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Spread of extensively drug-resistant tuberculosis in KwaZulu-Natal province, South Africa.

Moodley P, Shah NS, Tayob N, Connolly C, Zetola N, Gandhi N, Friedland G, Sturm AW - PLoS ONE (2011)

Bottom Line: Drug-susceptibility test results for isoniazid, rifampicin, ethambutol, streptomycin, kanamycin and ofloxacin were available for all patients as well as the location of the hospital where their clinical diagnosis was made.Four hundred and forty three (11%) of the MDR tuberculosis cases displayed the XDR tuberculosis susceptibility profile.Only 1429 (34%) of the MDR-TB patients were seen at the provincial referral hospital for treatment.

View Article: PubMed Central - PubMed

Affiliation: KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH), Durban, South Africa. moodleyp@ukzn.ac.za

ABSTRACT

Background: In 2005 a cluster of 53 HIV-infected patients with extensively drug-resistant tuberculosis (XDR-TB) was detected in the Msinga sub-district, the catchment area for the Church of Scotland Hospital (CoSH) in Tugela Ferry, in KwaZulu-Natal province (KZN), South Africa. KZN is divided into 11 healthcare districts. We sought to determine the distribution of XDR TB cases in the province in relation to population density.

Methods: In this cross-sectional study, the KZN tuberculosis laboratory database was analysed. Results of all patients with a sputum culture positive for Mycobacterium tuberculosis from January 2006 to June 2007 were included. Drug-susceptibility test results for isoniazid, rifampicin, ethambutol, streptomycin, kanamycin and ofloxacin were available for all patients as well as the location of the hospital where their clinical diagnosis was made.

Findings: In total, 20858 patients attending one of 73 hospitals or their adjacent clinics had cultures positive for M. tuberculosis. Of these, 4170 (20%) were MDR-TB cases. Four hundred and forty three (11%) of the MDR tuberculosis cases displayed the XDR tuberculosis susceptibility profile. Only 1429 (34%) of the MDR-TB patients were seen at the provincial referral hospital for treatment. The proportion of XDR-TB amongst culture-confirmed cases was highest in the Msinga sub-district (19.6%), followed by the remaining part of the Umzinyati district (5.9%) and the other 10 districts (1.1%). The number of hospitals with at least one XDR-TB case increased from 18 (25%) to 58 (80%) during the study period.

Interpretation: XDR-TB is present throughout KZN. More than 65% of all diagnosed MDR-TB cases, including XDR-TB patients, were left untreated and likely remained in the community as a source of infection.

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Related in: MedlinePlus

Geographical distribution and increase in number of hospitals with at least one case of XDR tuberculosis between January 2006 and June 2007.Each red dot depicts one hospital.
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pone-0017513-g002: Geographical distribution and increase in number of hospitals with at least one case of XDR tuberculosis between January 2006 and June 2007.Each red dot depicts one hospital.

Mentions: On the 1st of January 2006, patients infected with XDR tuberculosis had been detected in 16 (22%) hospitals, which increased to 58 (78%) by the end of June 2007. The geographical distribution of this increasing number of hospitals over time is shown in figure 2.


Spread of extensively drug-resistant tuberculosis in KwaZulu-Natal province, South Africa.

Moodley P, Shah NS, Tayob N, Connolly C, Zetola N, Gandhi N, Friedland G, Sturm AW - PLoS ONE (2011)

Geographical distribution and increase in number of hospitals with at least one case of XDR tuberculosis between January 2006 and June 2007.Each red dot depicts one hospital.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3104985&req=5

pone-0017513-g002: Geographical distribution and increase in number of hospitals with at least one case of XDR tuberculosis between January 2006 and June 2007.Each red dot depicts one hospital.
Mentions: On the 1st of January 2006, patients infected with XDR tuberculosis had been detected in 16 (22%) hospitals, which increased to 58 (78%) by the end of June 2007. The geographical distribution of this increasing number of hospitals over time is shown in figure 2.

Bottom Line: Drug-susceptibility test results for isoniazid, rifampicin, ethambutol, streptomycin, kanamycin and ofloxacin were available for all patients as well as the location of the hospital where their clinical diagnosis was made.Four hundred and forty three (11%) of the MDR tuberculosis cases displayed the XDR tuberculosis susceptibility profile.Only 1429 (34%) of the MDR-TB patients were seen at the provincial referral hospital for treatment.

View Article: PubMed Central - PubMed

Affiliation: KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH), Durban, South Africa. moodleyp@ukzn.ac.za

ABSTRACT

Background: In 2005 a cluster of 53 HIV-infected patients with extensively drug-resistant tuberculosis (XDR-TB) was detected in the Msinga sub-district, the catchment area for the Church of Scotland Hospital (CoSH) in Tugela Ferry, in KwaZulu-Natal province (KZN), South Africa. KZN is divided into 11 healthcare districts. We sought to determine the distribution of XDR TB cases in the province in relation to population density.

Methods: In this cross-sectional study, the KZN tuberculosis laboratory database was analysed. Results of all patients with a sputum culture positive for Mycobacterium tuberculosis from January 2006 to June 2007 were included. Drug-susceptibility test results for isoniazid, rifampicin, ethambutol, streptomycin, kanamycin and ofloxacin were available for all patients as well as the location of the hospital where their clinical diagnosis was made.

Findings: In total, 20858 patients attending one of 73 hospitals or their adjacent clinics had cultures positive for M. tuberculosis. Of these, 4170 (20%) were MDR-TB cases. Four hundred and forty three (11%) of the MDR tuberculosis cases displayed the XDR tuberculosis susceptibility profile. Only 1429 (34%) of the MDR-TB patients were seen at the provincial referral hospital for treatment. The proportion of XDR-TB amongst culture-confirmed cases was highest in the Msinga sub-district (19.6%), followed by the remaining part of the Umzinyati district (5.9%) and the other 10 districts (1.1%). The number of hospitals with at least one XDR-TB case increased from 18 (25%) to 58 (80%) during the study period.

Interpretation: XDR-TB is present throughout KZN. More than 65% of all diagnosed MDR-TB cases, including XDR-TB patients, were left untreated and likely remained in the community as a source of infection.

Show MeSH
Related in: MedlinePlus