MDR MANAGEMENT LABORATORY SERVICES

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MDR MANAGEMENTLABORATORY SERVICES

• BY
• Dr Mtanios Saade-NTP Manager Lebanon
• Cairo November 2007

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Organization of Laboratory network in Lebanon 1

• Provincial level includes 6 public lab
  performing smear examination (free of charge) .
  They are annexed to the 6 TB centers (2 in the
  South, 2 in the Bekaa, one in the North and one
  in Mont Lebanon)
• Central level includes
• - 2 public lab performing ( free of charge)
  smear examination . They are annexed to the 2 TB
  centers in the capital Beirut
• - one private national reference lab
  (American hospital of Beirut) performing smear,
  culture and identification (Mycobacterium
  tuberculosis or MOTT) , first line anti-TB drugs
  DST ,Training and supervision, EQA and OR ,
  beside other laboratory services Hematology,
  biochemistry, serology and urine analysis.

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Organization of Laboratory network in Lebanon 2

• 8 public lab and 68 private lab distributed in
  the whole country (provincial and central level)
  performing smear and other laboratory services,
  among them 4 doing culture.
• Geographical coverage One lab for 50 000
  people.
• the laboratory Network is used
• - To diagnose TB.
• - To monitor effectiveness of treatment.
• - To revise the TB regimen
• - And to evaluate the outcome of smear TB
  cases (classical and MDR TB cases)

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Role of the laboratory network in the resistance
pattern

• Microscopy prove the presence of the
  mycobacterium
• Identification distinguish between the
  different species of mycobacterium
• Culture prove the existence and the viability of
  bacilli
• DST Determine sensitivity or resistance to first
  and second line drugs

• At least 2 sputum specimens (ISTC) should be
  submitted in good conditions to the lab for
  microscopy (ziel -nelson) .
• Culture use 2 medias, one solid (LJ) and the
  BACTEC Machine. The result by BACTEC is given
  within 10 to 14 days and differentiate the
  mycobacterium complex from the MOTT.
• DST, confirm sensitivity or resistance to any of
  first line anti-TB drugs (INH, Rifa, Ethambutol
  and Streptomycin) and clarify MDR (resistance at
  least to INH and rifampicine).

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Patients eligible to DST(MDR?)

• NEW CASES
• SMEAR STILL POSTIVE AT THE END OF THE 3rd MONTH
• SMEAR POSITIVE IN CONTACT WITH MDR-TB PATIENT
• FAILURE AFTER THE END OF THE 5TH MONTH
• RETURN AFTER DEFAULTER (more than 2 months)

• PREVIOUSLY TREATED
• CASES
• RELAPSE AFTER A FULL COURSE OF TREATMENT OR
  RETREATMENT
• CHRONIC CASES

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Follow up - Monitoring and Supervision

• During the intensive phase, on monthly basis
• 1-Smear and culture
• 2-blood analysis (liver kidney)

• During the continuation phase
• 1-perform smear and culture examination every 2
  months
• 2- other examinations if needed

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DOTS- plus strategy in Lebanon

• From May 2005 till October 2007, 12 patients were
  enrolled to the strategy(9 in 2005,2 in 2006, 2
  in 2007) and followed the standard regimen
  adopted for MDR TB patients in Lebanon ,plus one
  patient that his initial phase was started in
  Jordan (Total13)
• Result 5 cured (included patient that started
  his treatment in Jordan) ,1 defaulter with S-,6
  under treatment, 1 still positive.
• 11 out of the 12 patients converse their smear
  and culture between the 3rd and the 6th month of
  treatment except one who is still positive.

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Thank you