International Journal of Tuberculosis and Lung Disease
Volume 18, Issue 6, 2014, Pages 655-662+i-iii

Survey of tuberculosis drug resistance among Tibetan refugees in India (Article)

Salvo F.* , Dorjee K. , Dierberg K. , Cronin W. , Sadutshang T.D. , Migliori G.B. , Rodrigues C. , Trentini F. , Di Serio C. , Chaisson R. , Cirillo D.M.
  • a Emerging Pathogens Unit, San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
  • b Tibetan Delek Hospital, Central Tibetan Administration, Dharamsala, India
  • c Division of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States
  • d Maryland Department of Health and Mental Hygiene, Baltimore, MD, United States
  • e Tibetan Delek Hospital, Central Tibetan Administration, Dharamsala, India
  • f WHO Collaborating Centre for TB and Lung Diseases, Fondazione S Maugeri, Care and Research Institute, Tradate, Italy
  • g Department of Microbiology, Parmanand Deepchand Hinduja Hospital and Medical Research Centre, Mumbai, India
  • h University Center for Statistics in the Biomedical Sciences, Università Vita-Salute San Raffaele, Milan, Italy
  • i University Center for Statistics in the Biomedical Sciences, Università Vita-Salute San Raffaele, Milan, Italy
  • j Division of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, United States
  • k Emerging Pathogens Unit, San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy

Abstract

SETTING: Tuberculosis (TB) is a major health problem among Tibetans living in exile in India. Although drug-resistant TB is considered common in clinical practice, precise data are lacking. OBJECTIVE: To determine the proportion of drug-resistant cases among new and previously treated Tibetan TB patients. DESIGN: In a drug resistance survey in five Tibetan settlements in India, culture and drug susceptibility testing (DST) for first-line drugs were performed among all consecutive new and previously treated TB cases from April 2010 to September 2011. DST against kanamycin (KM), ethionamide, para-aminosalicylic acid and ofloxacin (OFX) was performed on multidrug-resistant TB (MDR-TB) isolates. RESULTS: Of 307 patients enrolled in the study, 264 (193 new and 71 previously treated) were culture-positive and had DST available. All patients tested for the human immunodeficiency virus (n = 250) were negative. Among new TB cases, 14.5% had MDR-TB and 5.7% were isoniazid (INH) monoresistant. Among previously treated cases, 31.4% had MDR-TB and 12.7% were INH-monoresistant. Of the MDR-TB isolates, 28.6% of new and 26.1% of previously treated cases were OFX-resistant, while 7.1% of new cases and 8.7% of previously treated cases were KM-resistant. Three patients had extensively drug-resistant TB. CONCLUSIONS: MDR-TB is common in new and previously treated Tibetans in India, who also show additional complex resistance patterns. Of particular concern is the high percentage of MDR-TB strains resistant to OFX, KM or both. © 2014 The Union.

Author Keywords

Tuberculosis in refugees MDR-TB Tibetan refugees Drug resistance survey

Index Keywords

monotherapy refugee India aminosalicylic acid demography human multidrug resistant tuberculosis priority journal Tibetan (people) drug susceptibility testing Human immunodeficiency virus kanamycin ofloxacin male female tuberculosis risk factor socioeconomics Article major clinical study adult isoniazid antibiotic resistance ethionamide health survey
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84901269030&doi=10.5588%2fijtld.13.0516&partnerID=40&md5=8adca3f564290ccb13d3f840ce848af9
DOI: 10.5588/ijtld.13.0516
ISSN: 10273719
Cited by: 19
Original Language: English