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Extensively drug-resistant tuberculosis - case analysis 2003/2007
Presented by Fernando Maltez, Portugal.
F. Maltez1, P. Cachado1, T. Martins1, L. Brum2, H. Peres3, J. Machado1
1Hospital Curry Cabral, Infectious Diseases, Lisbon, Portugal, 2Instituto Ricardo Jorge, Laboratório de Micobacteriologia, Lisbon, Portugal, 3Hospital Curry Cabral, Laboratório de Micobacteriologia, Lisbon, Portugal
Background: Extensively drug-resistant tuberculosis (XDR-TB) was first described in 2006 - due to Mycobacterium tuberculosis resistant to at least two main first-line tuberculosis (TB) drugs - isoniazid and rifampicin (Multidrug Resistant TB - MDR-TB) and also to fluroquinolones and any of the second-line anti-TB injectable drugs (amikacin, kanamycin or capreomycin).
Objective: Measure the proportion of patients with XDR-TB admitted in our infectious diseases’ ward between 2003 and 2007.
Methods: A retrospective study of all Bactec TB culture positive strains for 5 years. First and second-line drug resistance and validation were made in reference laboratories.
Results: We found 595 patients with culture-confirmed TB, 68 of which were MDR-TB and 17 were XDR-TB. From these 17, 82% were male, mean age 41,7 years, mean hospitalization duration 61 days. HIV1 seropositivity in 65%, 40% of which under HAART. Median CD4+ count of 116 cells/mm3. HCV seropositivity and intravenous drug abuse in 52%. Prior history of TB in 64%, 63% of which already MDR-TB. Mycobacterium tuberculosis’ isolation was made in the sputum for 88% of the patients, 6% in gastric juice and 6% in broncho-alveolar lavage. All patients had pulmonary manifestations (76% with cavitations) and 2 had extra-pulmonary (nodal). Mean time to persistent negative cultures was 49,4 days. As for first-line drug resistance, 82% were resistant to all four drugs (isoniazid, rifampin, ethambutol, pyrazinamide), 12% to 3 and 6% to 2. As for second-line drugs more than half were resistant to all injectable drugs and fluroquinolones. There were 2 fatal events. 53% were discharged after at least 3 culture-negative samples.
Conclusions: XDR-TB had an important prevalence in our study and was closely related to HIV infection. The mortality wasn’t very high, however, our data emphasize the need for better surveillance and effective treatment in all patients. If not, XDR-TB will be a serious threat to public health.
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