Long term follow-up of drug resistant and drug susceptible tuberculosis contacts in a Low incidence setting

BMC Infectious Diseases

Mark Fitzgerald⁴  Victoria Cook⁴  Patrick Tang²  Kevin Elwood³  Amir Ibrahim⁴  Andrew Admon¹  James Johnston⁴ 

[1] Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, 48109, USA;Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada;Division of Tuberculosis Control, British Columbia Centre for Disease Control, Vancouver, BC, Canada;Department of Medicine, University of British Columbia, Vancouver, BC, Canada

关键词: Latent tuberculosis;    Epidemiology;    Contact investigation;    Multidrug-resistant;    Tuberculosis;   

Others  :  1159625
DOI  :  10.1186/1471-2334-12-266

 received in 2012-02-08, accepted in 2012-10-18,  发布年份 2012

【 摘 要 】

Background

Studies examining the transmission of multidrug-resistant tuberculosis (MDR-TB) strains have yielded conflicting results.

Methods

We examined transmission of MDR-TB strains using contact tracing data from a low incidence setting. Contacts of MDR-TB cases diagnosed in British Columbia, Canada, from 1990-2008 were identified through a provincial tuberculosis (TB) registry. Tuberculin skin test (TST) results and TB disease incident rates were determined for contacts. For comparison, TB disease incident rates and TST results were measured in close contacts of isoniazid mono-resistant (HMR-TB) and drug susceptible TB (DS-TB) cases.

Results

Of 89 identified close contacts of MDR-TB patients, 5 patients (6%) developed TB disease and 42 (47%) were TST positive. The incidence rate of TB disease (3%, p = 0.31) and TST positivity (49%, p = 0.82) were similar in contacts of HMR-TB cases. Compared with MDR-TB contacts, DS-TB contacts had lower incidence rate of TB disease (2%, p = 0.04) and TST positivity (32%, p < 0.01). All MDR-TB contacts with culture positive TB diagnosed in follow-up were drug-susceptible; three of six HMR-TB contacts with culture positive TB were HMR-TB. Multivariate analysis demonstrated that contact with MDR-TB (adjusted OR 1.72; 95%CI 1.05-2.81) and HMR-TB (adjusted OR 1.99; 95%CI 1.48-2.67) was associated with TST positivity. In addition, adult age, male gender, BCG positivity, source case sputum smear positivity, foreign birth and fewer contacts per source case were significantly associated with TST positivity in the multivariate model.

Conclusion

Contacts of MDR-TB and HMR-TB patients in a low incidence setting show high rates of TST positivity and TB disease but low rates of drug resistance.

【 授权许可】

   
2012 Johnston et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]World Health Organization. Multidrug and extensively drug-resistant TB (M/XDR-TB): 2010 Global report on surveillance and response. 2011. Available from: http://whqlibdoc.who.int/publications/2010/9789241599191_eng.pdf webcite
• [2]Johnston JC, Shahidi NC, Sadatsafavi M, Fitzgerald JM: Treatment outcomes of multidrug-resistant tuberculosis: a systematic review and meta-analysis. PLoS One 2009, 4:e6914.
• [3]Gandhi NR, Nunn P, Dheda K, Schaaf HS, Zignol M, van Soolingen D, et al.: Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis. Lancet 2010, 375:1830-1843.
• [4]Borrell S, Gagneux S: Infectiousness, reproductive fitness and evolution of drug-resistant Mycobacterium tuberculosis. Int J Tuberc Lung Dis 2009, 13:1456-1466.
• [5]Dye C, Williams BG, Espinal MA, Raviglione MC: Erasing the world’s slow stain: strategies to beat multidrug-resistant tuberculosis. Science 2002, 295:2042-2046.
• [6]Garcia-Garcia ML, Ponce De Leon A, Jimenez-Corona ME, Jimenez-Corona A, Palacios-Martinez M, Balandrano-Campos S, et al.: Clinical consequences and transmissibility of drug-resistant tuberculosis in southern Mexico. Arch Intern Med 2000, 160:630-636.
• [7]Toungoussova OS, Sandven P, Mariandyshev AO, Nizovtseva NI, Bjune G, Caugant DA: Spread of drug-resistant Mycobacterium tuberculosis strains of the Beijing genotype in the Archangel Oblast, Russia. J Clin Microbiol 2002, 40:1930-1937.
• [8]Burgos M, DeRiemer K, Small PM, Hopewell PC, Daley CL: Effect of drug resistance on the generation of secondary cases of tuberculosis. J Infect Dis 2003, 188:1878-1884.
• [9]Fandinho FC, Kritski AL, Hofer C, Junior Conde H, Ferreira RM, Saad MH, et al.: RFLP patterns and risk factors for recent tuberculosis transmission among hospitalized tuberculosis patients in Rio de Janeiro, Brazil. Trans R Soc Trop Med Hyg 2000, 94:271-275.
• [10]Vazquez-Gallardo R, Anibarro L, Fernandez-Villar A, Diaz-Cabanela D, Cruz-Ferro E, del Molino ML P, et al.: Multidrug-resistant tuberculosis in a low-incidence region shows a high rate of transmission. Int J Tuberc Lung Dis 2007, 11:429-435.
• [11]Godfrey-Faussett P, Sonnenberg P, Shearer SC, Bruce MC, Mee C, Morris L, et al.: Tuberculosis control and molecular epidemiology in a South African gold-mining community. Lancet 2000, 356:1066-1071.
• [12]Nitta AT, Knowles LS, Kim J, Lehnkering EL, Borenstein LA, Davidson PT, et al.: Limited transmission of multidrug-resistant tuberculosis despite a high proportion of infectious cases in Los Angeles County, California. Am J Respir Crit Care Med 2002, 165:812-817.
• [13]Attamna A, Chemtob D, Attamna S, Fraser A, Rorman E, Paul M, et al.: Risk of tuberculosis in close contacts of patients with multidrug resistant tuberculosis: a nationwide cohort. Thorax 2009, 64:271.
• [14]Teixeira L, Perkins MD, Johnson JL, Keller R, Palaci M, Do Valle Dettoni V, et al.: Infection and disease among household contacts of patients with multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2001, 5:321-328.
• [15]Kritski AL, Marques MJ, Rabahi MF, Vieira MA, Werneck-Barroso E, Carvalho CE, et al.: Transmission of tuberculosis to close contacts of patients with multidrug-resistant tuberculosis. Am J Respir Crit Care Med 1996, 153:331-335.
• [16]Becerra MC, Appleton SC, Franke MF, Chalco K, Arteaga F, Bayona J, et al.: Tuberculosis burden in households of patients with multidrug-resistant and extensively drug-resistant tuberculosis: a retrospective cohort study. Lancet 2011, 377:147-152.
• [17]Singla N, Singla R, Jain G, Habib L, Behera D, et al.: Tuberculosis among household contacts of multidrug-resistant tuberculosis patients in Delhi, India. Int J Tuberc Lung Dis 2011, 15(10):1326-1330.
• [18]Grandjean L, Crossa A, Gilman RH, Herrera C, Bonilla C, Jave O, et al.: Tuberculosis in household contacts of multidrug-resistant tuberculosis patients. Int J Tuberc Lung Dis 2011, 15(9):1164-1169.
• [19]Vella V, Racalbuto V, Guerra R, Marra C, Moll A, Mhlanga Z, et al.: Household contact investigation of multidrug-resistant and extensively drug-resistant tuberculosis in a high HIV prevalence setting. Int J Tuberc Lung Dis 2011, 15(9):1170-1175.
• [20]Bayona J, Chavez-Pachas A, Palacios E, Llaro K, Sapag R, Becerra MC: Contact investigation as a means of detection and timely treatment of persons with infectious multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2003, 7:S501-S509.
• [21]World Health Organization: Antituberculosis drug resistance in the world: fourth global report. Geneva: World Health Organization; 2008.
• [22]BCCDC: Annual Report 2004-2008. Vancouver: BC Centre for Disease Control; 2008.
• [23]Fraser A, Paul M, Attamna A, Leibovici L: Treatment of latent tuberculosis in persons at risk for multidrug-resistant tuberculosis: systematic review. Int J Tuberc Lung Dis 2006, 10:19-23.
• [24]Long R, Ellis E: Canadian tuberculosis standards. 6th edition. 2010. [Tuberculosis committee of the Canadian thoracic society of the Canadian lung association] Available from: http://www.phac-aspc.gc.ca/tbpc-latb/pubs/tbstand07-eng.php webcite
• [25]Clinical and Laboratory Standards Institute (CLSI): Susceptibility testing of mycobacteria, nocardiae, and other aerobic actinomycetes; approved standard. 2nd edition. Wayne, PA, USA: CLSI; 2011:M24-A2.
• [26]Zwerling A, Behr MAV, Brewer T, Menzies D, Pai M: BCG world atlas [internet]. Available from: http://www.bcgatlas.org webcite
• [27]Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a Joint Statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC): This statement was endorsed by the council of the infectious diseases society of America. (IDSA), September 1999, and the sections of this statement. Am J Respir Crit Care Med 2000, 161:S221-S247.
• [28]World Health Organization: Guidelines for the programmatic management of drug-resistant tuberculosis. [Internet]. 2011. Available from: http://www.stoptb.org/assets/documents/resources/publications/technical/tb_guidelines.pdf webcite
• [29]Fraser A, Paul M, Attamna A, Leibovici L: Drugs for preventing tuberculosis in people at risk of multiple-drug-resistant pulmonary tuberculosis. Cochrane Database of Systematic Reviews 2006, 19(2):CD005435.
• [30]Papastavros T, Dolovich LR, Holbrook A, Whitehead L, Loeb M: Adverse events associated with pyrazinamide and levofloxacin in the treatment of latent multidrug-resistant tuberculosis. CMAJ 2002, 167:131-136.
• [31]Horn DL, Hewlett D, Alfalla C, Peterson S, Opal SM: Limited tolerance of ofloxacin and pyrazinamide prophylaxis against tuberculosis. N Engl J Med 1994, 330:1241.
• [32]Younossian AB, Rochat T, Ketterer JP, Wacker J, Janssens JP: High hepatotoxicity of pyrazinamide and ethambutol for treatment of latent tuberculosis. Eur Respir J 2005, 26:462-464.
• [33]Cohen T, Lipsitch M, Walensky RP, Murray M: Beneficial and perverse effects of isoniazid preventive therapy for latent tuberculosis infection in HIV-tuberculosis coinfected populations. Proc Natl Acad Sci U S A 2006, 103:7042-7047.
• [34]Warren RM, Victor TC, Streicher EM, Richardson M, Beyers N, van Pittius NC G, et al.: Patients with active tuberculosis often have different strains in the same sputum specimen. Am J Respir Crit Care Med 2004, 169:610-614.
• [35]van Rie A, Victor TC, Richardson M, Johnson R, van der Spuy GD, Murray EJ, et al.: Reinfection and mixed infection cause changing Mycobacterium tuberculosis drug-resistance patterns. Am J Respir Crit Care Med 2005, 172:636-642.
• [36]Colijn C, Cohen T, Murray M: Latent coinfection and the maintenance of strain diversity. Bull Math Biol 2009, 71:247-263.
• [37]Behr MA: Tuberculosis due to multiple strains: a concern for the patient? A concern for tuberculosis control? Am J Respir Crit Care Med 2004, 169:554-555.
• [38]Behr MA, Hopewell PC, Paz EA, Kawamura LM, Schecter GF, Small PM: Predictive value of contact investigation for identifying recent transmission of Mycobacterium tuberculosis. Am J Respir Crit Care Med 1998, 158:465-469.