Prevalence of Drug Resistant Tuberculosis Examined

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The Acting HOD in UKZN’s Department of Medicine, Dr Nombulelo Magula, presented her study titled: “Prevalence of Drug Resistant Tuberculosis in Patients Presenting with a Large Pericardial Effusion at King Edward VIII Hospital”, at the College of Health Sciences Research Symposium.

The study aimed to determine the prevalence of drug resistant tuberculosis in patients admitted at King Edward VIII Hospital with a pericardial effusion.

According to Magula, the prevalence of drug resistant tuberculosis is high in South Africa but its frequency in patients with pericardial tuberculosis is unknown: ‘The burden of TB in South Africa is severe and its intersection with HIV leads to unusual and complicated forms of TB. The study highlights the importance of performing invasive investigations to confirm the diagnosis of TB pericarditis. Failure to do so might lead to inappropriate therapy and unfavourable outcomes.

The study focused on the management of TB pericarditis which, according to Magula is a dangerous form of TB that can cause fluid build-up and compression of the heart killing a quarter of those who contract it. ‘Drug resistant TB is a type that does not respond to standard medications and is more difficult to treat.’

A cross sectional study was conducted on adult participants with a clinical diagnosis of TB pericarditis who enrolled in the Investigation of the Management of Pericarditis (IMPI) study from October 2009 to August 2013. Diagnostic and therapeutic pericardiocentesis was performed where suitable as well as biochemistry, microscopy, liquid culture (MGIT 960), line probe assay and cytology.

Magula’s research was a sub-study of a much larger clinical trial on the use of steroids in treating TB pericarditis. The clinical trial found that the addition of steroids to TB treatment in patients with TB pericarditis made no difference to their mortality rate. ‘More importantly, in HIV infected patients, steroid treatment increased the risk of cancer. However, steroids offered benefit by reducing fibrosis and scarring around the heart,’ she explained.

Central to the clinical trial was establishing the diagnosis of TB pericarditis. The goal of the sub-study was to establish the prevalence of drug resistant TB. ‘We aspirated the fluid collection caused by TB around the heart (pericardiocentesis). Laboratory tests found Multi-drug and Extremely drug resistant TB in 10% of patients who had TB identified by microscopy or culture.’

According to Magula the clinical trial was the first multi-national trial of TB pericarditis and the largest trial of the use of steroid therapy in HIV-associated TB.

‘Identification of drug resistant TB following pericardiocentesis, underscores the importance of performing this procedure in patients with a presumed diagnosis of TB.’

The parent study enrolled 1 400 patients with TB pericarditis from 19 hospitals in eight African countries.

Magula, who said research funding was a major challenge in conducting the study, is currently finalising her PhD thesis on “Metabolic Complications of Antiretroviral Therapy” supervised by Professor Umesh Lalloo and Professor Ayesha Motala.

She is Head of the Clinical Unit at King Edward VIII Hospital, a lecturer at UKZN and a member of Council of the College of Physicians of South Africa.

Magula received an award for best Clinical Oral Presentation at this year’s 49th Congress of the Society for Endocrinology, Metabolism and Diabetes of South Africa for her PhD work.

She also received an award at the 16th International Congress on Infectious Diseases and was invited to present her PhD work at the Emerging African Investigators Symposium. The Medical Research Council has granted her funding to pursue further research on Metabolic Complications beyond her PhD thesis.

Married to an ENT surgeon, Magula has three daughters and is a host-mother to a “daughter” from Michigan on a long-term Rotary exchange.

Running keeps the KwaMashu-born Magula going. ‘Running up hills really does it for me, the steeper the hill the better. I also enjoy gardening and baking.’

Nombuso Dlamini