scholarly journals Immigrant Arrival and Tuberculosis among Large Immigrant- and Refugee-Receiving Countries, 2005–2009

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Zachary White ◽  
John Painter ◽  
Paul Douglas ◽  
Ibrahim Abubakar ◽  
Howard Njoo ◽  
...  
Keyword(s):  
The United States ◽  
Multidrug Resistant ◽  
The Philippines ◽  
Health Concern ◽  
Foreign Born ◽  
Tuberculosis Control ◽  
Tuberculosis Case ◽  
Resistant Tuberculosis ◽  
Mdr Tb ◽  
Immigrant And Refugee

Objective. Tuberculosis control in foreign-born populations is a major public health concern for Australia, Canada, New Zealand, United Kingdom, and the United States, large immigrant- and refugee-receiving countries that comprise the Immigration and Refugee Health Working Group (IRHWG). Identifying and comparing immigration and distribution of foreign-born tuberculosis cases are important for developing targeted and collaborative interventions.Methods. Data stratified by year and country of birth from 2005 to 2009 were received from these five countries. Immigration totals, tuberculosis case totals, and multidrug-resistant tuberculosis (MDR TB) case totals from source countries were analyzed and compared to reveal similarities and differences for each member of the group.Results. Between 2005 and 2009, there were a combined 31,785,002 arrivals, 77,905 tuberculosis cases, and 888 MDR TB cases notified at the federal level in the IRHWG countries. India, China, Vietnam, and the Philippines accounted for 41.4% of the total foreign-born tuberculosis cases and 42.7% of the foreign-born MDR tuberculosis cases to IRHWG.Interpretation. Collaborative efforts across a small number of countries have the potential to yield sizeable gains in tuberculosis control for these large immigrant- and refugee-receiving countries.

scholarly journals Multidrug-resistant tuberculosis (MDR-TB) and multidrug-resistant HIV (MDR-HIV) syndemic: challenges in resource limited setting

2019 ◽  
Vol 12 (8) ◽  
pp. e230628 ◽  
Author(s):  
Christian Francisco ◽  
Mary Ann Lansang ◽  
Edsel Maurice Salvana ◽  
Katerina Leyritana
Keyword(s):  
Psoas Abscess ◽  
Multidrug Resistant ◽  
Health Concern ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Resource Limited ◽  
Persons Living With Hiv ◽  
Mdr Tb ◽  
Living With Hiv

Tuberculosis (TB) is common among persons living with HIV. This public health concern is aggravated by infection with multidrug-resistant organisms and adverse effects of polypharmacy. There are few published cases of multidrug-resistant tuberculosis (MDR-TB) in multidrug-resistant HIV (MDR-HIV) infected patients. We report a case of a 29-year-old Filipino man with HIV on zidovudine (AZT)-containing antiretroviral therapy (ART) but was eventually shifted to tenofovir due to anaemia. He presented with left flank tenderness, which was found to be due to an MDR-TB psoas abscess, and for which second-line anti-TB treatment was started. HIV genotyping showed MDR-HIV infection susceptible only to AZT, protease inhibitors and integrase inhibitors. Subsequently, he developed neck abscess that grew Mycobacterium avium complex and was treated with ethambutol and azithromycin. ART regimen was revised to AZT plus lamivudine and lopinavir/ritonavir. Erythropoietin was administered for recurrent AZT-induced anaemia. Both abscesses resolved and no recurrence of anaemia was noted.

scholarly journals Multidrug-resistant tuberculosis in the United States, 2011–2016: patient characteristics and risk factors

2020 ◽  
Vol 24 (1) ◽  
pp. 92-99 ◽  
Author(s):  
M. P. Chen ◽  
R. Miramontes ◽  
J. S. Kammerer
Keyword(s):  
United States ◽  
Risk Factors ◽  
Patient Characteristics ◽  
The United States ◽  
Multidrug Resistant ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Recent Transmission ◽  
National Tuberculosis ◽  
Mdr Tb

OBJECTIVE: To determine risk factors for multidrug-resistant tuberculosis (MDR-TB) and describe MDR-TB according to three characteristics: previous TB disease, recent transmission of MDR-TB, and reactivation of latent MDR-TB infection.SETTING and DESIGN: We used 2011–2016 surveillance data from the US National Tuberculosis Surveillance System and National Tuberculosis Genotyping Service and used logistic regression models to estimate risk factors associated with MDR-TB.RESULTS: A total of 615/45 209 (1.4%) cases were confirmed as MDR-TB; 111/615 (18%) reported previous TB disease; 41/615 (6.7%) were attributed to recent MDR-TB transmission; and 449/615 (73%) to reactivation. Only 12/41 (29%) patients with TB attributed to recent transmission were known to be contacts of someone with MDR-TB. For non-US-born patients, the adjusted odds ratios of having MDR-TB were 32.6 (95%CI 14.6–72.6) among those who were known to be contacts of someone with MDR-TB and 6.5 (95%CI 5.1–8.3) among those who had had previous TB disease.CONCLUSION: The majority of MDR-TB cases in the United States were associated with previous TB disease or reactivation of latent MDR-TB infection; only a small proportion of MDR-TB cases were associated with recent transmission.

scholarly journals Multidrug-Resistant Tuberculosis in Alberta and British Columbia, 1989 to 1998

1999 ◽  
Vol 6 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Ahmed Hersi ◽  
Kevin Elwood ◽  
Robert Cowie ◽  
Dennis Kunimoto ◽  
Richard Long
Keyword(s):  
British Columbia ◽  
Multidrug Resistant ◽  
Drug Resistant ◽  
Foreign Born ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Resistant Strains ◽  
Drug Resistant Strains ◽  
Culture Positive

OBJECTIVE: To describe the extent of the problem of multidrug-resistant tuberculosis (MDR-TB) in Alberta and British Columbia from 1989 to 1998.DESIGN: A retrospective, population-based descriptive study of all notified MDR-TB cases in the context of all notified TB cases, all notified culture-positive TB cases and all notified drug-resistant TB cases.SETTING: Provinces of Alberta and British Columbia, and their TB registries.PATIENTS: All people with TB reported to the TB registries of Alberta and British Columbia between January 1, 1989 and June 30, 1998.MAIN OUTCOME MEASURES: Drug susceptibility testing was performed in all cases of culture-positive TB. Demographic, clinical and laboratory data on all cases of MDR-TB were recorded.RESULTS: Of 4606 notified cases of TB, 3553 (77.1%) were culture positive. Of these, 365 (10.3%) were drug resistant; of the drug-resistant cases, 24 (6.6%) were MDR. Most MDR-TB patients were foreign-born; of the four Canadian-born patients, two were infected while travelling abroad. Although foreign-born patients were significantly more likely to harbour drug-resistant strains, 14.3% versus 4.8%, respectively (P<0.001), among those who were harbouring a drug-resistant strain, the proportion of Canadian-born versus foreign-born patients with an MDR strain was the same (6.7% versus 6.6%, respectively). From 1994 to 1998 versus 1989 to 1993, the proportion of all drug-resistant strains that were MDR was greater (9.0% versus 4.3%, respectively), but the difference was not statistically significant. Isolates from 16 of the 24 MDR-TB cases had been archived. Each of these was fingerprinted and found to be unique. Most MDR-TB cases (88%) were respiratory. Of those tested for human immunodeficiency virus (n=17), only one was seropositive. MDR-TB was ‘acquired’ in 67% and ‘primary’ in 33% of cases. Eight (33%) of the MDR-TB cases received curative courses of treatment, six (25%) are still being treated, and the remainder have either died (five, 21%), transferred out (four, 17%) or become ‘chronic’ (one, 4%). No secondary case of MDR-TB has been identified in Alberta and British Columbia.CONCLUSIONS: Most MDR-TB in Alberta and British Columbia is imported. The proportion of all drug-resistant cases that are MDR appears to be increasing, but not because of disease acquired from recent contact with MDR-TB in Canada.

Multidrug-resistant tuberculosis care in the United States

2020 ◽  
Vol 24 (4) ◽  
pp. 409-413 ◽  
Author(s):  
A. N. Gobaud ◽  
C. A. Haley ◽  
J. W. Wilson ◽  
R. Bhavaraju ◽  
A. Lardizabal ◽  
...  
Keyword(s):  
Medical Training ◽  
The United States ◽  
Multidrug Resistant ◽  
Expert Advice ◽  
Provider Type ◽  
Centers Of Excellence ◽  
Public Health Departments ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Mdr Tb

BACKGROUND: To examine the utilization of the Tuberculosis (TB) Centers of Excellence (COE) medical consultation service and evaluate how these services were being employed for patients in relation to multidrug-resistant TB (MDR-TB).METHODS: Medical consults are documented in a secure database. The database was queried for MDR-TB consultations over the period 1 January 2013–31 December 2017. All were analyzed to assess provider type, center, setting, year of call, and type of patient (pediatric vs. adult). A subgroup was randomly selected for thematic analysis.RESULTS: The centers received 1560 MDR-TB consultation requests over this period. Providers requesting consults were primarily physicians (55%). The majority of requests were from public health departments (64%) and for adult patients (80%). Four major topic areas emerged: 1) initial management of MDR-TB, 2) MDR-TB longitudinal treatment and complications, 3) management of persons exposed to MDR-TB, and 4) MDR-TB treatment completion.CONCLUSIONS: Analysis of these consultations provides insight into the type of expert advice about MDR-TB that was provided. These findings highlight topics where increased medical training and education may help to improve MDR-TB-related practices.

scholarly journals 770. Multi-Drug-Resistant Tuberculosis Cases in Arkansas in 2017: A Tale of Two Threats

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S276-S276
Author(s):  
Emily Weldon ◽  
Naveen Patil ◽  
Jan Voyles ◽  
Sandra Chai ◽  
Marsha Majors ◽  
...  
Keyword(s):  
Drug Resistance ◽  
The United States ◽  
The Philippines ◽  
Drug Susceptibility Testing ◽  
Marshall Islands ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb

Abstract Background Multi-drug-resistant tuberculosis (MDR-TB) is a threat to TB elimination strategies worldwide. From 1998 to 2016, six cases of MDR-TB were reported in Arkansas. In 2017 alone, three cases were detected. We sought to describe the characteristics of these cases to inform our MDR-TB prevention strategy in AR. Methods The surveillance database identified three MDR-TB cases in 2017. A detailed review was done to define the demographics, clinical presentation, and laboratory reports relating to drug susceptibility testing (DST), including molecular detection of drug resistance (MDDR). A search was done in the Genotyping database for genotype patterns of the patient isolates. Results All three cases were born outside the United States and developed active disease after arrival in AR. Case 1, age 52, was born in the Marshall Islands, arrived in 2016, and had a history of Type 2 diabetes. He developed MDR-TB in February 2017. Case 2, age 42, was born in Mexico, arrived over 20 years ago, and was HIV positive. He developed TB in July 2016 with a pan-sensitive organism and completed an intermittent treatment regimen. A second TB episode with matching genotype but different drug sensitivities occurred in April 2017, less than 4 months after treatment completion, and was considered treatment failure. Case 3, age 56, was born in the Philippines, arrived in 1990, and was reportedly treated for latent TB infection in 1993 with 6 months of isoniazid. She visited the Philippines April–May 2017 and developed MDR-TB in October 2017. Her isolate was in cluster with a case in Oklahoma who came from Mexico in 2006 and was admitted in an AR hospital with a pan-sensitive organism. There are no epidemiological links between the two cases; only one isolate in each case. Because both isolates were identified in AR State TB laboratory, a complex contamination has been considered with no definite resolution at this time. Conclusion MDR-TB, due to both primary and secondary drug resistance, remains a threat in AR. Cooperation and communication between all levels of healthcare are crucial to avoid delayed diagnosis of MDR-TB. Timely DST via technologies like GeneXpert and MDDR service at CDC is critical. Consultation from Centers of Excellence is vital in the treatment of MDR-TB complicated by diabetes and HIV. Whole-genome sequencing could provide clarity in the cluster with discordant DST patterns. Disclosures All authors: No reported disclosures.

Multidrug-resistant tuberculosis in Lisbon: unfavourable treatment and associated factors, 2000–2014

2019 ◽  
Vol 23 (10) ◽  
pp. 1075-1081
Author(s):  
M. Bhering ◽  
A. Kritski ◽  
C. Nunes ◽  
R. Duarte
Keyword(s):  
Multidrug Resistant ◽  
Foreign Born ◽  
Loss To Follow Up ◽  
Factors Associated ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Immunodeficiency Virus ◽  
Mdr Tb ◽  
The City

SETTING: The incidence of tuberculosis (TB) has been decreasing in Portugal. Lisbon concentrates the largest number of cases of multidrug-resistant (MDR) TB in the country. This study aims at identifying clinical and demographic factors associated with unfavourable treatment results of patients with MDR-TB in the city.METHOD: The data on 265 MDR-TB cases, notified from 2000 to 2014 in the District of Lisbon, were collected from the Tuberculosis Surveillance System. Unfavourable cases were classified as failure, loss to follow-up (LTFU) and death. Bivariate and multivariate logistic regressions were undertaken to estimate the factors associated with unfavourable outcomes, LTFU and death.RESULTS: The proportion of unfavourable outcomes was 30.5%. These were associated mostly with being male, foreign-born and resistant to kanamycin. Death was associated with being human immunodeficiency virus-positive and resistant to kanamycin. Being foreign-born had a 4.46-fold higher odds of a LTFU outcome than did being Portuguese-born. The foreign-born patients were mostly African immigrants.CONCLUSION: The main finding in this study is that foreign-born patients are associated with a higher probability of unfavourable outcomes than Portuguese-born patients. Therefore, foreign-born patients need more careful monitoring in the control of MDR-TB.

scholarly journals Retrospective analysis of multidrug-resistant tuberculosis case notifications in Australia (1999–2018)

2020 ◽  
Vol 44 ◽  
Author(s):  
Hendrik S Camphor ◽  
Kerri Viney ◽  
Ben Polkinghorne ◽  
Kate Pennington
Keyword(s):  
Clinical Laboratory ◽  
Treatment Success ◽  
Multidrug Resistant ◽  
Current Data ◽  
Notification Rate ◽  
Tuberculosis Case ◽  
Tb Control ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb

This study describes the epidemiology and treatment outcomes of multidrug-resistant tuberculosis (MDR-TB) cases notified in Australia between 1999 and 2018, and investigates whether current data fields in the national tuberculosis (TB) dataset allow description and measurement of surveillance information pertaining to the diagnosis and clinical management of MDR-TB. In May 2019, de-identified demographic, clinical, laboratory, drug susceptibility, treatment, risk factor and outcome data for all MDR-TB case notifications were extracted from the Australian National Notifiable Disease Surveillance System. The dataset included ten treatment outcome categories, which were aggregated to four categorical outcomes for descriptive and inferential analyses. The majority of cases were overseas-born (91%). Absolute case numbers increased over time; however, the MDR-TB notification rate remained fairly stable during the study period. Treatment success was achieved in nearly two-thirds of cases (62.1%). Whilst timeframes between initial presentation, specimen collection, case notification and treatment commencement were calculated, current data fields in the national dataset precluded measurement and description of other parameters deemed important for MDR-TB surveillance. This study demonstrates that while Australia’s MDR-TB burden is low, cases will continue to occur until TB control improves in countries with which Australia shares cultural and migration links. Australia should continue to support national and regional TB control programmes to sustain progress towards national elimination of TB. This study’s findings support a review of data fields in the national TB dataset with potential expansion or adjustment to improve national data reporting, including the monitoring of evidence-based recommendations for the prevention and management of MDR-TB.

scholarly journals Prevalence of multidrug resistant tuberculosis among TB patients in Malaysia.

2020 ◽  
Author(s):  
Mahindran Rajendran Rajendran ◽  
Rafdzah Ahmad Zaki ◽  
Zamzurina Abu Bakar ◽  
Nasrin Aghamohammadi
Keyword(s):  
Smoking Status ◽  
Multidrug Resistant ◽  
Health Concern ◽  
Diabetic Patients ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Risk Characteristics ◽  
Significant Public Health ◽  
Mdr Tb ◽  
Associated Risk Factors

Abstract Background: Currently multidrug-resistant tuberculosis (MDR-TB) poses a significant public health concern in Malaysia.Objective: This study is aimed to evaluate the prevalence of MDR-TB in Malaysian tuberculosis patients. Method. A retrospective analysis was performed, and data was obtained from the Malaysian National TB Information System (TBIS) between 2009 and 2019. A record of 989 MDR-TB cases were identified and associated risk characteristics such as marital status, gender, ethnicity, employment status, alcohol consumption, diabetic status and smoking status were determined. The statistical analysis was performed using the SPSS software version 20.Results: Overall, the occurrence of MDR-TB among patients with TB infections in Malaysia was 0.34% based on data collected from TBIS. The findings revealed major variations in the incidence of MDR-TB between male and female patients (0.44%, 0.20%, p < 0.001), single and married patients (1.63% vs 0.24%, p < 0.001), ethnicity (p < 0.001), working and non-working patients (0.48% vs 0.32%, p < 0.001), alcoholic and non-alcoholic patients (0.44% vs 0.32%, p < 0.001), diabetic patients and non-diabetic patients (0.39% vs 0.27%, p < 0.001), followed by smoking and non-smoking patients (0.13% vs 0.27%, p < 0.001).Conclusion: This study provides a substantial assessment of MDR-TB prevalence and associated risk factors that could be useful for the implementation of new strategies in Malaysia's national TB policy.

scholarly journals 775. An Epidemiological Analysis of Patients With Multidrug-Resistant Tuberculosis Among Tibetan Refugees in India

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S277-S278
Author(s):  
Tenzin Desel ◽  
Naonori Tsuda ◽  
Tenzin Tsundue ◽  
Rangjung Lingtsang ◽  
Sonam Topgyal ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Multidrug Resistant ◽  
Health Concern ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Increased Risk ◽  
Mdr Tb ◽  
Study Population ◽  
Previously Treated ◽  
Tibetan Refugees

Abstract Background Globally, refugee populations face an increased risk for tuberculosis (TB) due to malnutrition, overcrowding, and poor living conditions. Compared with the general Indian population, Tibetan refugees in India display a higher incidence rate of both TB and multidrug-resistant TB (MDR-TB). The high incidence of MDR-TB in younger population is a serious public health concern. Methods We retrospectively reviewed the medical records of patients with MDR-TB treated from January 2010 to December 2013 in Tibetan Delek Hospital, which is the center of TB control among Tibetan refugees. Patients were classified into either new cases (supposed infection by exposure to MDR-TB) or previously treated MDR-TB cases (suspected acquirement of MDR-TB through anti-TB treatment or by MDR-TB exposure after treatment). We compared patients’ age, sex, birthplace, residence type, occupation, contact history, and treatment outcome. Results Of 749 patients with TB, we enrolled 134 patients with MDR-TB [median age, 26 (interquartile range: 22–35) years; males, 55%]. The Tibetan ethnicity comprised 96% of the study population, whereas Indians (trans-Himalayan) comprised 4%. The birthplace was Tibet for 22% patients, India for 75%, and Nepal for 2%. New MDR-TB cases were 28% and previously treated MDR-TB cases were 72%. Failure was observed in 42% patients and cured and completed in 54% patients, during their previous TB treatment. The median age was significantly lower in new cases than in previously treated MDR-TB cases (24 vs. 28.5 years; P &lt; 0.01). Tibet was the birthplace of 34% new cases and 18% in previously treated cases (P = 0.04). The residence was of the congregated type in 58% of new cases and 30% in previously treated MDR-TB cases (P = 0.01). The occupation was “student” and “unemployed” in 58% and 8% in new cases and 33% and 24% in previously treated cases, respectively (P = 0.03). Contact history with TB type and treatment outcome were not considerably different, although the rates of cured and completed were high in both new (82%) and previously treated (84%) MDR-TB cases. Conclusion This study shows that new MDR-TB correlates with younger age, birth in Tibet, congregated residence, and student occupation. Targeting the above-listed characteristics could be effective in further reducing the MDR-TB transmission among Tibetan refugees in India. Disclosures All authors: No reported disclosures.

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