Prevalence and treatment follow-up of drug-resistant extra-pulmonary tuberculosis in rural communities in Narshingdi, Bangladesh

Hafsa Afroz, Md. Azhar Ali, Md. Fakruddin ., Kamrunnahar ., Suvamoy Datta


Tuberculosis is a chronic communicable disease. Infections are initially asymptomatic and latent but eventually progresses to active disease, which, if left untreated, may have ≥50% mortality. In 2011, an anti-tuberculosis drug resistance survey in Narsingdi, Bangladesh enrolled both new and retreatment patients. In the study, a number of villages were randomly selected and 152 extra pulmonary tuberculosis (EPTB) patients were identified. All the patients received treatment with standardized first-line drug (FLD) regimens and were investigated to document treatment efficiency. Among the patients, 34 were reported in lower income, 112 in medium income and only 06 in higher income group. Farmers (16.4%) in low income group, and female housewives (41.4%) in medium income group were mostly infected. Silicosis and malnutrition were assumed responsible for high EPTB cases in farmers and housewives respectively. The working youth groups (25-34) were found most vulnerable. Extra pulmonary TB sites of infection was found pleural TB 29.6% patients, glands TB 24.3% patients, abdominal TB 21.0% patients, spinal TV 19.7% patients, tubercular meningitis 436% patients & tubercular pericarditis 0.65% patient. Multi-drug resistant (MDR) EPTB was detected in both new and retreatment patients. Patients with MDR-EPTB who had been declared cured with first-line anti-TB treatment had a high rate of TB recurrence and death. The rate of TB recurrence and death was high four years after MDR-TB patients were judged to have been cured. PTB patients in Bangladesh had high recurrence and death rates even after treatment with standardized FLD regimens, reinforcing the need for early survey, diagnosis and treatment, including assessment of treatment outcomes.


Age, Bangladesh, Pulmonary tuberculosis, Socio-economic condition, Treatment efficiency

Full Text:



Afroz H, Ali MA, Fakruddin M, Kamrunnahar, Datta S. Prevalence of multi-drug resistant (MDR) pulmonary tuberculosis in a tertiary care hospital of Narshingdi, Bangladesh. Intl J Biomed Adv Res. 2013;4(2):98-104.

Rahman MM. Tuberculosis: global and regional scenarios. Anwar Khan Modern Med Coll J. 2010;1(1):19-22.

Gonzalez OY, Adams G, Teeter LD, Bui TT, Musser JM, Graviss EA. Extrapulmonary manifestations in a large metropolitan area with a low incidence of tuberculosis. Int J Tuberc Lung Dis. 2003;7:1178-85.

Garcia-Rodriguez JF, Alvarez-Diaz H, Lorenzo-Garcia MV, Marino-Callejo A, Fernandez-Rial A, Sesma-Sanchez P. Extrapulmonary tuberculosis: epidemiology and risk factors. Enferm Infecc Microbiol Clín. 2011;29(7):502-9.

Kamal SMM, Ahasan HAMN, Ahmed S, Ayaz KFM, Mahbub MS, Khan MAI, et al. Isolation and identification of mycobacterium from extrapulmonary specimen at NTRL, NIDCH. J Med. 2010;11(2):128-30.

Akhter Z, Hassan H, Hanif A. Study of Frequency of extra pulmonary tuberculosis in Gulab Devi hospital Lahore. J Fatima Jinnah Med Coll. 2013;7(1):45-51.

Golden MP, Vikram HR. Extrapulmonary tuberculosis: an overview. Am Family Physician. 2005;72(9):1761-8.

Lönnroth K, Raviglione M. Global epidemiology of tuberculosis: prospects for control, Sem Resp Crit Care med. 2008;29(5):481-91.

Cox H, Kebede Y, Allamuratova S, Ismailov G, Davletmuratova Z, Byrnes G, et al. Tuberculosis recurrence and mortality after successful treatment: impact of drug resistance. PLoS Med. 2006;3(10):e384.

Espinal MA, Kim SJ, Suarez PG, Kam KM, Khomenko AG, Migliori GB, et al. Standard short-course chemotherapy for drug-resistant tuberculosis: treatment outcomes in 6 countries. JAMA. 2000;283:2537-45.

Dye C, Espinal MA, Watt CJ, Mbiaga C, Williams BG. Worldwide incidence of multidrug-resistant tuberculosis. J Infect Dis. 2002;185:1197-202.

Shah NS, Wright A, Bai GH, Barrera L, Boulahbal F, Martín-Casabona N, et al. Worldwide emergence of extensively drug-resistant tuberculosis. Emerg Infect Dis. 2007;13:380-7.

WHO. Guidelines for surveillance of drug resistance in tuberculosis. In: WHO, eds. WHO Guideline. 4th ed. Geneva, Switzerland: World Health Organization; 1997: 1-83.

An YS, Ding BC, Zhu JH, Xing Q, He XX. Report of WHO survey on drug- resistant tuberculosis in Beijing. The J Chinese Antitubercul Assoc. 2007;29:475-8.

WHO. Treatment of tuberculosis: guidelines for national programmes. WHO, eds. WHO Guideline. 3rd ed. Geneva, Switzerland: World Health Organization; 2003: 5-108.

Wang GJ, Xu JY, Wang GB, Zhen XA, Gao SY, Du CM. Impact of anti-tuberculosis drug resistance on treatment outcome of pulmonary tuberculosis patients receiving directly observed treatment strategy in Henan province, China. Chinese J Tubercul Resp Dis. 2006;29:527-30.

Quy HT, Cobelens FG, Lan NTN, Buu TN, Lambregts CS, Borgdorff MW. Treatment outcomes by drug resistance and HIV status among tuberculosis patients in Ho Chi Minh City, Vietnam. Int J Tuberc Lung Dis. 2006;10:45-51.

Karim MM, Chowdhury SA, Hussain MM, Faiz MA. A clinical study on extrapulmonary tuberculosis. J Bang Coll Phys Surg. 2006;24(1):19-28.

Hussain MW, Haque MA, Banu SA, Ekram ARMS, Rahman AF. Extrapulmonary tuberculosis: experience in Rajshahi chest disease clinic and chest disease hospital. TAJ: J Teachers Assoc. 2004;17(1):16-9.

Rabbi ANMA, Jahan FAJ, Aziz MM. Abdominal tuberculosis. KYAMC J. 2010;1(1):16-20.

Sultana A, Bhuiyan MSI, Bashar A, Islam MT, Rahman MM. Pattern of cutaneous tuberculosis among children and adolescent. Bangladesh Med Res Counc Bull. 2012;38:94-7.

Talukder MAS, Zakaria MM. Prevalence of Extra-pulmonary tuberculosis in hospital patients. 10th ASCON. 2002;087:117.

Chowdhury MR, Bari SMN, Islam KS, Rakibuzzaman AGM, Afrin S. Evaluation of real time pcr for the diagnosis of extrapulmonary tuberculosis and comparison with AFB microscopy among bangladeshi population. Intl J Nat Sci. 2012;2(1):26-32.

Deun AV, Salim MA, Das AP, Bastian I, Portaels F. Results of a standardised regimen for multidrug-resistant tuberculosis in Bangladesh. Int J Tuberc Lung Dis. 2004;8(5):560-7.

Amin MN, Rahman MA, Flora MS, Azad MAK. Factors associated with multidrug-resistant tuberculosis. Ibrahim Med Coll J. 2009;3(1):29-33.

Wadud AB, Rahman AS, Miah RA, Saleh AA. Drug resistance pattern of mycobacterium tuberculosis isolated from patients attending a referral hospital. Bang J Med Microbiol. 2009;03(01):13-7.

Miah MR, Ali MS, Saleh AA, Sattar H. Primary drug resistance pattern of mycobacterium tuberculosis in Dhaka, Bangladesh. Bangladesh Med Res Counc Bull. 2000;26(2):33-40.

Banu S, Mahmud AM, Rahman MT, Hossain A, Uddin MKM, Ahmed T, et al. Multidrug-resistant tuberculosis in admitted patients at a tertiary referral hospital of Bangladesh. PLoS One. 2012;7(7):e40545.

Rahman M, Kamal SMM, Mahammed FR, Alam MB, Ahasan H. Anti-tuberculosis drug resistance pattern among different category of tuberculosis patients. J Med. 2009;10:45-7.

Zaman K, Rahim Z, Yunus M, Arifeen S, Baqui A, Sack D, et al. Drug resistance of Mycobacterium tuberculosis in selected urban and rural areas in Bangladesh. Scand J Infect Dis. 2005;37:21-6.

Hussain MW, Haque MA, Ekram ARMS, Hossain M, Rahman MF. Multi-drug resistant tuberculosis in Rajshahi district. TAJ: J Teachers Assoc. 2005;18(2):113-7.

Rahman MA, Hussain MW, Alam F, Jahan MS. Multi-drug resistant tuberculosis: experience in Bogra. TAJ: J Teachers Assoc. 2005;18(1):30-6.