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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa
Lancet, Volume 368, No. 9547, Year 2006
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Description
Background: The epidemics of HIV-1 and tuberculosis in South Africa are closely related. High mortality rates in co-infected patients have improved with antiretroviral therapy, but drug-resistant tuberculosis has emerged as a major cause of death. We assessed the prevalence and consequences of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis in a rural area in KwaZulu Natal, South Africa. Methods: We undertook enhanced surveillance for drug-resistant tuberculosis with sputum culture and drug susceptibility testing in patients with known or suspected tuberculosis. Genotyping was done for isolates resistant to first-line and second-line drugs. Results: From January, 2005, to March, 2006, sputum was obtained from 1539 patients. We detected MDR tuberculosis in 221 patients, of whom 53 had XDR tuberculosis. Prevalence among 475 patients with culture-confirmed tuberculosis was 39% (185 patients) for MDR and 6% (30) for XDR tuberculosis. Only 55% (26 of 47) of patients with XDR tuberculosis had never been previously treated for tuberculosis; 67% (28 of 42) had a recent hospital admission. All 44 patients with XDR tuberculosis who were tested for HIV were co-infected. 52 of 53 patients with XDR tuberculosis died, with median survival of 16 days from time of diagnosis (IQR 6-37) among the 42 patients with confirmed dates of death. Genotyping of isolates showed that 39 of 46 (85%, 95% CI 74-95) patients with XDR tuberculosis had similar strains. Conclusions: MDR tuberculosis is more prevalent than previously realised in this setting. XDR tuberculosis has been transmitted to HIV co-infected patients and is associated with high mortality. These observations warrant urgent intervention and threaten the success of treatment programmes for tuberculosis and HIV. © 2006 Elsevier Ltd. All rights reserved.
Authors & Co-Authors
Gandhi, Neel R.
United States, New Haven
Section of Infectious Diseases
United States, New York
Albert Einstein College of Medicine of Yeshiva University
Moll, Anthony P.
South Africa
Philanjalo and Church of Scotland Hospital
Sturm, Adriaan Willem
South Africa, Durban
The Nelson R. Mandela Medical School
Pawinski, Robert A.
South Africa, Durban
The Nelson R. Mandela Medical School
Govender, Thiloshini
South Africa, Pietermaritzburg
Kwazulu-natal Department of Health
Lalloo, Umesh Gangaram
South Africa, Durban
The Nelson R. Mandela Medical School
Zeller, Kimberly A.
United States, New Haven
Section of Infectious Diseases
United States, Providence
The Warren Alpert Medical School
Andrews, Jason Randolph
United States, New Haven
Section of Infectious Diseases
Friedland, Gerald H.
United States, New Haven
Section of Infectious Diseases
Statistics
Citations: 1,523
Authors: 9
Affiliations: 6
Identifiers
Doi:
10.1016/S0140-6736(06)69573-1
ISSN:
01406736
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Randomised Control Trial
Cross Sectional Study
Study Locations
South Africa