Nosocomial Transmission of Extensively Drug-Resistant Tuberculosis in a Rural Hospital in South Africa

Gandhi, Neel R.; Weissman, Darren; Moodley, Prashini; Ramathal, Melissa; Elson, Inga; Kreiswirth, Barry N.; Mathema, Barun; Shashkina, Elena; Rothenberg, Richard; Moll, Anthony; Friedland, Gerald; Sturm, A. Willem; Shah, Neha

doi:10.1093/infdis/jis631

Cited by 119 publications

(135 citation statements)

References 40 publications

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“…2,5,6 A higher proportion of pre-and XDR-TB cases (82%) had an unfavourable outcome, similar to the 80% reported elsewhere in South Africa. 7 Unlike studies in Turkey 8 and in Pakistan, 9 where MDR-TB was more common among women, we had similar proportions of male and female DR-TB cases. However, in our study, being * Missing values were not displayed and were found in the following variables: anti-tuberculosis treatment outcome (n = 4, 1.5%), sex (n = 4, 1.5%), baseline smear (n = 29, 10.7%), oral adherence (n = 42, 15.4%), injectable adherence (n = 62, 22.8%), HIV status (n = 7, 2.6%), baseline culture (n = 40, 14.7%), weight (n = 20, 7.4%) and age (n = 33, 12.1%).…”

Section: Discussionmentioning

confidence: 53%

“…This may reflect the provision of antiretroviral treatment to these cases, which we did not assess and which can improve outcomes. 7 Treatment adherence of at least 80% with both oral and injectable drugs was poor. It is unclear why good adherence to injectable drugs did not have a significant effect on unfavourable outcomes; this requires further investigation.…”

Section: Public Health Action Drug-resistant Tb In the Northern Cape 203mentioning

confidence: 99%

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Factors affecting treatment outcomes in drug-resistant tuberculosis cases in the Northern Cape, South Africa

Elliott

Draper

Baitsiwe

et al. 2014

public health action

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Section: Discussionmentioning

confidence: 53%

Section: Public Health Action Drug-resistant Tb In the Northern Cape 203mentioning

confidence: 99%

Factors affecting treatment outcomes in drug-resistant tuberculosis cases in the Northern Cape, South Africa

Elliott

Draper

Baitsiwe

et al. 2014

public health action

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“…This is in contrast to the highly publicized outbreak of XDR-TB in HIV-positive individuals due to transmission in Tugela Ferry, South Africa. Similar to the outbreaks of MDR-TB in the 1990s (11)(12)(13), XDR-TB cases among HIV-infected patients often occurred as a result of transmission, because 55% of the cases had no history of TB treatment (14). In China, a recent national survey in 2007 showed that 5.7% of new cases and 25.6% of previously treated cases had MDR-TB, and 8% of MDR-TB cases had developed XDR-TB.…”

mentioning

confidence: 87%

Evolution and Transmission Patterns of Extensively Drug-Resistant Tuberculosis in China

Wang

Shao

Fan

et al. 2015

Antimicrob Agents Chemother

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The emergence and transmission of extensively drug-resistant tuberculosis (XDR-TB) pose an increasing threat to global TB control. This study aimed to identify the patterns of evolution and transmission dynamics of XDR-TB in populations in a region of China where TB is highly endemic. We analyzed a total of 95 XDR-TB isolates collected from 2003 to 2009 in Chongqing, China. Eight drug resistance genes covering 7 drugs that define XDR-TB were amplified by PCR followed by DNA sequencing. Variable-number tandem repeat 16-locus (VNTR-16) genotyping and genotypic drug resistance profiles were used to determine the evolution or transmission patterns of XDR-TB strains. Our results indicated that the Beijing genotype was predominant (85/95 [89.5%]) in XDR-TB strains, and as many as 40.0% (38/95) of the isolates were distributed into 6 clusters based on VNTR-16 genotyping and drug resistance mutation profiles. All isolates of each cluster harbored as many as six identical resistance mutations in the drug resistance genes rpoB, katG, inhA promoter, embB, rpsL, and gidB. Among the nine cases with continuous isolates from multidrug-resistant (MDR) to XDR-TB, 4 cases represented acquired drug resistance, 4 cases were caused by transmission, and 1 case was due to exogenous superinfection. The XDR-TB epidemic in China is mainly caused by a high degree of clonal transmission, but evolution from MDR to XDR and even superinfection with a new XDR strain can also occur.

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“…From these animal model and epidemiological data, one might conclude that drug resistance incurs a fitness cost leading to lower transmissibility. However, large outbreaks of MDR TB and XDR TB have been recorded (489,490); compensatory mutations that restore fitness but sustain resistance have been identified (224); and recent genotyping efforts have provided strong evidence of the international spread of an MDR M. tuberculosis clone of the Beijing genotype, particularly in East and Central Asia, Eastern Europe, and South Africa (455,491), as well as the large-scale spread of an MDR M. tuberculosis clone of the LAM genotype family in, and beyond, South Africa (492).…”

Section: Applications Of Strain Typing To M Tuberculosis Complex Isomentioning

confidence: 99%

Methodological and Clinical Aspects of the Molecular Epidemiology of Mycobacterium tuberculosis and Other Mycobacteria

et al. 2016

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SUMMARYMolecular typing has revolutionized epidemiological studies of infectious diseases, including those of a mycobacterial etiology. With the advent of fingerprinting techniques, many traditional concepts regarding transmission, infectivity, or pathogenicity of mycobacterial bacilli have been revisited, and their conventional interpretations have been challenged. Since the mid-1990s, when the first typing methods were introduced, a plethora of other modalities have been proposed. So-called molecular epidemiology has become an essential subdiscipline of modern mycobacteriology. It serves as a resource for understanding the key issues in the epidemiology of tuberculosis and other mycobacterial diseases. Among these issues are disclosing sources of infection, quantifying recent transmission, identifying transmission links, discerning reinfection from relapse, tracking the geographic distribution and clonal expansion of specific strains, and exploring the genetic mechanisms underlying specific phenotypic traits, including virulence, organ tropism, transmissibility, or drug resistance. Since genotyping continues to unravel the biology of mycobacteria, it offers enormous promise in the fight against and prevention of the diseases caused by these pathogens. In this review, molecular typing methods forMycobacterium tuberculosisand nontuberculous mycobacteria elaborated over the last 2 decades are summarized. The relevance of these methods to the epidemiological investigation, diagnosis, evolution, and control of mycobacterial diseases is discussed.

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Nosocomial Transmission of Extensively Drug-Resistant Tuberculosis in a Rural Hospital in South Africa

Cited by 119 publications

References 40 publications

Factors affecting treatment outcomes in drug-resistant tuberculosis cases in the Northern Cape, South Africa

Factors affecting treatment outcomes in drug-resistant tuberculosis cases in the Northern Cape, South Africa

Evolution and Transmission Patterns of Extensively Drug-Resistant Tuberculosis in China

Methodological and Clinical Aspects of the Molecular Epidemiology of Mycobacterium tuberculosis and Other Mycobacteria

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