Molecular Detection and Drug Resistance in Multidrug-Resistant Tuberculosis (MDR-TB) Patients in Bangladesh: A Case Report

Bangladesh is facing an emerging issue of Multidrug resistant tuberculosis (MDR-TB) as M. tuberculosis strains resistant to at least isoniazid and rifampicin, the two most potent first line anti TB drugs. Available evidence from Bangladesh indicates that the high prevalence of MDR-TB is due to lack of adherence to treatment, misdiagnosis and lack of surveillance systems that lead to high morbidity and mortality of patients with MDR-TB. This is because the traditional culture-based approach that is the most used method is slow and fails to detect drug resistant strains quickly. Beginning with molecular diagnostics, namely GeneXpert, polymerase chain reaction (PCR), and whole genome sequencing (WGS), M. tuberculosis drug resistance mutations have been detected. These technologies enable rapid identification of resistant strains and thus provide a timely and appropriate treatment intervention. For example, GeneXpert not only can deliver its results within hours, but do so much more quickly than conventional methods. Escape from constraints impose deep constraints on bacterial genomics inferring comprehensive insights into the genetic composition of the bacteria and enables specific mutation determinations of drug resistance allowing for discrimination of treatment regimens based upon specific mutations of patients. This is particularly significant with regards to genetic mutations that can lead to failure of treatment. Several mutations in genes such as rpoB, katG, and inhA are strongly linked to resistance to first line drugs and poor outcome. Molecular diagnostics of these mutations in Bangladesh not only expose us to the MDR TB epidemiology but also highlight the fact that personalized treatment strategies are essential to fight the rising health crisis. Improving MDR-TB management and reducing its burden in Bangladesh and other high burden areas requires integrating of advanced molecular techniques to routine clinical practice.