ABSTRACT Background: Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis. Anti-tuberculosis drug resistance is an emerging health problem in Kenya and especially in Coastal region. This is a major challenge in tuberculosis control. Diagnosis is based on Ziel-Neelsen staining alone and patients are treated without information on sensitivity patterns. Aim: This study aimed to determine drug susceptibility patterns of Mycobacterium tuberculosis in Coastal Kenya. Study Design: Hospital and laboratory based cross-sectional study was carried between April 2015 and July 2016 at Coast General Referral hospital; Tudor, Port-Reitz, Likoni Sub-County hospitals; Mlaleo, Kongowea and Mikindani health centers. Methodology: Sputum samples from patients with bacteriological confirmed TB on microscopy were cultured on Lowenstein Jensen (LJ) media. Strains of MTB complex from Lowenstein Jensen (LJ) slopes were subjected to drug susceptibility testing (DST) to first-line drugs including isoniazid (H), rifampicin (R), streptomycin (S) and Ethambutol (E) using proportional method on the Mycobacterium Growth Indicator Tube (MGIT) conventional method. Participants were offered diagnostic testing and counselling for HIV testing. Results: Drug sensitivity test was performed for a total of 210 Mycobacterium tuberculosis isolates for the first line anti-TB drugs. About seventy eight percent and twenty nine percent of the strains from new patients and previously treated patients were fully sensitive to all the drugs tested respectively. Prevalence of any resistance to one drug was 102 (48.6%, 95% CI: 20.45 - 28.23). Any single drug resistance was most frequent in isoniazid 30 (16.0%), Ethambutol 20 (10.0%), Streptomycin 18 (18.3%) and Rifampicin 4 (2.1%) in newly diagnosed patients. Among previously treated patients any resistance to streptomycin, ethambutol, isoniaziad and rifampicin was 10 (58.8%), 9 (52.9%), 7 (41.2%) and 4 (23.5%) respectively. Prevalence of MDR-TB defined as resistant to at least both isoniazid and rifampicin was 10 (4.8%) among new and previously treated patients respectively. Conclusion: The current study reveals that the overall resistance to first line anti-TB drugs was high. Although the rate of MDR-TB was relatively low, this signifies that conditions favouring the spread of MDR-TB are on high rise. Therefore, it is essential to address the problems of development of drug re-sistant strains of TB by establishing good TB programmes (DOTS). Patients’ adherence to anti-TB drugs and introducing drug sensitivity testing (DST) services at County level hospitals will minimize occurrence of drug resistant.
Cite this paper
Yonge, S. , Otieno, M. , Sharma, R. and Nteka, S. (2017) Drug Susceptibility Patterns of Mycobacterium tuberculosis Isolates from Tuberculosis Patients in Coastal Kenya. Journal of Tuberculosis Research, 5, 201-219. doi: 10.4236/jtr.2017.54022.
 World Health Organization, WHO Report (2013) Global Tuberculosis Report 2013. World Health Organization, Geneva.
 Dias, F., Michael, S., Hoffner, S.E., Martins, M.L., Norberg, R and Källeniusa, G. (1993) Drug Susceptibility in Mycobacterium tuberculosis of a Sample of Patient in Guinea Bissau. Tubercle and Lung Disease, 74, 129-130.
 Mitike, G., Kebede, M. and Yeneneh, H. (1997) Prevalence of Antituberculosis Drug Resistance in Harar Tuberculosis Centre, Ethiopia. East Africa Medical Journal, 74, 158-161.
 Glynn, J.R., Crampin, A.C., Traore, H., et al. (2005) Mycobacterium tuberculosis Beijing Genotype, Northern Malawi. Emerging Infectious Diseases, 11, 150-153.
 Lin, J., Sattar, A. and Puckree, T. (2004) An Alarming Rate of Drug-Resistant Tuberculosis at Ngwelezane Hospital in Northern KwaZulu Natal, South Africa. International Journal of Tuberculosis and Lung Disease, 8, 568-573.
 Kassa-Kelembho, E., Bobossi-Serengbe, G., Takeng, C., Nambea-Koisse, T., Yapou, F and Talarmin, A. (2004) Surveillance of Drug-Resistant Childhood Tuberculosis in Bangui, Central African Republic. International Journal of Tuberculosis and Lung Disease, 8, 574-578.
 Kuaban, C.R., Bercion, J., Noeske, P., Cunin, P., Nkamsse, S., et al. (2000) Anti-Tuberculosis Drug Resistance in the West Province of Cameroon. International Journal of Tuberculosis and Lung Disease, 4, 356-360.
 Urassa, W., Mugusi, F., Villamor, E., et al. (2008) Primary Antimicrobial Resistance among Mycobacterium tuberculosis Isolates from HIV Seropositive and HIV Seronegative Patients in Dar es Saalam Tanzania. BMC Research Notes, 1, Article 58.
 Lukoye, D., Adatu, F., Musisi, K., Kasule, G.W., Were, W., Odeke, R., Kalamya, J.N., Awor, A., Date, A. and Joloba, L.M. (2013) Anti-Tuberculosis Drug Resistance among New and Previously Treated Sputum Smear Positive Tuberculosis in Uganda: Results of the First National Survey. PLoS ONE, 8, e70763.
 Espinal, M., Laszlo, A., Simonsen, L., Boulahbal, F., Kim, S. and Reneiro, A. (2012) Global Trends in Resistance to Anti-Tuberculosis Drugs. World Health Organization-International Union against Tuberculosis and Lung Disease. British Medical Journal, 344, 1294-1303.
 Division of Leprosy, Tuberculosis and Lung Disease (2014) Ministry of Public Health and Sanitation. Government of Kenya, Annual Report.
 Mermin, J. (2007) Prevalence, Incidence and Mortality Associated with Tuberculosis in HIV-Infected Patients Initiating Antiretroviral Therapy in Rural Uganda. AIDS, 21, 713-719. https://doi.org/10.1097/QAD.0b013e328013f632
 Sarita, S., Wright, A., Bai, G., et al. (2007) Worldwide Emergence of Extensively Drug-Resistant Tuberculosis. Emerge infectious Disease, 13, 380-387.
 Niemann, S., Diel, R., Khechinashvili, G., Gegia, M., Mdivani, N. and Tang, Y.W. (2010) Mycobacterium Tuberculosis Beijing Lineage Favors the Spread of Multidrug-Resistant Tuberculosis in the Republic of Georgia. Journal of Clinical Microbiology, 48, 3544-3550. https://doi.org/10.1128/JCM.00715-10
 World Health Organization (2014) WHO Report 2014. Global Tuberculosis Report. World Health Organization, Geneva.
 Division of Leprosy, Tuberculosis and Lung Disease (2013) Ministry of Public Health and Sanitation. Government of Kenya, Annual Report.
 Ministry of Health, Kenya (2014) National Leprosy and Tuberculosis Control Programme (NLTP) Annual Report, 2009.
 Nyang’au, L.O., Amukoye, E. and Ng’ang’a, Z. (2014) First Line Anti-Tuberculosis Drug Resistance Among Human Immunodeficiency Virus Infected Patients Attending Maryland Comprehensive Care Centre Mathare 4a Nairobi Kenya. International Journal of Sciences, 15, 661-668.
 Taylor, J.P., Bergmire-Sweat and Suarez, L. (1999) Epidemiology of Drug Resistant Tuberculosis in Texas. American Medical Journal of Epidemiology, 149, 359-365.
 Zhiyuan, L., Kenneth, L.S. and Lyn, F. (2008) Epidemiology of Drug Resistant Tuberculosis in NewJersy from 1991 to 1995. International Journal of Epidemiology, 27, 121-126.
 Dye, C., Sheele, S., Dolin, P. and Pathania, V. (2011) Global Burden of TB. Estimated Incidence, Prevalence and Mortality by Country. British Medical Journal, 282, 677-686.
 World Health Organization, International Union against Tuberculosis and Lung Disease (2012) Guidelines for Surveillance of Drug Resistance in Tuberculosis. World Health Organization Document WHO/TB/96.216, 1-5.
 Kathryn, D., Louders, G., Mirriam, B., Manuel, P., Martinez, G., Peter, M., et al. (2005) Does DOTS Work in Populations with Drug Resistant Tuberculosis? The Lancet, 365.
 Quy, H.T., Lan, N.T., Borgdorff, W.W., Grosset, J., Link, P.D., et al. (2003) Drug Resistance among Failure and Relapse Cases of Tuberculosis: Is the Standard Retreatment Regimen Adequate? International Journal Tuberculosis Lung Disease, 7, 631-636.
 Division of Leprosy, Tuberculosis and Lung Disease (2015) Ministry of Public Health and Sanitation. Government of Kenya. Annual Report.
 World Health Organization (2009) Guidelines for Surveillance of Drug Resistance in Tuberculosis. 4th Edition, WHO/HTM/TB/2009.422, Geneva.
 Kent, P.T. and Kubica, G.P. (2010) Public Health Mycobacteriology. A Guide for III Laboratory Centers of Disease Control, Atlanta. Publication, No. 86, 345-456.
 Githui, W.A., Hawken, M.P., Juma, E.S., Godfrey-Fauset, P., Swai, O.B., Kibuga, D.K., Porter, J.D., Wilson, S.M., et al. (2000) Surveillance of Drug-Resistant Tuberculosis and Molecular Evaluation of Transmission of Resistant Strains in Refugee and Non-Refugee Populations in North-Eastern Kenyan. International Journal of Tuberculosis and Lung Disease, 4, 947-955.
 Agonafir, M., Lemma, E., Wolde-Meskel, D., et al. (2010) Phenotypic and Genotypic Analysis of Multidrug-Resistant Tube4rculosis in Ethiopia. International Journal of Tuberculosis and Lung Disease, 14, 1259-1265.
 Sanchez-Padilla, E., Ardizzoni, F., Sauvageot, D., et al. (2013) Multidrug- and Isoniazid-Resistant Tuberculosis in Three High HIV Burden African Regions. International Journal of Tuberculosis and Lung Disease, 17, 1036-1042.
 Ndung’u, P.W., Kariuki, S., Ng’ang’a, Z. and Revathi, G. (2012) Resistance Patterns of Mycobacterium Tuberculosis Isolates from Pulmonary Tuberculosis Patients in Nairobi. Journal of Infection in Developing Countries, 6, 33-39.
 Seyoum, B., Demissie, M., Worku, A., Bekele, S. and Aseffa, A. (2014) Prevalence and Drug Resistance Patterns of Mycobacterium tuberculosis among New Smear Positive Pulmonary Tuberculosis Patients in Eastern Ethiopia. Tuberculosis Research and Treatment, 2014, 753492.
 Hellen, S., Juan, D., Roy, M., Sabine, R., Dennis, F., Ian, S., Darebsay, D., Yared, K. and Mohamed, A. (2004) Multidrug Resistance in Central Asia. Emerging Infectious Diseases, 10, 1210-1215.
 Githui, W.A., Juma, E.S., Van Gorkom, J., Kibuga, D., Odhiambo, J. and Drobniewski, F. (1998) Anti-Tuberculosis Drug Resistance Surveillance in Kenya, 1995. International Journal of Tuberculosis and Lung Disease, 2, 499-505.
 Abebe, G., Abdissa, K., Abdissa, A., Apers, L., Agonafir, M., de-Jong, B.C. and Colebunders, R. (2012) Relatively Low Primary Drug Resistant Tuberculosis in South-Western Ethiopia. BMC Research Notes, 5, 225.
 Magana, A.D.N., Pirera, A.J., Senarathe, V. and Chandrasekaharna, N.V. (2010) Patterns of Drug Resistance and RFLP Analysis of Mycobacterium tuberculosis Strains Isolated from Recurrent Tuberculosis Patients in Sri-Lanka, South-East Asia. Journal on Tropical Medicine and Public Health, 41, 583-589.
 WHO/GTP (2013) Multidrug and Extensively Drug Resistant TB: Global Report on Surveillance and Response. Report No. WHO/GTP/TB/2013.3, The Organizations, Geneva, 2013 Facilities, Congregate Settings and Households, WHO, Geneva.
 Mycal, P., Srikanth, T., Viskas, I., Ramash, K., Manoj, B., Amrita, D.M., Rajshekar, I., Annand, A., Sanjar, M. and Arun, R. (2005) Drug Resistance Pattern of Mycobacterim tuberculosis Seropositive and Seronegative HIV-TB Patients in Pune, India. Indian Journal of Medical Respiratory, 121, 225-239.
 Zwarenstein, M., Schoeman, J.H., Vundule, C. and Tatley, M. (1998) Randomized Control Trial of Self-Supervised and Directly Treatment of Tuberculosis. The Lancet, 352, 1340-1343.
 Sharma, S., Mohan, A., Kadhiravan, et al. (2005) HIV-TB Co-Infection: Epidemiology, Diagnosis and Management. Indian Journal of Respiratory Medicine, 121, 50-67.
 Githui, W.A., Meme, H., Juma, E., Karimi, F., Kinyajui, P., Chakaya, J., Kangangi, J. and Kutwa, A. (1994) Isolation of Multi-Drug Resistant Tuberculosis Strains in Patients from Private and Public Facilities in Nairobi, Kenya. International Journal of Tuberculosis and Lung Disease, 8, 837-841.
 Sharma, S.K., Kaushik, G., Jha, B., et al. (2011) Prevalence of Multidrug-Resistant Tuberculosis among Newly Diagnosed Cases of Sputum-Positive Pulmonary Tuberculosis. Indian Journal of Medical Research, 133, 308-311.
 Raviglione, M.C., Marian, J.P. and Kochia, A. (1992) HIV-Associated Tuberculosis in Developing Countries: Clinical Features, Diagnosis and Treatment. Bulletin of World Health Organization, 70, 515-526.
 Diandé, S., Sangaré, L., Kouanda, S., Dingoumda, B. and Traoré, A. (2009) Drug Resistance of Mycobacterium tuberculosis Complex among Newly Diagnosed Tuberculosis Cases in Burkina Faso. West Africa Journal of Medicine, 28, 353-357.
 Lukoye, D., Cobelens, J., Ezati, N., et al. (2011) Rates of Anti-Tuberculosis Drug Resistance in Kampala-Uganda Are Low and Not Associated with HIV Infection. PLoS ONE, 6, 16130. https://doi.org/10.1371/journal.pone.0016130
 Zignol, M., Hossein, M.S., Wright, A., Weezenbeck, C.L., Nuun, P., Watt, C.J., Williams, B.G. and Dye, C. (2006) Global Incidence of Multidrug Resistant Tuberculosis. The Journal of Infectious Diseases, 194, 479-485. https://doi.org/10.1086/505877
 Githui, W.A., Kwamanga, D., Chakaya, J.M., Karimi, F.G. and Waiyaki, P.G. (1993) Anti-Tuberculosis Initial Drug Resistance of Mycobacterium tuberculosis in Kenya: A Ten-Year Review. East African Medical Journal, 70, 609-612.
 Affolabi, D., Adjagba, O., Tanimomo-Kledjo, B., Gninafon, M., Anagonou, S. and Portaels, F. (2007) Anti-Tuberculosis Drug Resistance among New and Previously Treated Pulmonary Tuberculosis Patients in Cotonou, Benin. International Journal of Tuberculosis and Lug Disease, 11, 1221-1224.
 WHO (2010) Global Tuberculosis Control, Surveillance, Planning and Financing. WHO Report, WHO/HTM/TB, 349, Geneva.
 Sanchez-Padilla, E., Dlamini, T., Ascorra, A., et al. (2012) High Prevalence of Multidrug-Resistant Tuberculosis, Swaziland, 2009-2010. Emerging Infectious Diseases, 18, 29-37. https://doi.org/10.3201/eid1801.110850
 Nunes, E.A., De Capitani, E.M., Coelho, E., et al. (2005) Patterns of Anti-Tuberculosis Drug Resistance among HIV-Infected Patients in Maputo, Mozambique, 2002-2003. International Journal of Tuberculosis and Lung Disease, 9, 494-500.
 Sindani, I., Fitzpatrick, C., Falzon, D., et al. (2013) Multidrug-Resistant Tuberculosis, Somalia, 2010-2011. Emerging Infectious Diseases, 119, 478-480.
 Asmam, D., Seyoum, B., Makonnen, E., et al. (2008) Primary Drug Resistance in Newly Diagnosed Smear Positive Tuberculosis Patients in Addis Ababa. Ethiopian Medical Journal, 46, 367-374.
 Yimmer, S.A., Agonafir, M., Derese, Y., Sni, Y., Bjune, G.A. and Holm-Hansen, C. (2012) Primary Drug Resistance to Anti-Tuberculosis Drugs Resistance in Major Towns of Amhara Region, Ethiopia. APMIS, 120, 503-509.
 Demissie, M., Lemma, E., Gebeyehu, M. and Lindtjorn, B. (2001) Sensitivity to Ant-Tuberculosis Drugs in HIV-Positive and HIV-Negative Patients in Addis Abba. Scandinavian Journal of Infectious Diseases, 33, 914-919.
 Minime-Lingoupou, F., Manirakiza, A., Yango, F., Zandanga, G., Le and Faou, A. and Rigouts, L. (2011) Relatively Low Primary Resistance to Anti-Tuberculosis Drugs in Bangui and Bimbo, Central African Republic. International Journal of Tuberculosis and Lung Disease, 15, 657-661. https://doi.org/10.5588/ijtld.10.0292
 Millen, S.J., Uys, P.W., Hargrove, J., Van Helden and Williams, B.G. (2008) The Effect of Diagnostic Delays on the Dropout Rate and the Total Delay to Diagnosis of Tuberculosis. PLoS ONE, 3, 1933.
 Suchindran, S., Brouwer, E.S. and Van, R.A. (2009) Is HIV Infection a Risk Factor for Multi-Drug Resistant Tuberculosis? Asystematic Review. PLoS ONE, 4, E5561.