug, and 17 (81.0%) were resistant to SM. As for the second-line drug 6, one strain each was resistant to ETH CPM and LVFX. However, no isolate was resistant to KM, AMK, PAS or CS and no isolate belonged to the category of XDR-TB.</p></sec><sec sec-type="discussion"><title>Discussion</title><p>Of the 83 specimens, 40 (48.2%) were culture negative. Although all specimen used in this study were smear positive, some patients may have been carrying dead bacilli because most of the patients were under treatment. The duration of sample collection and inoculation did not affect the recovery. But it is possible that a power disruption occurred during storage at the clinic. It cannot be denied that the condition of sample storage may affect the recovery ratio. It is understandable that there are many drug-resistant TB cases because the target patients were Category II, IV or smear positive at follow-up microscopy. We found many isolates resistant to SM as compared to other drugs. Although we suspected the inactivation of the drug, a similar result was reported by Forson et al. [<xref rid="B5" ref-type="bibr">5</xref>]. Since second-line drugs were not approved in Ghana at the time of the study, second-line drug-resistant TB bacilli may have been imported from abroad because as the second-line anti-TB drugs, in general, cannot be found in private pharmacies or hospitals in Ghana. Fortunately, no XDR-TB was detected in this study. However, the total number of collected specimens was low because most of the patients who came to the hospitals were new cases and we could not obtain a large number of retreatment cases. If more samples are collected in future studies, it may be possible to detect XDR-TB cases. In this study, the specimens with numbers 056, 066 and 074 were identified as MDR-TB by MGIT 960 at a different laboratory, but one was not MDR-TB. This may be due to a difference in methods used by the two laboratories.</p><p>In conclusion, it was indicated that some second-line drug-resistant TB bacilli may be imported from abroad. Since XDR-TB is prevalent in neighboring countries [<xref rid="B6" ref-type="bibr">6</xref>, <xref rid="B7" ref-type="bibr">7</xref>], preventing the import of drug-resistant TB is probably one of best ways to control TB in Ghana.</p></sec></body><back><ack><title>Acknowledgement</title><p>The authors gratefully acknowledge the excellent administrative support by Noguchi Memorial Institute for Medical Research and Professor Nobuo Ohta at Tokyo Medical Dental University. We thank Dr. Audrey Forson and Mr. Samuel Kudzawu at Korle-Bu teaching hospital for assisting in sample collection. Mr. Samuel Ofori Addo contributed as a laboratory assistant during the study. The study was supported by a grant from the Ministry of Education, Culture, Sports, Science and Technology, Japan.</p></ack><ref-list><title>References</title><ref id="B1"><label>1</label><mixed-citation publication-type="other" publisher-type="web">Ghana Factsheets of Health Statistics 2010. World Health Organization. Available at <ext-link ext-link-type="uri" xlink:href="http://www.afro.who.int/en/ghana/country-health-profile.html">http://www.afro.who.int/en/ghana/country-health-profile.html</ext-link></mixed-citation></ref><ref id="B2"><label>2</label><mixed-citation publication-type="other" publisher-type="web">WHO Report 2011. Global Tuberculosis Control. World Health Organization. Available at <ext-link ext-link-type="uri" xlink:href="http://apps.who.int/iris/bitstream/10665/44728/1/9789241564380_eng.pdf">http://apps.who.int/iris/bitstream/10665/44728/1/9789241564380_eng.pdf</ext-link></mixed-citation></ref><ref id="B3"><label>3</label><mixed-citation publication-type="other" publisher-type="web">GLOBAL AIDS RESPONSE, Country Progress Report, Nigeria GARPR 2012. UNSIFD. Available at <ext-link ext-link-type="uri" xlink:href="http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/Nigeria%202012%20GARPR%20Report%20Revised.pdf">http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/Nigeria%202012%20GARPR%20Report%20Revised.pdf</ext-link></mixed-citation></ref><ref id="B4"><label>4</label><mixed-citation publication-type="other" publisher-type="web">The Kenya AIDS epidemic update 2011, UNAIDS. Available at <ext-link ext-link-type="uri" xlink:href="http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/ce_KE_Narrative_Report.pdf">http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/ce_KE_Narrative_Report.pdf</ext-link></mixed-citation></ref><ref id="B5"><label>5</label><mixed-citation publication-type="journal" publisher-type="journal"><person-group person-group-type="author"><name><surname>Forson</surname><given-names>A</given-names></name><name><surname>Kudzawu</surname><given-names>S</given-names></name><name><surname>Kwara</surname><given-names>A</given-names></name><name><surname>Flanigan</surname><given-names>T</given-names></name></person-group><article-title>High Frequency of First-Line Anti-Tuberculosis Drug Resistance among Persons with Chronic Pulmonary Tuberculosis at a Teaching Hospital Chest Clinic</article-title>. <source>Ghana Med J</source><year>2010</year>; <volume>44</volume>: <fpage>42</fpage>–<lpage>46</lpage><pub-id pub-id-type="pmid">21327002</pub-id></mixed-citation></ref><ref id="B6"><label>6</label><mixed-citation publication-type="other" publisher-type="web">Stop TB Department, World Health Organization. Frequently asked questions - XDR-TB. Geneva, Switzerland, 2012. Available at <ext-link ext-link-type="uri" xlink:href="http://www.who.int/tb/challenges/xdr/faqs/en/index.html">http://www.who.int/tb/challenges/xdr/faqs/en/index.html</ext-link> (last accessed 31 August 2012).</mixed-citation></ref><ref id="B7"><label>7</label><mixed-citation publication-type="journal" publisher-type="journal"><person-group person-group-type="author"><name><surname>Zignol</surname><given-names>M</given-names></name><name><surname>van Gemert</surname><given-names>W</given-names></name><name><surname>Falzon</surname><given-names>D</given-names></name><name><surname>Sismanidis</surname><given-names>C</given-names></name><name><surname>Glaziou</surname><given-names>P</given-names></name><name><surname>Floyd</surname><given-names>K</given-names></name><name><surname>Raviglione</surname><given-names>M</given-names></name></person-group><article-title>Surveillance of anti-tuberculosis drug resistance in the world: an updated analysis, 2007–2010</article-title>. <source>Bull World Health Organ</source><year>2012</year>; <volume>90</volume>: <fpage>111</fpage>–<lpage>119</lpage>D.<pub-id pub-id-type="pmid">22423162</pub-id></mixed-citation></ref></ref-list></back><floats-group><table-wrap id="T1" orientation="portrait" position="float"><label>Table 1.</label><caption><p>Result of DST of <italic>M. tuberculosis</italic> isolated in Ghana.</p></caption><table frame="hsides" rules="groups"><thead><tr><th rowspan="2" colspan="1"></th><th rowspan="1" colspan="1">Drug</th><th rowspan="1" colspan="1">INH</th><th rowspan="1" colspan="1">RFP</th><th rowspan="1" colspan="1">SM</th><th rowspan="1" colspan="1">EB</th><th rowspan="1" colspan="1">KM</th><th rowspan="1" colspan="1">AMK</th><th rowspan="1" colspan="1">CPM</th><th rowspan="1" colspan="1">TH</th><th rowspan="1" colspan="1">PAS</th><th rowspan="1" colspan="1">CS</th><th rowspan="1" colspan="1">LVFX</th><th rowspan="2" colspan="1">Status</th></tr><tr><th rowspan="1" colspan="1">(µg/mL)</th><th rowspan="1" colspan="1">0.2</th><th rowspan="1" colspan="1">40</th><th rowspan="1" colspan="1">4</th><th rowspan="1" colspan="1">2</th><th rowspan="1" colspan="1">30</th><th rowspan="1" colspan="1">40</th><th rowspan="1" colspan="1">40</th><th rowspan="1" colspan="1">20</th><th rowspan="1" colspan="1">1</th><th rowspan="1" colspan="1">40</th><th rowspan="1" colspan="1">1</th></tr></thead><tbody><tr><td rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1">NSW2</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Cat I</td></tr><tr><td rowspan="1" colspan="1">2</td><td rowspan="1" colspan="1">KB3</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Cat II</td></tr><tr><td rowspan="1" colspan="1">3</td><td rowspan="1" colspan="1">KB12</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Cat II</td></tr><tr><td rowspan="1" colspan="1">4</td><td rowspan="1" colspan="1">KB16</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Cat II</td></tr><tr><td rowspan="1" colspan="1">5</td><td rowspan="1" colspan="1">KB17</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Identified as MDR-TB at PHL*</td></tr><tr><td rowspan="1" colspan="1">6</td><td rowspan="1" colspan="1">KB18</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Identified as MDR-TB at PHL</td></tr><tr><td rowspan="1" colspan="1">7</td><td rowspan="1" colspan="1">KB20</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Identified as MDR-TB at PHL</td></tr><tr><td rowspan="1" colspan="1">8</td><td rowspan="1" colspan="1">056</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Identified as MDR-TB at PHL</td></tr><tr><td rowspan="1" colspan="1">9</td><td rowspan="1" colspan="1">066</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Identified as MDR-TB at PHL</td></tr><tr><td rowspan="1" colspan="1">10</td><td rowspan="1" colspan="1">074</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td rowspan="1" colspan="1">Identified as MDR-TB at PHL</td></tr><tr><td rowspan="1" colspan="1">11</td><td rowspan="1" colspan="1">KN14</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Cat I</td></tr><tr><td rowspan="1" colspan="1">12</td><td rowspan="1" colspan="1">KN17</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Cat I</td></tr><tr><td rowspan="1" colspan="1">13</td><td rowspan="1" colspan="1">KN26</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Cat I</td></tr><tr><td rowspan="1" colspan="1">14</td><td rowspan="1" colspan="1">KN30</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">New</td></tr><tr><td rowspan="1" colspan="1">15</td><td rowspan="1" colspan="1">KN31</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">New</td></tr><tr><td rowspan="1" colspan="1">16</td><td rowspan="1" colspan="1">LG1</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Cat I</td></tr><tr><td rowspan="1" colspan="1">17</td><td rowspan="1" colspan="1">LG7</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Cat I</td></tr><tr><td rowspan="1" colspan="1">18</td><td rowspan="1" colspan="1">LG13</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Cat I</td></tr><tr><td rowspan="1" colspan="1">19</td><td rowspan="1" colspan="1">LG14</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">Cat I</td></tr><tr><td rowspan="1" colspan="1">20</td><td rowspan="1" colspan="1">LG17</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">New</td></tr><tr><td rowspan="1" colspan="1">21</td><td rowspan="1" colspan="1">LG18</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">R</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td align="center" rowspan="1" colspan="1">S</td><td rowspan="1" colspan="1">New</td></tr><tr><td colspan="14" rowspan="1"><hr></hr></td></tr><tr><td colspan="2" rowspan="1">Susceptible</td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">14</td><td align="center" rowspan="1" colspan="1">4</td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">21</td><td align="center" rowspan="1" colspan="1">21</td><td align="center" rowspan="1" colspan="1">20</td><td align="center" rowspan="1" colspan="1">15</td><td align="center" rowspan="1" colspan="1">21</td><td align="center" rowspan="1" colspan="1">21</td><td align="center" rowspan="1" colspan="1">20</td><td rowspan="1" colspan="1"></td></tr><tr><td colspan="2" rowspan="1">Resistant</td><td align="center" rowspan="1" colspan="1">6</td><td align="center" rowspan="1" colspan="1">7</td><td align="center" rowspan="1" colspan="1">17</td><td align="center" rowspan="1" colspan="1">6</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">1</td><td align="center" rowspan="1" colspan="1">6</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1"></td></tr><tr><td colspan="2" rowspan="1">Resistant (%)</td><td align="center" rowspan="1" colspan="1">28.6</td><td align="center" rowspan="1" colspan="1">33.3</td><td align="center" rowspan="1" colspan="1">81.0</td><td align="center" rowspan="1" colspan="1">28.6</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">4.8</td><td align="center" rowspan="1" colspan="1">28.6</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">4.8</td><td rowspan="1" colspan="1"></td></tr></tbody></table><table-wrap-foot><p>S: Susceptible, R: Resistant</p><p>*PHL: Public Health Reference Laboratory</p></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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