Yield of Systematic Longitudinal Screening of Household Contacts of Pre-Extensively Drug Resistant (PreXDR) and Extensively Drug Resistant (XDR) Tuberculosis Patients in Mumbai, India.

Roma Haresh Paryani,Reeta Yadav,Sabira Sheikh,Sriram Selvaraju,Vivek Gupta,Madhur Verma,Homa Mansoor,Stobdan Kalon,Mrinalini Das,Pramila Singh,Gabriella Ferlazzo,Chinmay Laxmeshwar,Petros Isaakidis

doi:10.3390/tropicalmed5020083

Abstract

While risk of tuberculosis (TB) is high among household contacts (HHCs) of pre-extensively drug resistant (pre-XDR) TB and XDR-TB, data on yield of systematic longitudinal screening are lacking. We aim to describe the yield of systematic longitudinal TB contact tracing among HHCs of patients with pre-XDR-TB and XDR-TB. At the Médecins Sans Frontières (MSF) clinic, Mumbai, India a cohort comprising 518 HHCs of 109 pre-XDR and XDR index cases was enrolled between January 2016 and June 2018. Regular HHC follow-ups were done till one year post treatment of index cases. Of 518 HHCs, 23 had TB (21 on TB treatment and two newly diagnosed) at the time of first visit. Of the rest, 19% HHCs had no follow-ups. Fourteen (3.5%) TB cases were identified among 400 HHCs; incidence rate: 2072/100,000 person-years (95% CI: 1227–3499). The overall yield of household contact tracing was 3% (16/518). Of 14 who were diagnosed with TB during follow-up, six had drug susceptible TB (DSTB); six had pre-XDR-TB and one had XDR-TB. Five of fourteen cases had resistance patterns concordant with their index case. In view of the high incidence of TB among HHCs of pre-XDR and XDR-TB cases, follow-up of HHCs for at least the duration of index cases’ treatment should be considered.

Highlights

Tuberculosis (TB) is a long-standing global health issue, disproportionately affecting low- and middle-income countries
The overall yield was 3% during the longitudinal household contact tracing for TB in patients diagnosed with pre-extensively drug resistant (pre-XDR) and XDR-TB receiving care in Médecins Sans Frontières (MSF) Clinic in Mumbai, India
Our findings are in line with those of Leung and colleagues, who conducted follow-up of household contacts (HHCs) of multi-drug resistant TB (MDR-TB) and reported that presence of XDR-TB significantly increased the odds of identifying a prevalent TB as well as hazard of incident case by almost five times after 18 months [16]

Summary

Introduction

Tuberculosis (TB) is a long-standing global health issue, disproportionately affecting low- and middle-income countries. Drug-resistant tuberculosis (DR-TB) is reported to have an increasing trend in the country. Pre-extensively drug resistant (pre-XDR-TB) is the presence of resistance to rifampicin and isoniazid along with resistance to either one of the fluoroquinolones (ofloxacin, levofloxacin or moxifloxacin) or second-line injectables (amikacin, capreomycin or kanamycin). In case the TB bacilli have resistance to both fluoroquinolones and second-line injectables, along with rifampicin and isoniazid, they are classified as extensively drug resistant (XDR). According to the drug-resistance survey report, in India, 28% patients with TB have resistance to any anti-tubercular drugs and 6.2% have multi-drug resistant TB (MDR-TB); among MDR-TB, 21.8% have pre-XDR-TB and 1.3% have XDR-TB [3]. Some studies from the country have reported a higher prevalence of XDR-TB [4,5,6]

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