Early and Accurate Detection of MDR-TB-BD Max

Video link: https://www.youtube.com/watch?v=82eRB6pb7us 

Mycobacterium tuberculosis is a rod-shaped bacterium with a thick, waxy cell that makes it resistant to desiccation and many common disinfectants. Mycobacterium tuberculosis is an airborne, serious infectious disease affecting the lungs, but it is preventable and curable. However, the infection can spread to the brain, spine, or kidneys. 

Tuberculosis (TB) is a leading killer of young adults worldwide. As per the reports shared by the World Health Organization (WHO), approximately 8 million people develop active TB, and nearly 2 million die. Besides, patients coinfected with the human immunodeficiency virus (HIV) are at a greater risk of developing the disease. 

No doubt, India has shown significant progress in combating tuberculosis. Still, the disease remains a major public health challenge. In 2023, India reported about 27.8 lakh TB cases, a slight increase from the previous year’s 27.4 lakh cases. 

The Indian government's efforts in managing Tuberculosis include the National TB Elimination Programme (NTEP). Its strategy is to see a rapid decline in the burden of TB, morbidity, and mortality while removing TB from the country by 2025. 

Now, the question arises of how to save lives, even though the challenges continue, mainly with malnutrition, undernourishment, HIV co-infection, and diabetes.

The answer is a timely and accurate diagnosis.

Relevance of a timely and accurate diagnosis to cure Mycobacterium tuberculosis

Mycobacterium tuberculosis, also known as Koch’s bacillus, is a pathogenic bacterium that causes tuberculosis (TB). It affects the lungs and other parts of the body. Tuberculosis, or TB, spreads through airborne droplets when an infected person coughs, sneezes, or talks. TB is highly contagious. 

 The timely and accurate diagnosis of Mycobacterium tuberculosis is important for several reasons:

• Prevention of disease spread: Early tuberculosis (TB) detection allows immediate isolation of infectious individuals to reduce the risk of transmission to others. 
• Effective Treatment: An accurate diagnosis benefits TB patients by providing proper and timely treatment.
• Reduction in Morbidity and Mortality: Early diagnosis and treatment initiation do not allow disease progression, and they also reduce complications. Hence, we can expect lower mortality rates. 
• Improved quality of life: Early diagnosis and treatment can quickly make the symptoms less severe, thus enhancing the quality of life in TB patients.
• Diagnostic techniques: Molecular techniques such as gene Xpert MTB/RIF enable fast and accurate detection of TB and its resistance to rifampicin. Further, traditional methods such as sputum microscopy and culture are still widely used. The chest X-rays assess the extent of lung involvement. 

In short, the timely and accurate diagnosis of TB is the key to controlling the disease, improving patient outcomes, and reducing its public health impact. 

Check out a case study to learn about the importance of timely diagnosis in Mycobacterium treatment

A consultant microbiologist at Redcliffe Labs, Noida discussed the case study. The symptoms observed in her were: 

• Fatigue
• Nausea
• Night Sweats
• Fever
• Weight Loss

Case Report

A 48-year-old female whose sample was received for the test, MDR TB BD MAX, the case emphasizes understanding the reason for the negative treatment outcome for Mycobacterium tuberculosis. 

BD Max is a fully automated multiplex PCR, the first machine that was launched in India by Redcliffe Labs. It helps in the detection of MTB and also commends the rifampicin (antibiotic) and additionally the isoniazid in a single run.

Despite the patient having no significant medical history, the doctor and his team detected MTB, and isoniazid was resistant. However, rifampicin was sensitive. This case turned out to be an isoniazid mono-resistant case. 

While sharing his views on isoniazid mono-resistance, the healthcare provider said that they consider rifampicin, a surrogate marker for first-line therapy. But in this case, the initiated treatment was an utter failure because of isoniazid mono resistance. Consequently, in such cases, considering rifampicin as a surrogate marker contributes to treatment failure, and relapses and additional acquiring resistance can be done.

Before starting the first-line treatment, it is imperative to check sensitivity for both rifampicin and isoniazid. 

The Next Steps: 

This is how the expert handled the negative treatment outcome for Mycobacterium tuberculosis. The reports were conveyed to the concerned department. 

An accurate diagnosis is the key to the right treatment and better health outcomes. The targeted treatments reduce the risk of further complications.