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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 3  |  Issue : 3  |  Page : 147-149

Drug-resistant tuberculosis and cross-border patient: A retrospective analysis from a Thailand–Myanmar border area


1 TWS Medical Center, Bangkok, Thailand
2 Department of Community Medicine, Dr. D. Y. Patil University, Pune, Maharashtra, India

Date of Submission16-Jun-2019
Date of Decision26-Jun-2019
Date of Acceptance30-Jul-2019
Date of Web Publication10-Sep-2019

Correspondence Address:
Dr. Pathum Sookaromdee
TWS Medical Center, Bangkok
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bbrj.bbrj_84_19

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  Abstract 


Background: Drug-resistant tuberculosis becomes an important clinical problem in clinical mycobacteriology. The high incidence of drug-resistant tuberculosis is presently reported from Indochina, a tropical zone of the world. Methods: This work is a retrospective study on the available epidemiological data regarding drug-resistant tuberculosis in a Thailand–Myanmar border area. Results: The change of incidence of tuberculosis and drug-resistant tuberculosis can be demonstrated. The cross-border patient contributes to an important proportion of overall cases with tuberculosis and drug-resistant tuberculosis in this setting. Conclusion: Cross-border patient can affect the local situation of drug-resistant tuberculosis. To have a specific action regarding tuberculosis control for the cross-border patient is very important.

Keywords: Border, drug, Myanmar, resistant, Thailand, tuberculosis


How to cite this article:
Sookaromdee P, Wiwanitkit V. Drug-resistant tuberculosis and cross-border patient: A retrospective analysis from a Thailand–Myanmar border area. Biomed Biotechnol Res J 2019;3:147-9

How to cite this URL:
Sookaromdee P, Wiwanitkit V. Drug-resistant tuberculosis and cross-border patient: A retrospective analysis from a Thailand–Myanmar border area. Biomed Biotechnol Res J [serial online] 2019 [cited 2019 Nov 20];3:147-9. Available from: http://www.bmbtrj.org/text.asp?2019/3/3/147/266567




  Introduction Top


Tuberculosis is an important mycobacterial infection. This infection can be seen around the world, and it is still an important public health problem globally. The infection can result in chronic infection and leads to several clinical complications. The chronically ill patient might get a great suffer, and death might be the final result. An important emerging clinical problem for the management of tuberculosis is drug resistance. Drug-resistant tuberculosis already exists in several areas around the world.[1] The problem is already seen in Indochina, a tropical zone of the world. In Southeast Asia, tuberculosis is common. The high incidence of drug-resistant tuberculosis is observable in this area, and there is a high incidence rate among HIV-infected patients.[2]

In Indochina, tuberculosis is still an important local public health threatening.[3] The emerging drug-resistant tuberculosis superimposes the situation to be more problematic. At the areas between international borders of countries in Indochina, the basic health-care system is usually poor, and there are several problematic local endemic infections including to tuberculosis.[4] In the present study, the authors focus on the epidemiology of drug-resistant tuberculosis and cross-border patients. A retrospective analysis from a Thailand–Myanmar border area is performed.


  Methods Top


This study is a retrospective study on the available epidemiological data regarding drug-resistant tuberculosis in a Thailand–Myanmar border area. The work is an epidemiological analysis on primary public available data and does not deal with any human, animal, or clinical sample and requires no ethical approval. The primary data regarding number of patients with tuberculosis and drug-resistant tuberculosis reported from a local district hospital, namely Mae Sot Hospital, Tak province, Thailand, during a 5-year period, 2011–2015, were used for further retrospective study. The setting is a specific international border area between Thailand and Myanmar [Figure 1].
Figure 1: Map showing the study setting. Pink circle is the Mae Sot district

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The specific data focusing on number of tuberculosis and drug-resistant tuberculosis are specifically analyzed. Categorizing of the patient to be local Thai and cross-border patients from Myanmar is done before incidence analysis. The incidence of tuberculosis and drug-resistant tuberculosis is determined. The valid percentage is used for calculation of rate when it is appropriate. To assess the relationship between nationality of the patients and antituberculosis drug resistant, the Chi-square test is applied.


  Results Top


According to the study, there are 1515 tuberculosis patients (581 Thai patients (38.35%) and 934 patients (61.65%)). During the 5-year period, the change in the incidence of tuberculosis can be demonstrated [Figure 2]. The cross-border patients contribute to an important proportion of overall cases with tuberculosis and drug-resistant tuberculosis in this setting.
Figure 2: Incidence of tuberculosis cases during the 5-year period

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Regarding drug-resistant tuberculosis, there are 39 cases (2.57%). Focusing on drug-resistant tuberculosis, from 39 cases (100%), there are 7 Thai (17.95%) and 32 Myanmar patients (82.05%), respectively. The rates of drug-resistant tuberculosis to overall tuberculosis cases for Thai and Myanmar patients are equal to 1.2% and 3.43%, respectively. There is a significant relationship between nationality of the patient and drug resistant (Chi-square test, P < 0.05) [Table 1].
Table 1: Incidence of tuberculosis and drug-resistant tuberculosis

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  Discussion Top


Basically, the management of tuberculosis required antituberculosis drug. The complete drug therapy becomes the main important critical point for success in treatment and control of tuberculosis. Nevertheless, failure in treatment and control is not uncommon and the problem becomes the present important public health issue. The improper drug treatment program and the genetic mutation are important factors contributing to the resistant of the Mycobacterium pathogen to the antituberculosis drug.[5] With drug resistant, the management of the disease by standard antituberculosis drug regimen usually fails.[5] As noted by Pokam et al., a good public health plan is needed for proper management of the emerging drug-resistant tuberculosis problem.[6] The implementation of good diagnostic system and guidelines for proper antituberculosis drug use is very important.[7]

The drug-resistant tuberculosis emerges around the world. The problem becomes a serious local problem in Southeast Asia. The rapidly increased number of drug-resistant tuberculosis draws attention from the medical society. The WHO documented this area is one of the important endemic areas of tuberculosis to be managed. As noted by Li et al., there is still a requirement for improvement of health education via several media aiming at successful control of tuberculosis among migrant people in Indochina.[8] In the present report, the authors focus on the incidence of tuberculosis and drug-resistant tuberculosis among patients receiving treatment from a main local hospital at the Thailand–Myanmar border area. This area is well documented for the high incidence of drug-resistant tuberculosis.[9] Both smear-positive and smear-negative tuberculosis cases are detected in this area and require proper antituberculosis drug treatment.[10] As noted by Joob and Wiwanitkit, there is a high incidence of children at Thailand–Myanmar border area who are prone to tuberculosis infection.[11]

Based on the available data, it can show that both local Thai and cross-borer Myanmar patients have tuberculosis. The high proportion of Myanmar patients should be noted. The increased number of the cross-border patients can be seen. The main proportion of drug-resistant tuberculosis is from cross-border Myanmar patients. This result is concordant with a recent report by Tschirhart et al.[12] In fact, the similar problem is also observable in border areas in developing countries in Asia. The good example is the high incidence of drug-resistant tuberculosis in Northern states of India which share the international border with other Asian countries.[13]

Due to the humanity welfare concept, the local hospital has to give care to all patients, including to cross-border patients. Nevertheless, the important consideration is difficult in disease control. The monitoring of drug intake and compliance for the cross-border tuberculosis patient is usually difficult. Due to international border barrier and the local poor infrastructure in remote border area, it is sometimes difficult to monitor the case. Planning for community disease control is also difficult when an indexed patient is detected.[12],[14],[15]

How to promote a good system, linking collaboration between local health-care workers at border areas of both Thailand, Myanmar, to become effective partner for tuberculosis control, and management is an interesting future plan.[12],[14],[15] Indeed, the international cross-border referral system and follow-up monitoring is the important consideration for success in international tuberculosis border control at present.[16] Finally, it should also not forget to have a parallel public health manipulation to manage of problem that might increase the risk of tuberculosis in the same area such as the environmental pollution.[17]


  Conclusion Top


Based on the data analysis, cross-border patient results in the fluctuation of the local situation of drug-resistant tuberculosis. It is necessary to have a specific action regarding tuberculosis control for cross-border patient is very important.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Khan MK, Islam MN, Ferdous J, Alam MM. An overview on epidemiology of tuberculosis. Mymensingh Med J 2019;28:259-66.  Back to cited text no. 1
    
2.
Solante MB, Chagan-Yasutan H, Hattori T, Leano S, Garfin AG, Soolingen DV, Telan E. High rates of human immunodeficiency virus and drug resistance in tuberculosis patients in Manila, Philippines. Biomed Biotechnol Res J 2017;1:157-62.  Back to cited text no. 2
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3.
Hanson C, Osberg M, Brown J, Durham G, Chin DP. Finding the missing patients with tuberculosis: Lessons learned from patient-pathway analyses in 5 countries. J Infect Dis 2017;216:S686-95.  Back to cited text no. 3
    
4.
Sharma P, Lalwani J, Pandey P, Thakur A. Factors associated with the development of secondary multidrug-resistant tuberculosis. Int J Prev Med 2019;10:67.  Back to cited text no. 4
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5.
al-Orainey IO. Drug resistance in tuberculosis. J Chemother 1990;2:147-51.  Back to cited text no. 5
    
6.
Pokam BT, Asuquo AE, Abia-Bassey LN, Idasa MB, Umoh NO, Eko FO, et al. Multidrug resistance and demography of newly diagnosed tuberculosis patients in cross river state, Nigeria. Int J Mycobacteriol 2013;2:89-93.  Back to cited text no. 6
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7.
Yasri S, Wiwanitkit V. Knowledge on tuberculosis in rural Myanmar. Int J Mycobacteriol 2017;6:412-3.  Back to cited text no. 7
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8.
Qi Z, Yang W, Wang YF, Liu C. Pulmonary tuberculosis incidence and drug resistance-related factors analysis in North China. Biomed Biotechnol Res J 2019;3:46-52.  Back to cited text no. 8
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9.
Wise J. WHO identifies 16 countries struggling to control tuberculosis. BMJ 1998;316:957.  Back to cited text no. 9
    
10.
Sookaromdee P, Wiwanitkit V. Smear-negative pulmonary tuberculosis: Relative incidence and outcome of treatment in a drug-resistant endemic setting in Indochina. Biomed Biotechnol Res J 2019;3:109-10.  Back to cited text no. 10
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11.
Joob B, Wiwanitkit V. Rate of children at Thailand–Myanmar border area prone to tuberculosis infection: An epidemiological prediction with referencing to bacillus Calmette–Guerin vaccination in Thailand. Biomed Biotechnol Res J 2019;3:42-5.  Back to cited text no. 11
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12.
Tschirhart N, Nosten F, Foster AM. Migrant tuberculosis patient needs and health system response along the Thailand-Myanmar border. Health Policy Plan 2017;32:1212-9.  Back to cited text no. 12
    
13.
Kumar A, Singh AK, Upadhyay V, Pandey J. Epidemiology of multi-drug-resistant tuberculosis in Northern India. Biomed Biotechnol Res J 2018;2:112-21.  Back to cited text no. 13
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14.
Thi SS, Parker DM, Swe LL, Pukrittayakamee S, Ling CL, Amornpaisarnloet K, et al. Migration histories of multidrug-resistant tuberculosis patients from the Thailand-Myanmar border, 2012-2014. Int J Tuberc Lung Dis 2017;21:753-8.  Back to cited text no. 14
    
15.
Tschirhart N, Thi SS, Swe LL, Nosten F, Foster AM. Treating the invisible: Gaps and opportunities for enhanced TB control along the Thailand-Myanmar border. BMC Health Serv Res 2017;17:29.  Back to cited text no. 15
    
16.
Ohkado A, Querri A, Shimamura T, Ota M, Celina Garfin AM. Referral and treatment outcomes of tuberculosis patients who crossed the border from Japan to the Philippines. Int J Mycobacteriol 2019;8:180-4.  Back to cited text no. 16
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Joob B, Wiwanitkit V. Incidence of pulmonary tuberculosis and particulate matter 2.5 pollutant level: The association analysis for 2019 air pollution Crisis, Bangkok Thailand. Biomed Biotechnol Res J 2019;3:126-8.  Back to cited text no. 17
  [Full text]  


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