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Management of MDR-TB household contacts: how difficult is it to climb the mountain?

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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DOI: 10.5588/ijtld.11.0225

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Abstract

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 cases.
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.

Item Type:Article
ID Code:6637
Status:Published
Refereed:Yes
Uncontrolled Keywords:Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB), household contacts
Subjects:Area 06 - Scienze mediche > MED/01 Statistica medica
Divisions:001 Università di Sassari > 01 Dipartimenti > Scienze biomediche
Publisher:International Union against Tuberculosis and Lung Disease
eISSN:1815-7920
Copyright Holders:© 2011 The Union
Deposited On:22 Nov 2011 16:12

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