Detection and determination of drug resistance pattern of MTB among non-suspected TB patients admitted in a tertiary care level hospital in Bangladesh using FAST Strategy

Background: Tuberculosis (TB) and drug-resistant tuberculosis (DR-TB) often present with overlapping symptoms, leading to misclassification as other lung diseases.This misclassification acts as a significant barrier to effective TB control.The FAST strategy has proven to be effective in overcoming this barrier by facilitating early detection.Aim: This study aimed to detect TB and DR-TB among patients provisionally diagnosed with other lung diseases, with or without a previous history of TB, by using rapid diagnostic techniques such as GeneXpert MTB/RIF, LED fluorescence microscopy, and solid culture with drug susceptibility testing (DST). Methods:The study was conducted from April to September 2015, involving 476 consecutively admitted patients diagnosed with various lung diseases at a tertiary-level hospital.Sputum specimens were collected from all patients, including early morning spu- Am J Biomed Sci & ResCopyright Md Samiul Bashir 212 tum samples from both TB-suspected and non-suspected cases.These specimens were tested using LED fluorescence microscopy, GeneXpert MTB/RIF, and culturebased DST (NALC-NaOH method) to identify Mycobacterium tuberculosis (MTB) and detect drug resistance.Results: Among the 476 patients, 114 (24%) had a history of TB, and 362 (76%) had no previous TB history.TB was detected in 26 (22.8%) patients with a previous TB history and 33 (9.1%) patients without prior TB history.A total of 59 MTB cases (12.39%) were detected by GeneXpert MTB/RIF, including 4 (6.78%)rifampicin-resistant cases.The microscopy test identified 16 MTB-positive cases in the group with previous TB history and 20 in the group without previous TB history.Among the 59 GeneXpert-positive cases, 56 were confirmed by culture, and 4 of them were found to be multidrug-resistant TB (MDR-TB) by DST. Conclusion:The study reveals that TB and DR-TB cases are frequently misclassified as other lung diseases due to overlapping symptoms, even in tertiary-level hospitals.Rapid diagnostic techniques, such as GeneXpert MTB/RIF, play a crucial role in detecting hidden TB and DR-TB cases, ultimately improving early detection and TB control efforts.