A Unique Case of Pretonamid Resistance on MDR TB Patient: A Case Report

Mustofa Hassen Yesuf; Getachew Mekete Diress; Abraham Eshetu Mamo; Abdurehman Seid Mohammed

doi:doi:10.11648/j.wjph.20240904.17

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A Unique Case of Pretonamid Resistance on MDR TB Patient: A Case Report

Mustofa Hassen Yesuf

, Getachew Mekete Diress

, Abraham Eshetu Mamo

, Abdurehman Seid Mohammed^*

Published in World Journal of Public Health (Volume 9, Issue 4)

Received: 12 October 2024 Accepted: 14 November 2024 Published: 28 November 2024

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Abstract

Background: Pretomanid is a novel medication that belongs to the class of nitroimid-azooxazines. The development of resistance to this novel agent not only complicates clinical management but also poses a threat to public health efforts aimed at controlling TB. This case report highlights the clinical presentation, laboratory findings, and therapeutic implications associated with a patient exhibiting pretonamid resistance. Through this examination, we aim to enhance understanding of resistance mechanisms, underscore the importance of ongoing surveillance, and advocate for refined treatment strategies in the context of MDR-TB management understanding the mechanism of this resistance is crucial for developing effective treatment strategy and improving patient outcome. Case presentation: a sixteen-year-old male patient diagnosed with rifampicin-resistant PTB (RR-PTB) after he presented with a cough of two weeks duration and he is on treatment for RR-PTB, and he is on BpaLM regimen. The third-month second-line phenotypic DST result revealed pretomanid (Pa) resistance. [Stm, INH, RIF, EMB, Pa are resistant, and Bdq, Clf, Dlm, Lfx, Lzd, and Mfx are sensitive]. Clinical Discussion: Following the hospital’s clinical panel team and national TB program expert’s discussion we changed the regimen to individualized (Lfx, Cs, Bdq, Dlm, Cfz and Lzd). Conclusion: Pretomanid resistance in humans reveals a low prevalence but highlight the need for vigilance. And since it’s the incorporated in BPaL regimine and its among the backbone of the regimen we should have to follow the resistance pattern. While facing Pretomanid resistance Consult experts, engage a physician experienced in drug-resistant TB for treatment planning and management, monitor adverse effects closely observe patients for signs of myelosuppression, peripheral neuropathy, and hepatotoxicity during treatment with the BPaL regimen. And also ensure timely susceptibility testing for all components of the BPaL regimen to guide effective treatment adjustments then go for alternative regimen.

Published in	World Journal of Public Health (Volume 9, Issue 4)
DOI	10.11648/j.wjph.20240904.17
Page(s)	380-385
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Pretomanid, Ethiopia, Addis Ababa, Tuberculosis, Multidrug Resistance

References

[1]	Bagcchi, S., WHO's global tuberculosis report 2022. The Lancet Microbe, 2023. 4(1): p. e20.
[2]	Goletti, D., et al., World Tuberculosis Day 2023 theme “Yes! We Can End TB!”. International Journal of Infectious Diseases, 2023. 130: p. S1-S3.
[3]	Min, S., et al., The global tuberculosis report 2022: key data analysis for China and the global world. Electronic Journal of Emerging Infectious Diseases, 2023. 8(1): p. 87.
[4]	Zala, D., N. Rathi, and P. Patani, Development Of Pretomanids And Their Therapeutic Uses In The Treatment Of Tuberculosis. Journal of Pharmaceutical Negative Results, 2022: p. 2307-2313.
[5]	Bennani, K., et al., Progress in programmatic management of drug-resistant TB, WHO Eastern Mediterranean Region, 2018-2023. IJTLD open, 2024. 1(9): p. 398-403.
[6]	Nedelman, J. R., et al., An exposure-response perspective on the clinical dose of pretomanid. Antimicrobial Agents and Chemotherapy, 2020. 65(1): p. https://doi.org/10.1128/aac.01121-20
[7]	Ignatius, E. H., et al., Pretomanid pharmacokinetics in the presence of rifamycins: interim results from a randomized trial among patients with tuberculosis. Antimicrobial agents and chemotherapy, 2021. 65(2): p. https://doi.org/10.1128/aac.01196-20
[8]	Stancil, S. L., F. Mirzayev, and S. M. Abdel-Rahman, Profiling pretomanid as a therapeutic option for TB infection: evidence to date. Drug Design, Development and Therapy, 2021: p. 2815-2830.
[9]	Velásquez, G. E. and P. Nahid, Promise and Peril of Pretomanid–Rifamycin Regimens for Drug-susceptible Tuberculosis. 2023, American Thoracic Society. p. 816-818.
[10]	Dooley, K. E., et al., Assessing Pretomanid for Tuberculosis (APT), a randomized phase 2 trial of pretomanid-containing regimens for drug-sensitive tuberculosis: 12-week results. American Journal of Respiratory and Critical Care Medicine, 2023. 207(7): p. 929-935.
[11]	Kannigadu, C. and D. N'Da, Recent advances in the synthesis and development of nitroaromatics as anti-infective drugs. Current Pharmaceutical Design, 2020. 26(36): p. 4658-4674.
[12]	Haley, C. A., et al., Implementation of bedaquiline, pretomanid, and linezolid in the United States: experience using a novel all-oral treatment regimen for treatment of rifampin-resistant or rifampin-intolerant tuberculosis disease. Clinical Infectious Diseases, 2023. 77(7): p. 1053-1062.
[13]	Kline, J. M., E. A. Smith, and A. Zavala, Pertussis: Common Questions and Answers. Am Fam Physician, 2021. 104(2): p. 186-192.
[14]	Zhao, B., et al., Prevalence and genetic basis of Mycobacterium tuberculosis resistance to pretomanid in China. Ann Clin Microbiol Antimicrob, 2024. 23(1): p. 40.
[15]	Nguyen, T. V. A., et al., Pretomanid resistance: An update on emergence, mechanisms and relevance for clinical practice. Int J Antimicrob Agents, 2023. 62(4): p. 106953.

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APA Style

Yesuf, M. H., Diress, G. M., Mamo, A. E., Mohammed, A. S. (2024). A Unique Case of Pretonamid Resistance on MDR TB Patient: A Case Report. World Journal of Public Health, 9(4), 380-385. https://doi.org/10.11648/j.wjph.20240904.17

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ACS Style

Yesuf, M. H.; Diress, G. M.; Mamo, A. E.; Mohammed, A. S. A Unique Case of Pretonamid Resistance on MDR TB Patient: A Case Report. World J. Public Health 2024, 9(4), 380-385. doi: 10.11648/j.wjph.20240904.17

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AMA Style

Yesuf MH, Diress GM, Mamo AE, Mohammed AS. A Unique Case of Pretonamid Resistance on MDR TB Patient: A Case Report. World J Public Health. 2024;9(4):380-385. doi: 10.11648/j.wjph.20240904.17

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@article{10.11648/j.wjph.20240904.17,
  author = {Mustofa Hassen Yesuf and Getachew Mekete Diress and Abraham Eshetu Mamo and Abdurehman Seid Mohammed},
  title = {A Unique Case of Pretonamid Resistance on MDR TB Patient: A Case Report
},
  journal = {World Journal of Public Health},
  volume = {9},
  number = {4},
  pages = {380-385},
  doi = {10.11648/j.wjph.20240904.17},
  url = {https://doi.org/10.11648/j.wjph.20240904.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjph.20240904.17},
  abstract = {Background: Pretomanid is a novel medication that belongs to the class of nitroimid-azooxazines. The development of resistance to this novel agent not only complicates clinical management but also poses a threat to public health efforts aimed at controlling TB. This case report highlights the clinical presentation, laboratory findings, and therapeutic implications associated with a patient exhibiting pretonamid resistance. Through this examination, we aim to enhance understanding of resistance mechanisms, underscore the importance of ongoing surveillance, and advocate for refined treatment strategies in the context of MDR-TB management understanding the mechanism of this resistance is crucial for developing effective treatment strategy and improving patient outcome. Case presentation: a sixteen-year-old male patient diagnosed with rifampicin-resistant PTB (RR-PTB) after he presented with a cough of two weeks duration and he is on treatment for RR-PTB, and he is on BpaLM regimen. The third-month second-line phenotypic DST result revealed pretomanid (Pa) resistance. [Stm, INH, RIF, EMB, Pa are resistant, and Bdq, Clf, Dlm, Lfx, Lzd, and Mfx are sensitive]. Clinical Discussion: Following the hospital’s clinical panel team and national TB program expert’s discussion we changed the regimen to individualized (Lfx, Cs, Bdq, Dlm, Cfz and Lzd). Conclusion: Pretomanid resistance in humans reveals a low prevalence but highlight the need for vigilance. And since it’s the incorporated in BPaL regimine and its among the backbone of the regimen we should have to follow the resistance pattern. While facing Pretomanid resistance Consult experts, engage a physician experienced in drug-resistant TB for treatment planning and management, monitor adverse effects closely observe patients for signs of myelosuppression, peripheral neuropathy, and hepatotoxicity during treatment with the BPaL regimen. And also ensure timely susceptibility testing for all components of the BPaL regimen to guide effective treatment adjustments then go for alternative regimen.
},
 year = {2024}
}

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TY  - JOUR
T1  - A Unique Case of Pretonamid Resistance on MDR TB Patient: A Case Report

AU  - Mustofa Hassen Yesuf
AU  - Getachew Mekete Diress
AU  - Abraham Eshetu Mamo
AU  - Abdurehman Seid Mohammed
Y1  - 2024/11/28
PY  - 2024
N1  - https://doi.org/10.11648/j.wjph.20240904.17
DO  - 10.11648/j.wjph.20240904.17
T2  - World Journal of Public Health
JF  - World Journal of Public Health
JO  - World Journal of Public Health
SP  - 380
EP  - 385
PB  - Science Publishing Group
SN  - 2637-6059
UR  - https://doi.org/10.11648/j.wjph.20240904.17
AB  - Background: Pretomanid is a novel medication that belongs to the class of nitroimid-azooxazines. The development of resistance to this novel agent not only complicates clinical management but also poses a threat to public health efforts aimed at controlling TB. This case report highlights the clinical presentation, laboratory findings, and therapeutic implications associated with a patient exhibiting pretonamid resistance. Through this examination, we aim to enhance understanding of resistance mechanisms, underscore the importance of ongoing surveillance, and advocate for refined treatment strategies in the context of MDR-TB management understanding the mechanism of this resistance is crucial for developing effective treatment strategy and improving patient outcome. Case presentation: a sixteen-year-old male patient diagnosed with rifampicin-resistant PTB (RR-PTB) after he presented with a cough of two weeks duration and he is on treatment for RR-PTB, and he is on BpaLM regimen. The third-month second-line phenotypic DST result revealed pretomanid (Pa) resistance. [Stm, INH, RIF, EMB, Pa are resistant, and Bdq, Clf, Dlm, Lfx, Lzd, and Mfx are sensitive]. Clinical Discussion: Following the hospital’s clinical panel team and national TB program expert’s discussion we changed the regimen to individualized (Lfx, Cs, Bdq, Dlm, Cfz and Lzd). Conclusion: Pretomanid resistance in humans reveals a low prevalence but highlight the need for vigilance. And since it’s the incorporated in BPaL regimine and its among the backbone of the regimen we should have to follow the resistance pattern. While facing Pretomanid resistance Consult experts, engage a physician experienced in drug-resistant TB for treatment planning and management, monitor adverse effects closely observe patients for signs of myelosuppression, peripheral neuropathy, and hepatotoxicity during treatment with the BPaL regimen. And also ensure timely susceptibility testing for all components of the BPaL regimen to guide effective treatment adjustments then go for alternative regimen.

VL  - 9
IS  - 4
ER  -

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Author Information

Mustofa Hassen Yesuf

Department of Internal Medicine, Saint Peter Specialized Hospital, Addis Ababa, Ethiopia

Contact Email

http://orcid.org/0009-0004-6191-4102
Getachew Mekete Diress

Department of Anesthesia, College of Health Sciences, School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia

Contact Email

http://orcid.org/0009-0006-1463-3222
Abraham Eshetu Mamo

Department of Infectious Disease, Saint Peter Specialized Hospital, Addis Ababa, Ethiopia

Contact Email

http://orcid.org/0009-0006-1747-2241
Abdurehman Seid Mohammed

Department of Public Health, Saint Peter Specialized Hospital, Addis Ababa, Ethiopia

Contact Email

http://orcid.org/0009-0003-2335-1508

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Plain Text BibTeX RIS

APA Style

Yesuf, M. H., Diress, G. M., Mamo, A. E., Mohammed, A. S. (2024). A Unique Case of Pretonamid Resistance on MDR TB Patient: A Case Report. World Journal of Public Health, 9(4), 380-385. https://doi.org/10.11648/j.wjph.20240904.17

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ACS Style

Yesuf, M. H.; Diress, G. M.; Mamo, A. E.; Mohammed, A. S. A Unique Case of Pretonamid Resistance on MDR TB Patient: A Case Report. World J. Public Health 2024, 9(4), 380-385. doi: 10.11648/j.wjph.20240904.17

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AMA Style

Yesuf MH, Diress GM, Mamo AE, Mohammed AS. A Unique Case of Pretonamid Resistance on MDR TB Patient: A Case Report. World J Public Health. 2024;9(4):380-385. doi: 10.11648/j.wjph.20240904.17

Copy | Download

@article{10.11648/j.wjph.20240904.17,
  author = {Mustofa Hassen Yesuf and Getachew Mekete Diress and Abraham Eshetu Mamo and Abdurehman Seid Mohammed},
  title = {A Unique Case of Pretonamid Resistance on MDR TB Patient: A Case Report
},
  journal = {World Journal of Public Health},
  volume = {9},
  number = {4},
  pages = {380-385},
  doi = {10.11648/j.wjph.20240904.17},
  url = {https://doi.org/10.11648/j.wjph.20240904.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjph.20240904.17},
  abstract = {Background: Pretomanid is a novel medication that belongs to the class of nitroimid-azooxazines. The development of resistance to this novel agent not only complicates clinical management but also poses a threat to public health efforts aimed at controlling TB. This case report highlights the clinical presentation, laboratory findings, and therapeutic implications associated with a patient exhibiting pretonamid resistance. Through this examination, we aim to enhance understanding of resistance mechanisms, underscore the importance of ongoing surveillance, and advocate for refined treatment strategies in the context of MDR-TB management understanding the mechanism of this resistance is crucial for developing effective treatment strategy and improving patient outcome. Case presentation: a sixteen-year-old male patient diagnosed with rifampicin-resistant PTB (RR-PTB) after he presented with a cough of two weeks duration and he is on treatment for RR-PTB, and he is on BpaLM regimen. The third-month second-line phenotypic DST result revealed pretomanid (Pa) resistance. [Stm, INH, RIF, EMB, Pa are resistant, and Bdq, Clf, Dlm, Lfx, Lzd, and Mfx are sensitive]. Clinical Discussion: Following the hospital’s clinical panel team and national TB program expert’s discussion we changed the regimen to individualized (Lfx, Cs, Bdq, Dlm, Cfz and Lzd). Conclusion: Pretomanid resistance in humans reveals a low prevalence but highlight the need for vigilance. And since it’s the incorporated in BPaL regimine and its among the backbone of the regimen we should have to follow the resistance pattern. While facing Pretomanid resistance Consult experts, engage a physician experienced in drug-resistant TB for treatment planning and management, monitor adverse effects closely observe patients for signs of myelosuppression, peripheral neuropathy, and hepatotoxicity during treatment with the BPaL regimen. And also ensure timely susceptibility testing for all components of the BPaL regimen to guide effective treatment adjustments then go for alternative regimen.
},
 year = {2024}
}

Copy | Download

TY  - JOUR
T1  - A Unique Case of Pretonamid Resistance on MDR TB Patient: A Case Report

AU  - Mustofa Hassen Yesuf
AU  - Getachew Mekete Diress
AU  - Abraham Eshetu Mamo
AU  - Abdurehman Seid Mohammed
Y1  - 2024/11/28
PY  - 2024
N1  - https://doi.org/10.11648/j.wjph.20240904.17
DO  - 10.11648/j.wjph.20240904.17
T2  - World Journal of Public Health
JF  - World Journal of Public Health
JO  - World Journal of Public Health
SP  - 380
EP  - 385
PB  - Science Publishing Group
SN  - 2637-6059
UR  - https://doi.org/10.11648/j.wjph.20240904.17
AB  - Background: Pretomanid is a novel medication that belongs to the class of nitroimid-azooxazines. The development of resistance to this novel agent not only complicates clinical management but also poses a threat to public health efforts aimed at controlling TB. This case report highlights the clinical presentation, laboratory findings, and therapeutic implications associated with a patient exhibiting pretonamid resistance. Through this examination, we aim to enhance understanding of resistance mechanisms, underscore the importance of ongoing surveillance, and advocate for refined treatment strategies in the context of MDR-TB management understanding the mechanism of this resistance is crucial for developing effective treatment strategy and improving patient outcome. Case presentation: a sixteen-year-old male patient diagnosed with rifampicin-resistant PTB (RR-PTB) after he presented with a cough of two weeks duration and he is on treatment for RR-PTB, and he is on BpaLM regimen. The third-month second-line phenotypic DST result revealed pretomanid (Pa) resistance. [Stm, INH, RIF, EMB, Pa are resistant, and Bdq, Clf, Dlm, Lfx, Lzd, and Mfx are sensitive]. Clinical Discussion: Following the hospital’s clinical panel team and national TB program expert’s discussion we changed the regimen to individualized (Lfx, Cs, Bdq, Dlm, Cfz and Lzd). Conclusion: Pretomanid resistance in humans reveals a low prevalence but highlight the need for vigilance. And since it’s the incorporated in BPaL regimine and its among the backbone of the regimen we should have to follow the resistance pattern. While facing Pretomanid resistance Consult experts, engage a physician experienced in drug-resistant TB for treatment planning and management, monitor adverse effects closely observe patients for signs of myelosuppression, peripheral neuropathy, and hepatotoxicity during treatment with the BPaL regimen. And also ensure timely susceptibility testing for all components of the BPaL regimen to guide effective treatment adjustments then go for alternative regimen.

VL  - 9
IS  - 4
ER  -

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