Genotype MTBDRsl [SL-LPA] was endorsed as a tool for early diagnosis of fluoroquinolones (FQ) and injectable second-line TB drugs (SLID) resistance in DR-TB. Correlation between specific genetic mutations using this tool and clinical outcome has not hitherto been studied in India. We conducted a observational cohort study to evaluate the predictive value of specific mutations for bad outcome. Our study identified 15 different types of gyrA mutations, commonest being A90V and D94G. Poor outcome was associated with mutations D94G and D94N/D94Y.Most XDR-TB patients harbored the high risk mutation of A1401G. Hence information of specific mutations using SL-LPA can help prognosticate and design appropriate treatment regimens.

Prison inmates are generally considered to be a high-risk group for tuberculosis (TB). When compared to the general population, the incidence and prevalence rates for TB are significantly higher among inmates. This follow-up survey examines the TB situation in Berlin prison facilities from 2011-2016 in comparison to the years 1996-1998 and 2007-2010. It is based on a retrospective case series of all cases with active pulmonary TB documented in the Berlin Prison Hospital from 2011-2016. There, the chest X‑ray examination (CXR) according to § 36 (5) IfSG is an essential pillar of active case finding.The migration of the civilian population is accompanied by increases in case finding rates and multi-drug resistant (MDR) TB (16.7%) in the Berlin prison system. For the first time, nine first-infected cases of MDR-TB were recorded among 142 inmates with active lung TB (men: 97.2%, median age: 36.5 years, foreign nationals: 81.7%). Due to short periods of incarceration, treatment success by the time of release decreased to 14.6%.Through professional treatment and adequate monitoring of a vulnerable risk group that is hard to reach in a civilian environment, prison facilities make an important contribution to prevention of infection and TB control in Germany. However, in many cases, short detention periods require the release of inmates from prison while still under therapy. Lack of therapeutic success or incomplete treatments can thus contribute to the transmission of multi-resistant pathogens. Therefore, continuous health reporting, nationwide harmonised healthcare in prison facilities and ensuring the continuation and successful termination of anti-tuberculosis therapy following release, makes the relevance of an ongoing cooperation between the prison system and public health services more important.

BACKGROUND: CAT IV regimen or the standardized drug regimen (SDR) under the Revised National Control Program (RNTCP) uses six second-line anti-tubercular drugs in the initial intensive phase (IP). These drugs have many side effects and toxicity; they are less efficacious and have poor acceptability. The present study was conducted to evaluate the efficacy and outcome of Cat-IV regimen and the factors which influence the treatment outcome in MDR TB patients.
METHODS: It was a prospective observational study, which was done in the CAT II treatment failure, LPA proven MDR TB patients, above the age of 18 years, who were referred to DOTS Plus center for treatment. The study was approved by the hospital ethics committee and patient consent was obtained before inclusion.
RESULTS: We observed culture conversion in 63.04% and ADR in 96.5%, default in 15.65%, and death in11.3% cases. The factors which influenced outcome included low body weight, long duration of illness cavitatory disease and indulgence in both tobacco & alcohol. The radiological favorable response strongly and significantly correlated with the bacteriological and clinical response during the IP.
CONCLUSIONS: We suggest that the efficacy can be further augmented by reducing default and controlling deaths which accounts for substantial numbers and occur mostly during IP.