Research Article
Volume 17 Issue 9 - 2021
Antimicrobial Susceptibility Profile of Mycobacterium tuberculosis among Patients with Pulmonary Tuberculosis in Anambra State, Southeast Nigeria
Ngozichukwu Gertrude Uzoewulu1*, Wilson Chukwuneke Igwe2, Chika Florence Ubajaka3 and Goyal Madhu4
1Department of Medical Microbiology/Parasitology, Faculty of Medicine, Nnamdi Azikiwe University Nnewi, Nigeria
2Department of Pediatrics, Faculty of Medicine, Nnamdi Azikiwe University Nnewi, Nigeria
3Department of community Medicine, Faculty of Medicine ,Nnamdi Azikiwe University Nnewi
4Department of Microbiology, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, England, United K
*Corresponding Author: Ngozichukwu Gertrude Uzoewulu, Department of Medical Microbiology/Parasitology, Faculty of Medicine, Nnamdi Azikiwe University Nnewi, Anambra State, Nigeria.
Received: May 05, 2021; Published: August 30, 2021


Background: Mycobacterium tuberculosis drug resistance is a threat to global control of tuberculosis especially in resource limited settings. This study evaluated the anti-tuberculosis drug susceptibility pattern of Mycobacterium tuberculosis, strains isolated from patients with pulmonary tuberculosis in Anambra state, southeast Nigeria.

Methods: This was a cross-sectional study that involved the analysis of sputum samples of tuberculosis patients seen from 2010- 2012 in randomly selected public hospitals in Anambra state, southeast Nigeria. All the sputum samples were processed according to standard operating procedure and cultured using Lowenstein Jensen medium (LJ). One hundred and eighty colonies of Mycobacterium tuberculosis strains grown were identified on the basis of morphology, pigment production and biochemical characteristics. Drug susceptibility testing of each isolate to the first line anti-TB drugs (Streptomycin, Isoniazid, Rifampicin and Ethambutol) was performed by proportional method on LJ medium.

Results: Of the 180 M. tuberculosis isolates, 143 (79.4%) were from new TB cases and 37 (20.6%) from retreatment TB cases. A total of 95 (52.8%) {95% CL: 45.34 - 59.76} strains were susceptible to either one or more Tb drugs, of which 86 (47.8%) were from new TB cases while 9 (5%) were from retreatment TB cases. A total of 85 (47.2%) {95% CI: 22.68 - 69.32. P = 0.0001} were drug resistant strains. Of these resistant strains, 57 (31.7%) {95% CI: 23.59 - 39.40} were from new TB cases, while 28 (15.6%) {95% CI: 7.58 - 22.42} were retreatment TB cases. The rates of the sensitivity to a single first line anti-TB drug were: Streptomycin 78%, Isoniazid 68%, Rifampicin 85% and Ethambutol 75%. The rates of resistance to a single anti-TB drug were: Streptomycin 22%, Isoniazid 32%, Rifampicin 15% and Ethambutol 25%). Resistance to drugs were higher with Isoniazid compared to other drugs while Rifampicin was more susceptible than other anti-TB drugs. Among the total of 180 culture positive TB cases, 34(18.9%) were found to be monoresistance {95% CI: 10.45-26.58}. The prevalence rate 23(12.8%) among new TB cases was significantly higher than the retreatment 11(6.1%) diagnosed TB cases. About 16(8.9%) were MDR-TB [95%CI:2.34-15.55} with 7 (3.9%) new TB cases and 9(5%) retreatment TB cases . There was an association between retreatment TB cases and MDR-TB (P=0.0001). Of the total culture positive TB cases 35(19.4%) were Poly-resistant [ 95% CI: 11.66-27.34} of which the prevalence rate 27(15%) among new TB cases was significantly higher than 8(4.4%) retreatment TB cases and the difference was statistically significant. Drug resistance increased in both the new and retreatment TB cases. Also, of the 85 (47.2%) drug resistant TB, 14 (7.8%) (95% CL: 3.037: P = .386} were HIV positive while 71 (39.4%) were HIV negative. Those older than 21 years were most likely to have drug resistant TB (95% CI: 27.449: P = .156).

Conclusion: Retreatment cases of Pulmonary TB is significantly associated with drug resistance and patients who were treated at NAUTH Nnewi site had significantly higher rate of Multi-drug resistant TB compared to other hospitals investigated..

Keywords: Drug Resistance; Mycobacterium tuberculosis; Pulmonary Tuberculosis; Anambra State


  1. World Health Organization. Global tuberculosis report 2019. Geneva: World Health Organizatio (2019).
  2. Burk T. “Tuberculosis resistance funding and drug”. Lancet Infectious Disease 10 (2010): 297-298.
  3. JA Caminero. “Multi- resistant tuberculosis: Epidemiology, risk factors and case finding”. International Journal of Tuberculosis and Lung Disease 14 (2010): 382-390.
  4. Onyedum CC., et al. “Prevalence of drug resistant tuberculosis in Nigeria. A systematic review and Meta- analysis”. PloS One7 (2017): e0180996.
  5. World Health Organization. Global tuberculosis report 2018. Geneva: World Health Organization (2018).
  6. Nwachukwu NO., et al. “Prevalence of pulmonary tuberculosis and its associated risks factors in Anambra state, Nigeria”. FTSTJ 2 (2016): 486-488.
  7. Okonkwo RC., et al. “Prevalence of HIV infection in pulmonary tuberculosis suspects assessing the Nnamdi Azikewe University Teaching Hospital Nnewi, Nigeria”. Advances in life science and Technology 14 (2013): 87-91.
  8. World Health Organization. Multi drug-resistance tuberculosis (MDR-TB). Update 2013.Geneva World Health Organization (2013).
  9. World Health Organisation. Global tuberculosis report 2020 country profiles (2020).
  10. Gidado M., et al. “Assessment of GeneXpert MTB/RIF performance by type and level of health-care facilities in Nigeria”. Nigerian Medical Journal 60 ( 2019): 33-39.
  11. International Union Against Tuberculosis and Lung Disease(IUATLD) . Technical guide for sputum examination for tuberculosis by direct microscopy in low income countries (2000): 20-25.
  12. World Health Organization. Guideline for surveillance of drug resistance in tuberculosis (2009).
  13. Cheesbrough M. “District laboratory practice in tropical countries, part 2. 2nd edition. Cambridge: Cambridge University Press (2006).
  14. World Health Organization. Laboratory services in tuberculosis control part III, culture. Geneva, Switzerland (1998).
  15. Kome Otokunefor., et al. “Multi-drug resistant Mycobacterium tuberculosis in Port Harcourt, Nigeria”. African Journal of Laboratory Medicine2 (2018): 1-12.
  16. Akaninyene Otu., et al. “Drug resistant among pulmonary tuberculosis patients in Calabar, Nigeria”. Pulmonary Medicine (2013): 235190.
  17. Affolabi D., et al. “First insight into a Nationwide genotypic diversity of Mycobacterium tuberculosis among previously treated pulmonary tuberculosis cases in Benin, West Africa”. Canadian Journal of Infectious Diseases and Medical Microbiology (2017): 6.
  18. Masoud Shamaei., et al. “Fist-line anti-tuberculosis drug resistace patterns and trends at the national TB referral center in Iran eight years of surveillance”. International Journal of Infeactious Disease5 (2009): 236-240.
  19. Kelemework Adane., et al. “Prevalence and drug resistance profile of Mycobacterium tuberculosis isolated from pulmonary tuberculosis patients attending two public hospitals in East Gojiam zone, northwest Ethiopia”. BMC Public Health 15 (2015): 572.
  20. World Health Organization. Multi drug and Extensively drug resistant TB (M/XDR-TB), Global report on surveillance and response Geneva, Switzerland (2010).
  21. Tilahun M., et al. “Molecular epidemiology and drug sensitivity pattern of Mycobacterium tuberculosis strains isolated from pulmonary tuberculosis patients in and around Ambo town, Central Ethiopia”. PloS One2 (2018): e0193083.
  22. Lawson L., et al. “Resistance to first – line tuberculosis drugs in three cities of Nigeria”. Tropical Medicine and International Health8 (2011): 974-980.
  23. M Agnoafir., et al. “Phenotypic and genotypic analysis of multi-drug resistant tuberculosis in Ethiopia”. International Journal of Tuberculosis and Lung Disease5 (2010): 1259-1265.
  24. K Desta., et al. “Prevalence of smear negative pulmonary tuberculosis among patients visiting St. Peters tuberculosis specialized Hospital. Addis Ababa, Ethiopia”. Ethiopia Medical Journal1 (2009): 17-24.
  25. Vishal Goyal., et al. “Prevalence of drug resistant pulmonary tuberculosis in India: systematic review and meta- analysis”. BMC Public Health817 (2017): 1-21.
  26. O Idigbe., et al. “Initial drug resistance among HIV seropositive prison inmates in Lagos, Nigeria”. International conference on AIDS 12 (1998): 137.
  27. Desiree TB., et al. “High level of multi drug resistant tuberculosis in new and treatment failure. Patients from the revised national tuberculosis control programme in an urban metropolis (Mumbai) in Western India”. Biomedical Central Public Health 9 (2009): 211-215.
  28. Guy Thwaites. “Tuberculosis. Manson Tropical infectious disease”. Twenty-Thirdedition (2014): 468-505.
  29. Kemo Otokunefor., et al. “Multi-drug resistant Mycobacterium tuberculosis in Portharcourt, Nigeria”. African Journal of Laboratory Medicine2 (2018).
  30. Ani AT., et al. “Drug resistance profile of Mycobacterium tuberculosis isolated from pulmonary tuberculosis patients in Jos, Nigeria”. Transaction of the Royal Society of Tropical Medicine and Hygiene 103 (2009): 87-71.
  31. D Anastasis., et al. “A restrospective study of human immunodeficiency virus infection and drug resistant tuberculosis in Durban, South African”. International Journal of Tuberculosis and Lung Disease3 (1997): 220-222.
  32. Nwankwo NC., et al. “Epidemiology of pulmonary tuberculosis in some parts of Abia state, Federal Republic of Nigeria”. Asian Journal of Epidemiology 2 (2009): 13-19.
  33. Nwachukwu NO., et al. “Delay in diagnosis of pulmonary tuberculosis among presumptive tuberculosis cases in parts of Anambra state, Nigeria”. Emerging Infectious Diseases4 (2016): 120.
  34. Imam TS and Oyeyi TI. “Retrospective study of pulmonary tuberculosis (PTB) prevalence amongst patients attending infectious diseases hospital (IDH) in Kano, Nigeria”. BAJOPAS1 (2008): 10-15.
  35. Muvunyi CM., et al. “Prevalence and diagnostic aspects of sputum smear positive tuberculosis cases at a tertiary care institution in Rwanda”. African Journal of Microbiology Research2 (2010): 88-91.
  36. Onubuogu CC., et al. “Sensitivity of direct smear microscopy for the diagnosis TB in high HIV prevalent population”. Scientific Research and Essay5 (2012): 593-597.
  37. American Thoracic society. “Diagnostic standard and classification of tuberculosis in adult and children”. American Journal of Respiratory and Critical Care Medicine 161 (2000): 1376-1395.
  38. Subba S., et al. “Antibiotic susceptibility pattern of Mycobacterium tuberculosis”. Journal of Nepal Health Research Council14 (2009): 33-41.
  39. Al-Marri MRHA. “Pattern of mycobacteria resistance to four anti-tuberculosis drugs in pulmonary tuberculosis patients in the state of Qarter after the implementation of DOTS and limited expatriate screening programme”. The International Journal of Tuberculosis and Lung Disease12 (2001): 1116-1121.
Citation: Ngozichukwu Gertrude Uzoewulu., et al. “Antimicrobial Susceptibility Profile of Mycobacterium tuberculosis among Patients with Pulmonary Tuberculosis in Anambra State, Southeast Nigeria”. EC Microbiology 17.9 (2021): 21-31.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

November Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 09, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.