Abstract
Overall numbers of multidrug-resistant (MDR) tuberculosis (TB) rose sharply in the United Kingdom and Scotland in 2007. Risk factors associated with MDR TB in the United Kingdom have been identified but there has been no previous report on risk factors associated with MDR TB in Scotland. Enhanced Surveillance of Mycobacterial Infections (ESMI) data were used to examine demographic and clinical characteristics and treatment outcome of MDR TB cases notified in Scotland between 2000-7. There was a total of 11 culture-positive cases of MDR TB, five of which were notified in 2007. The majority of patients were female, 15-44 years old and unemployed. All were born outside the United Kingdom and most had arrived within the past year from or frequently travelled to their home countries in China, the Indian subcontinent or Africa. Except for one individual, our patients did not self report a history of previous diagnosis of TB which was previously identified as a risk factor for MDR TB in the United Kingdom. Only three patients received directly observed treatment (DOT). Only two patients had completed treatment at 12 months, partially due to the inadequate length of follow-up under the current ESMI system. Our results suggest that most patients had primary resistance due to transmission of MDR TB in high incidence countries and thus point to the importance of international efforts to control MDR TB in these countries. In Scotland, national efforts should be made to increase the number of MDR TB patients receiving DOT and to extend follow-up to improve monitoring of treatment outcome. It is important to identify high risk groups for MDR TB infection in order to deliver effective community-based disease control measures.
Highlights
There are an estimated nine million new cases of tuberculosis (TB) worldwide each year and 5.3% of these are multidrug-resistant (MDR) [1]
Most affected (8) had been resident in the United Kingdom for one year or less and all had been in the United Kingdom for less than five years
Between 2000-4 the majority of MDR TB patients (4) were resident in urban areas with large cities which were covered by larger health boards
Summary
There are an estimated nine million new cases of tuberculosis (TB) worldwide each year and 5.3% of these are multidrug-resistant (MDR) [1]. The number of MDR TB cases per year has increased from 28 in 2000 to 55 in 2007 [2]. This rise is important in terms of future public health planning and resource allocation. Treatment failure is more common and subsequently leads to higher mortality rates and relapse [6,7]. It may result in the emergence of extensively drug-resistant TB (XDR TB). In the UK, the management of an MDR TB case has been estimated to cost the NHS £60,000 compared to £6,040 for a patient with drug-sensitive TB [8]
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