Pontali, Emanuele and Sotgiu, Giovanni and Migliori, Giovanni Battista (2011) Management of MDR-TB household contacts: how difficult is it to climb the mountain? International Journal of Tuberculosis and Lung Disease, Vol. 15 (9), p. 1137-1138. eISSN 1815-7920. Article.
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THE ISSUE of multidrug-resistant (MDR) and extensively
drug-resistant (XDR) tuberculosis (TB) is
still hot in many perspectives. Policy makers and public
health offi cers, in addition to clinicians managing
index patients, require evidence supporting targeted
interventions among household contacts of MDR-TB
The yield of secondary cases among contacts of
drug-susceptible TB is known to have important
i nter-country variations (from 1% to 8%), although
these estimates are not clearly time-bound. The question
as to whether the transmission rates of drugr
esistant TB are similar remains unanswered, given
the longer period of infectiousness, often attributed
to delays in diagnosis, and to the diffi culties in achieving bacteriological conversion in such cases.
Conversely, the reduced transmissibility of drugresistant
strains due to the potential fi tness cost of resistance
mutations has often been discussed but has never been demonstrated.
Two very interesting contributions on this question
are presented in this issue of the Journal, from
pivotal countries in the fi ght against MDR- and XDRTB:
South Africa and Peru. Both studies demonstrate
very high TB incidence among household contacts.
In the South African study, the incidence of MDRand
XDR-TB cases among contacts was respectively
1765 and 1952 per 100 000 population, while the
study from Peru shows that 5% of the contacts developed
TB in a 3-year follow-up period (2360 per
100 000 contact follow-up years). Among those with
available drug susceptibility test (DST) results, 80%
had MDR-TB strains. Therefore, MDR-TB incidence
among Peruvian contacts could be estimated at
1888/100 000 contact follow-up years.
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