Abstract
BackgroundIn 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.MethodsIn 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.FindingsIn 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.InterpretationXDR-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.
Highlights
Multidrug-resistant (MDR) tuberculosis, including its extensively resistant (XDR) form has become a threat to the success of tuberculosis control programs
Since there was no obvious reason why community spread should be restricted to the Msinga sub-district, we hypothesised that XDR tuberculosis was present throughout KwaZulu-Natal Province
M.tuberculosis was cultured from 20858 patients in KwaZulu-Natal Province
Summary
Multidrug-resistant (MDR) tuberculosis, including its extensively resistant (XDR) form has become a threat to the success of tuberculosis control programs. In 2005, 53 cases of extensively drug-resistant (XDR) tuberculosis were detected in the Msinga sub-district, Umzinyati health district, KwaZulu-Natal Province in South Africa (Fig. 1) [2]. They sought healthcare at the Church of Scotland Hospital (CoSH) in Tugela Ferry whose catchment area is the Msinga sub-district. This raised the question as to whether this was nosocomial transmission in CoSH, an isolated outbreak in the Msinga community, or a widespread epidemic involving other districts of KwaZulu-Natal Province. 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. We sought to determine the distribution of XDR TB cases in the province in relation to population density
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