Abstract
Two cases of multidrug-resistant tuberculosis (MDR TB) in a household are assumed to reflect within-household transmission. However, in high-incidence areas of MDR TB, secondary cases may arise through exposure to MDR TB in the community. To estimate the frequency of multiple introductions of MDR TB into households, we used spoligotyping and 24-loci mycobacterial interspersed repetitive unit- variable number tandem repeats to classify isolates from 101 households in Lima, Peru, in which >1 MDR TB patient received treatment during 1996-2004. We found different MDR TB strains in >10% of households. Alternate approaches for classifying matching strains produced estimates of multiple introductions in <38% of households. At least 4% of MDR TB patients were reinfected by a second strain of MDR Mycobacterium tuberculosis. These findings suggest that community exposure to MDR TB in Lima occurs frequently. Rapid drug sensitivity testing of strains from household contacts of known MDR TB patients is needed to identify optimal treatment regimens.
Highlights
All providers who undertake evaluation and treatment of patients with TB must recognize that, are they delivering care to an individual, they are assuming an important public health function
The Standards are intended to facilitate the effective engagement of all care providers in delivering highquality care for patients of all ages and all forms of TB including drugresistant TB and TB combined with human immunodeficiency virus (HIV) infection
The Standards are intended to facilitate the effective engagement of all care providers in delivering high-quality care for patients of all ages, including those with sputum smear-positive, sputum smear-negative, and extra pulmonary tuberculosis, tuberculosis caused by drug-resistant Mycobacterium tuberculosis complex (M. tuberculosis) organisms, and tuberculosis combined with human immunodeficiency virus (HIV) infection
Summary
The Standards are intended to facilitate the effective engagement of all care providers in delivering highquality care for patients of all ages and all forms of TB including drugresistant TB and TB combined with HIV infection. The diagnosis of intrathoracic (i.e., pulmonary, pleural, and mediastinal or hilar lymph node) tuberculosis in symptomatic children with negative sputum smears should be based on the finding of chest radiographic abnormalities consistent with tuberculosis and either a history of exposure to an infectious case or evidence of tuberculosis infection (positive tuberculin skin test or interferon gamma release assay) For such patients, if facilities for culture are available, sputum specimens should be obtained (by expectoration, gastric washings, or induced sputum) for culture. All providers of care for patients with tuberculosis should ensure that persons (especially children under 5 years of age and persons with HIV infection) who are in close contact with patients who have infectious tuberculosis are evaluated and managed in line with international recommendations. Research in these operational and clinical areas serves to complement ongoing efforts focused on developing new tools for tuberculosis control
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