Different types of Drug Resistant Tuberculosis and Diagnosis

Awareness is the first step towards good health. In infections such as Tuberculosis, it is important that patients are fully aware of the burden of the disease, the types of tests needed, the drugs used for treatment, duration of treatment, disease monitoring and treatment progression. Health awareness on a large scale is required to tackle a burden like Tuberculosis. We have seen India take strides in tackling Polio and Leprosy; the nation now needs to take up TB control on priority.

India has approximately two to three million people infected Tuberculosis, the largest in the World.

A person with active TB disease has drug resistant TB if the TB bacteria that the person is infected with, will not respond to, and are resistant to, at least one of the main TB drugs.

  • Mono Resistant Tuberculosis is resistant to one of the first line drugs
  • Poly resistant Tuberculosis is resistant to more than 1 drug but not to the combination of Rifampicin & Isoniazid
  • Multi Drug Resistant Tuberculosis is resistance to of Rifampicin & Isoniazid
  • Extensively Drug Resistant Tuberculosis is MDR + resistance to fluroquinolones and at least 1 of 3 injectable drugs
  • TDR or Total Drug Resistant tuberculosis is resistant to all first and second line TB drugs

The WHO has set protocols for TB diagnosis and four tests have been approved: two molecular tests viz. Gene Xpert and Line Probe Assay, LED microscope and liquid culture.

GenExpert Test

The biggest advantage of GenExpert test is the speed at which the test result is obtained. Results can be reported in 2 hours; presence of tuberculosis accurately determined and moreover detects resistance to Rifampicin. It is strongly recommended to be used as the initial diagnostic test in individuals suspected of having MDR-TB or HIV associated TB.

AFB (Acid Fast Bacilli) – Rapid Liquid Culture

Liquid Culture continues to the Gold standard for rapid diagnosis of active tuberculosis and for correct diagnosis and management of mono, poly, multi, extremely and total drug resistant tuberculosis. The test helps in identification and differentiation of M. Tuberculosis and non-tuberculosis mycobacteria (NTM). The test is extremely important in case of smear negative samples and extra pulmonary tuberculosis.

Despite all the advantages, the turnaround of the time could vary from 10 days to even up to 6 weeks. The TAT is dependent on the culture growth. Drug resistance testing in tuberculosis is of two types: Phenotype and Genotype. Phenotypic meaning the observable characteristic of an organism, whereas genotypic is the genetic characteristics of the organism. Liquid culture is used for phenotypic susceptibility testing for first and second line drugs.

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Different types of Drug Resistant Tuberculosis and Diagnosis

In close to 130 years since Koch’s discovery of tubercle bacilli, the search for effective diagnostic tools has moved through a succession of varied and ultimately more effective methods. In the majority of the world smear microscopy, a technique developed over 100 years ago, is still the mainstay of tuberculosis diagnosis. Globally, Liquid culture is still the gold standard for tuberculosis diagnosis, which has seen advancements by the use of automated liquid culture technology.

The WHO has set protocols for TB diagnosis and four tests have been approved: two molecular tests viz. Gene Xpert and Line Probe Assay, LED microscope and liquid culture.

GenExpert Test

The biggest advantage of GenExpert test is the speed at which the test result is obtained. Results can be reported in 2 hours; presence of tuberculosis accurately determined and moreover detects resistance to Rifampicin. It is strongly recommended to be used as the initial diagnostic test in individuals suspected of having MDR-TB or HIV associated TB.

Additionally, it May also be used as a follow-on test to microscopy esp. smear negatives.

Yet another bigger advantage of the GenExpert test is in accurately determining active tuberculosis as compared to latent tuberculosis.

In GenExpert the limit of detection is as few as 131 colony forming units/ml of MTB compared with approximately 10,000 colony forming units/ml with conventional smear microscopy. In addition, Genexpert is validated and WHO recommended for extrapulmonary samples such as lymph node aspirates, lymphnode tissues, & body fluids for diagnosis of active tuberculosis. For CSF, this is THE test of choice.

Line Probe Assay

The Line Probe Assay (1st line drugs) is a DNA strip test that allows simultaneous molecular identification of tuberculosis and the most common genetic mutations causing resistance to rifampicin and isoniazid. This technology can diagnose MDR-TB directly from smear-positive sputum samples, providing results in just five hours.

The test was endorsed by WHO in 2008 and the accuracy of detecting MDR TB is over 99%.

LPA can additionally also test for resistance to second line drugs (Fluroquinolones, ethambutol, aminoglycosides and cyclic peptides)

AFB (Acid Fast Bacilli) – Rapid Liquid Culture

Liquid Culture continues to the Gold standard for rapid diagnosis of active tuberculosis and for correct diagnosis and management of mono, poly, multi, extremely and total drug resistant tuberculosis.

The test helps in identification and differentiation of M. Tuberculosis and non-tuberculosis mycobacteria (NTM). The test is extremely important in case of smear negative samples and extra pulmonary tuberculosis.

Despite all the advantages, the turnaround of the time could vary from 10 days to even up to 6 weeks. The TAT is dependent on the culture growth.

Drug resistance testing in tuberculosis is of two types: Phenotype and Genotype. Phenotypic meaning the observable characteristic of an organism, whereas genotypic is the genetic characteristics of the organism. Liquid culture is used for phenotypic susceptibility testing for first and second line drugs.

Fluorescent Microscopy

The most important tool in the diagnosis of tuberculosis is direct microscopic examination of appropriately stained sputum specimens for acid-fast bacilli. The technique is simple and inexpensive, and detects those cases of tuberculosis, which are infectious. Sputum microscopy is also useful to assess the response to treatment, and to establish cure or failure at the end of treatment. A major shortcoming of conventional microscopy is its relatively low sensitivity compared with culture, especially in patients co-infected with HIV. Fluorescence microscopy and LED microscopy rather than conventional microscopy is fast becoming the standard diagnostic method.

Conclusion

Lack of diagnostic capacity has been a crucial barrier preventing an effective response to the challenges of MDR-TB (Multi-drug resistant tuberculosis) and XDR – TB . Also the critical gaps in laboratory capacity for culture and drug susceptibility testing (DST) have been a big challenge.

Traditionally sputum microscopy followed by culture sensitivity has been the line of diagnosis which takes a couple of days before the diagnosis is made. Metropolis Healthcare Limited has introduced Genexpert in early 2013 which ensures quick and accurate testing of MDR TB. It is a confirmatory test for tuberculosis which unlike the conventional method releases the result in two hours. Approved by WHO, Genexpert is highly reliable for detection of multidrug resistance tuberculosis for rifampicin.

Apart from Genexpert, other test offered by metropolis for further diagnose MDR are Line probe assay which helps diagnose resistance against two most commonly used drug to cure tuberculosis(rifampicin and isoniazid) and AFB- Rapid liquid culture for diagnosis of XDR and XXDR TB. Both these line of tests are highly recommended by WHO.

Quality, proficiency testing and accreditation are of utmost importance for Laboratory testing of tuberculosis. Mycobacteriology Laboratory at Metropolis is CAP, NABL certified and also Certified By Central Tuberculosis Division (RNTCP), GOI for Liquid culture, 1st line Drug Susceptibility Testing and Line Probe Assay.

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Role of Sodium in the Human Body

Sodium is often looked at as the main culprit that causes high blood pressure. But did you know that the body needs sodium in small amounts to play important roles in the body.

  • Sodium along with potassium helps in maintaining the right balance of fluids in the body. It removes excess fluid and retains the required amounts
  • Helps transmit never impulses
  • Regulates the contraction and relaxation of muscles
  • As vague as it may sound, sodium helps in controlling the blood pressure. However consuming excess of sodium can raise blood pressure.
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Why is MAIDA / white flour bad for health?

White Flour or popularly known as MAIDA in India is basically wheat flour that is refined and chemically bleached. During the refining processes, the wheat flour is stripped of precious fibre, B Vitamins and Iron.

People regularly consuming MAIDA or White Flour increase their risk for weight gain, obesity, type 2 diabetes, insulin resistance and elevated cholesterol.

You could be consuming white flour without actually knowing that these processed foods are made out of Maida. Did you know that the following foods contain white flour?

  • Pizza & Pasta
  • Nans & Rotis
  • Cakes & Cookies
  • Bread
  • Burger Buns
  • Samosa
  • Noodles
  • Doughnuts

Choose a healthy & nutritious diet and undergo regular blood parameter investigations to take complete control of your health.

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Symptoms of LEAD poisoning

According to a WHO study, lead exposure is estimated to account for 1,43,000 deaths per year with the highest burden in developing regions. Young children are particularly vulnerable to the toxic effects of lead and can suffer profound and permanent adverse health effects, particularly affecting the development of the brain and nervous system. Lead exposure is estimated to contribute to 6,00,000 new cases of children with intellectual disabilities every year. In growing children, lead poisoning causes low IQ, hyperactivity, attention deficit, learning disabilities and anemia.

Lead poisoning can be hard to detect even people who seem healthy can have high blood levels of lead. At high levels of exposure, lead damages the brain and central nervous system and can lead to coma, convulsions and even death, signs and symptoms of lead poisoning usually don’t appear until dangerous amounts have accumulated. Lead poisoning can be treated if detected at an early stage; taking some simple precautions can help protect yourself and your family.

Major sources of blood lead include leaded contaminated soil, drinking water, petrol emissions, household dust, battery recycling, silver refining, paints (especially yellow), pigments, printing presses, ceramic pottery glazes, cosmetics, colours (including kumkum, sindoor, spices and Holi colours), children’s toys (crayons and painted pencils), plant foods and traditional medicines.

Lead poisoning cases in young children are high because of licking or eating lead-containing paint when it is peeling off the walls or toys. Lead from a mother’s blood can pass to the fetus during pregnancy, possibly giving rise to genetic disorders.

Lead causes long-term harm in adults, including increased risk of high blood pressure and kidney damage. Adults who work with batteries, do home renovations or work in auto repair shops also may be exposed to lead. It can induce brain, kidney, stomach, heart, hearing, muscle and fertility damage. Exposure of pregnant women to high levels of lead can cause miscarriage, stillbirth, premature birth and low birth weight, as well as minor malformations. Women with high blood lead levels develop early osteoporosis, lower backache, joint pain and persistent anemia.

Health issues caused due to Lead Poisoning

  • Developmental Delay
  • Decline in Cognition and Memory Loss
  • Learning Difficulties
  • Irritability and Mood Swings
  • Weight loss
  • Loss of Appetite
  • Sluggishness and Fatigue
  • Abdominal Pain
  • Miscarriage & Preterm Birth
  • Vomiting or Constipation
  • Muscle Pain
  • Loss of Fertility
  • Low Sperm Count
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Sources of LEAD poisoning

Lead poisoning remains one of the most important environmental health concerns globally. It is a cumulative toxicant that affects multiple body systems and is particularly harmful to young children. At Metropolis Labs, Lead Poisoning is tested using high sensitivity technology called ICPMS (Inductively Coupled Plasma Mass Spectrometry) and Graphite Furnace Atomic absorption spectrometry. Blood, Serum and Urine samples can be tested for Lead.

According to a WHO study, lead exposure is estimated to account for 1,43,000 deaths per year with the highest burden in developing regions. Young children are particularly vulnerable to the toxic effects of lead and can suffer profound and permanent adverse health effects, particularly affecting the development of the brain and nervous system. Lead exposure is estimated to contribute to 6,00,000 new cases of children with intellectual disabilities every year. In growing children, lead poisoning causes low IQ, hyperactivity, attention deficit, learning disabilities and anemia.

Lead-based paint and lead-contaminated dust in older buildings are the most common sources of lead poisoning in children. Other sources include contaminated air, water and soil. Lead also causes long-term harm in adults, including increased risk of high blood pressure and kidney damage. Adults who work with batteries, do home renovations or work in auto repair shops also may be exposed to lead. It can induce brain, kidney, stomach, heart, hearing, muscle and fertility damage. Exposure of pregnant women to high levels of lead can cause miscarriage, stillbirth, premature birth and low birth weight, as well as minor malformations. Women with high blood lead levels develop early osteoporosis, lower backache, joint pain and persistent anemia.

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5 everyday foods that can prevent sugar spikes

Insulin is a hormone that regulates blood sugarand Type 2 diabetes occurs when the body’s production of insulin decreases. When the body does not produce enough insulin, sugar levels rise up in the blood and can lead to a series of consequences while also increasing your risk for heart disease and stroke. Uncontrolled diabetes can lead to more health problems, including kidney failure and blindness.

If you are diagnosed with Diabetes, it is important that you maintain a steady blood sugar level and certain foods can help you do just that.

Whole Grains like bran, barley and rye
Whole grains are rich in soluble fibre and gives you a feeling of fullness that lasts for a longer time. Whole grains are primarily carbohydrates and will raise the blood sugar, but in a very controlled manner. This is exactly opposite to processed foods that immediately spike up your blood sugar.

Nuts such as almonds, walnuts and pistachios
Nuts slow the body’s absorption of sugar but exercise caution on how many you intake at one go because even these healthy nuts are loaded with calories.

Nuts such as almonds, walnuts and pistachios
Apple Cider Vinegar is known to help with insulin sensitivity. Like Nuts, Apple Cider Vinegar slows down absorption of sugar.

Cinnamon
Cinnamon is known to drop fasting sugar levels though this has not been established through research. In addition, Cinnamon may also stimulate insulin secretion from pancreas.

Non Starchy vegetables such as broccoli, cucumber and carrots
Rich in fibre and provides essential nutrients.
Make the right diet choices to avoid sugar spikes. Also be sure to maintain healthy sugar levels through exercise, stress control and the right lifestyle choices
In addition, monitor your cholesterol regularly.

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Worried about your waistline? See how daily foods can help you!

Fruits and Veggies
Freshly cut fruits and baked/steamed vegetables are rich in fibre. This induces satiety thereby helps you avoid overeating. In addition, it is loaded with nutrients that will benefit your weight management plan

Green Tea
Green tea which is rich in EGCG and flavonoids helps reduce inflammation and body fat. In addition EGCG which is a polyphenol has powerful antioxidant effects and can protect you from disease.

Mono Unsaturated Fats
Reduces inflammation and raises HDL, high density cholesterol, which is the good cholesterol. Common sources of MUFAs are olive oil, avocados and nuts.

Omega 3 Fatty Acids
Regular consumption of foods rich in Omega 3 Fatty Acids can reduce inflammation and regulate lipids. Foods that provide omega-3 fatty acids include fish oil and certain plant and nut oils. Omega-3 fatty acids are thought to provide a wide range of health benefits, including a lower risk of coronary heart disease and improvement in cholesterol.

Spices
Spices like Cinnamon can fight inflammation and help in overall weight management

Whole Grains
Whole grains rich in fiber can moderate insulin response. Whole grains are a source of carbohydrate too but the sugar release in the blood is slower.

Water
Essential for hydration and reduction of inflammation
Weight management needs to be a healthy process and it is important to monitor your vital parameters like blood sugar, cholesterol, vitamins, minerals regularly to know if you are losing weight healthily.
Be sure to monitor your vital parameters regularly.

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Metropolis Healthcare essential fatty acids

It is quite a pity that fats have earned a reputation to be bad for health but that is not entirely true. Certain types of fat are not only good for your health but are in fact essential. Linolenic acid and Linoleic acid are two such fatty acids which cannot be made by the body and hence needs to be added through the diet. Linolenic Acid and Linoleic acid is important to produce omega 3 and omega 6 fatty acids which is essential for the normal functioning of all tissues in the body.
Food sources rich in omega 3 and omega 6 fatty acids include:

  • Fish, shellfish
  • Soya Oil
  • Pumpkin Seeds
  • Sunflower seeds
  • Leafy vegetables
  • Walnuts

Essential fatty acids (EFAs) perform many functions.

  • They are an important part of cell membranes.
  • Omega 3 and omega 6 fatty acids are required in the production of prostaglandins which is present in all cells and are responsible for many functions at cellular level and regulate many body processes such as: cardiovascular function, immune system processes and maintenance of the musculoskeletal system.
  • Regulate oxygen use, electron transportation and energy production
  • Essential fatty acids are important to produce Haemoglobin
  • Support the production of secretions of digestive enzymes.
  • These fatty acids help carry the cholesterol in the blood.
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How stress affects multiple organs

Stress causes whole body deterioration. Here is an easy guide on how stress affects multiple sites in the body

Brain: Stress leads to depression, anxiety, anger, irritation, lack of concentration and sleeplessness

Heart: Stress related hormones causes palpitation, high BP, elevated cholesterol and increases your risk for heart attack

Stomach: Over eating and stress related eating leads to irregular bowel movements, cramping and increases abdominal fat deposition.

Pancreas: Stress increases your risk for diabetes as sugar levels are constantly high

Reproductive system: Stress is known to reduce desire for sex and could also lead to irregular menstruation due to hormonal imbalance.

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