Tuberculosis burden in households of patients with multidrug-resistant and extensively drug-resistant tuberculosis: a retrospective cohort study

Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis have emerged as major global health threats. WHO recommends contact investigation in close contacts of patients with MDR and XDR tuberculosis. We aimed to assess the burden of tuberculosis disease in household contacts of su...

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Bibliographic Details
Published in:The Lancet (British edition) Vol. 377; no. 9760; pp. 147 - 152
Main Authors: Becerra, Mercedes C, Appleton, Sasha C, Franke, Molly F, Chalco, Katiuska, Arteaga, Fernando, Bayona, Jaime, Murray, Megan, Atwood, Sidney S, Mitnick, Carole D
Format: Journal Article
Language:English
Published: Kidlington Elsevier Ltd 08.01.2011
Elsevier
Elsevier Limited
Subjects:
Adolescent
Adult
Aged
Antitubercular Agents - pharmacology
Antitubercular Agents - therapeutic use
Bacterial diseases
Biological and medical sciences
Child
Cohort Studies
Contact Tracing
Cost of Illness
Data collection
drugs
Extensively Drug-Resistant Tuberculosis - epidemiology
Family Characteristics
Female
General aspects
Global health
Health risks
Households
Human bacterial diseases
Humans
Infection Control - methods
Infectious diseases
Internal Medicine
Male
Medical sciences
Middle Aged
Miscellaneous
multiple drug resistance
Mycobacterium tuberculosis
Mycobacterium tuberculosis - isolation & purification
patients
Peru
Peru - epidemiology
Population Surveillance - methods
Prevalence
Public health
Public health. Hygiene
Public health. Hygiene-occupational medicine
Retrospective Studies
risk
Studies
Tuberculosis
Tuberculosis and atypical mycobacterial infections
Tuberculosis, Multidrug-Resistant - epidemiology
Tuberculosis, Pulmonary - epidemiology
World Health Organization
Young Adult
Peru
Argentina, Buenos Aire, Lima
Human
Treatment resistance
Household
Patient
Retrospective study
Mycobacterial infection
Infection
Medicine
Tuberculosis
Cohort study
Multiple resistance
Bacteriosis
Public health
ISSN:0140-6736, 1474-547X, 1474-547X
Online Access:Get full text
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Summary:Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis have emerged as major global health threats. WHO recommends contact investigation in close contacts of patients with MDR and XDR tuberculosis. We aimed to assess the burden of tuberculosis disease in household contacts of such patients. We undertook a retrospective cohort study of household contacts of patients treated for MDR or XDR tuberculosis in Lima, Peru, in 1996–2003. The primary outcome was active tuberculosis in household contacts at the time the index patient began MDR tuberculosis treatment and during the 4-year follow-up. We examined whether the occurrence of active tuberculosis in the household contacts differed by resistance pattern of the index patient: either MDR or XDR tuberculosis. 693 households of index patients with MDR tuberculosis were enrolled in the study. In 48 households, the Mycobacterium tuberculosis isolate from the index patient was XDR. Of the 4503 household contacts, 117 (2·60%) had active tuberculosis at the time the index patient began MDR tuberculosis treatment—there was no difference in prevalence between XDR and MDR tuberculosis households. During the 4-year follow-up, 242 contacts developed active tuberculosis—the frequency of active tuberculosis was nearly two times higher in contacts of patients with XDR tuberculosis than it was in contacts of patients with MDR tuberculosis (hazard ratio 1·88, 95% CI 1·10–3·21). In the 359 contacts with active tuberculosis, 142 (40%) had had isolates tested for resistance against first-line drugs, of whom 129 (90·9%, 95% CI 85·0–94·6) had MDR tuberculosis. In view of the high risk of disease recorded in household contacts of patients with MDR or XDR tuberculosis, tuberculosis programmes should implement systematic household contact investigations for all patients identified as having MDR or XDR tuberculosis. If shown to have active tuberculosis, these household contacts should be suspected as having MDR tuberculosis until proven otherwise. The Charles H Hood Foundation, the David Rockefeller Center for Latin American Studies at Harvard University, and the Bill & Melinda Gates Foundation.
Bibliography:http://dx.doi.org/10.1016/S0140-6736(10)61972-1
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ISSN:0140-6736
1474-547X
1474-547X
DOI:10.1016/S0140-6736(10)61972-1