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Outbreak of multidrug-resistant tuberculosis - Texas, California, and Pennsylvania

Article Abstract:

The epidemiological aspects of the cases of several people who contracted pulmonary tuberculosis (TB) that was resistant to drug treatment are discussed. The index patient (first to come to medical attention) was hospitalized and treated for 14 months, but died. He was known to be in contact with four members of an extended family who were being treated for drug-resistant TB. Subsequently, eight persons in the family, and two close contacts, were diagnosed with active pulmonary TB. Another patient who died of TB, in spite of treatment, was associated with several additional infected people. Several of these people were hospitalized and became culture-negative (no signs of TB when tested), but relapsed when they left the hospital and failed to comply with treatment regimens. Outbreaks of drug-resistant TB have been reported in Mississippi, California, Montana, Nevada, Utah, and North Carolina. These outbreak involved only 10 people, but cost $950,433, a sum that vastly exceeds the yearly budget of the Fort Worth/Tarrant County Tuberculosis Control Program. To control such outbreaks, patients must be treated, and infected people need preventive therapy. An effective drug regimen should contain several drugs to which the organisms are vulnerable. Since noncompliance with TB treatment is often a problem, therapy needs supervision by a health department worker. If this is not successful, patients may need long-term hospitalization and special residential facilities, especially if they are homeless. Quarantine is the ultimate approach. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Demographic aspects, Drug resistance

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Initial therapy for tuberculosis in the era of multidrug resistance: recommendations of the advisory council for the elimination of tuberculosis

Article Abstract:

The Centers for Disease Control and Prevention (CDC) and the American Thoracic Society (ATS) have recommended certain treatments for patients with tuberculosis (TB). The number of patients newly diagnosed with TB started to increase in 1985 after declining for many years. One of the main problems encountered in the treatment of TB is the increased incidence of multidrug resistance. The CDC and ATS recommend that a sample of Mycobacterium be removed from each TB patient and tested for drug susceptibility in the laboratory. Mycobacterium is the bacterium that causes TB. Patients should initially be treated with a combination of four drugs rather than only one drug. Patients should be monitored closely during the initial stages of treatment. These guidelines will hopefully reduce the incidence of multidrug resistance and treatment failure among TB patients.

Health aspects, Antitubercular agents

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