Jebmh.com Original Research Article J. Evid. Based Med. Healthc., pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 5/Issue 53/Dec. 31, 2018 Page 3648 DIAGNOSIS OF MDR TUBERCULOSIS AT A TERTIARY CARE CENTRE WITH CBNAAT TECHNOLOGY- A TWO YEAR STUDY Puranjay Saha 1 , Royani Saha 2 1 Associate Professor, Department of Microbiology, Malda Medical College, West Bengal. 2 UG Student, Medical Biotechnology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim. ABSTRACT BACKGROUND Tuberculosis is a chronic multi system granulomatous disease with a predilection for the respiratory system. Traditional diagnostic protocols include history, chest x-ray and sputum collection and staining for acid fast bacilli along with culture in conventional media. These processes are time consuming and labour intensive. WHO recommends the use of Cartridge Based Nucleic Acid Amplification Testing (CBNAAT) using the Gene Xpert MTB/RIF apparatus which is a comparatively rapid PCR based test. MATERIALS AND METHODS In the present study, sputum and tissue samples from 1299 patients were taken and smear preparations were stained for acid fast bacilli. Subsequently, the samples were subjected to CBNAAT testing for both the presence of mycobacterium tuberculosis as well as rifampicin resistance, which is a marker for INH resistance as well. Rifampicin resistant tuberculosis is thus labelled as multi drug resistant tuberculosis (MDR TB). RESULTS In the results of the study, mycobacterium tuberculosis (MTB) was found in 1275 cases, Rifampicin sensitivity was found in 1095 cases, rifampicin resistance in 176 cases and indeterminate results in 4 cases. In 122 cases of the present study, CBNAAT has detected mycobacterium tuberculosis (MTB) where the cases were smear negative. On the other hand, 109 smear positive cases have been declared MTB negative by CBNAAT testing. 26 cases showed error, invalid test and no results. In 4 cases though MTB was detected, rifampicin resistance testing showed indeterminate results. CONCLUSION CBNAAT technology may be used as the standard diagnostic tool for tuberculosis. However for disputed cases, referral systems must be in place for mycobacterial culture and drug testing at reference laboratories. KEYWORDS Mycobacterium tuberculosis, Polymerase Chain Reaction, Acid Fast Staining, Cartridge Based Nucleic Acid Amplification Test, Rifampicin, Multi-Drug Resistance. HOW TO CITE THIS ARTICLE: Saha P, Saha R. Diagnosis of MDR tuberculosis at a tertiary care centre with CBNAAT technology - a two year study. J. Evid. Based Med. Healthc. 2018; 5(53), 3648-3653. DOI: 10.18410/jebmh/2018/743 BACKGROUND Tuberculosis (TB) is a disease which has its roots in antiquity. The organism has its only natural reservoir in man and is difficult to culture in animal models. The resurgence of tuberculosis in recent years in India is a result of several factors. The most important cause of the surge in TB cases is the lack of drug compliance of the existing TB patients, partly due to the lack of education and explanation of the course of the disease and its complications. The important point is that patients do not realize that treatment of TB is a long drawn out process and strict adherence to the drug regime is of paramount importance. It is not by any means sufficient to discontinue and resume treatment as and when convenient. The other aspect is lack of proper reporting of cases and contacts and accurate documentation and information sharing. All these factors have resulted in a huge load of multi drug resistant TB (MDR TB) in India, some of which are also extensively drug resistant (XDR TB). The cornerstone for the management of tuberculosis today remains early and rapid diagnosis, drug susceptibility testing, contact and high risk group screening and timely and effective treatment particularly cases of TB associated with concurrent immunosuppressive conditions like HIV infection. District level tuberculosis programs are under the supervision of the District Tuberculosis Officer in the RNTCP Scheme (Revised National Tuberculosis Control Program). Under this scheme, sputum is collected and tested for all suspicious cases of cough, haemoptysis, fever, loss of weight and other suggestive cases and tested for acid fast Financial or Other, Competing Interest: None. Submission 11-12-2018, Peer Review 18-12-2018, Acceptance 25-12-2018, Published 31-12-2018. Corresponding Author: Dr. Royani Saha, Shatadal Dental Clinic, B. G. Road, Mokdumpur, Malda Town, Malda- 732101, West Bengal. E-mail: rai.royani@gmail.com DOI: 10.18410/jebmh/2018/743