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High prevalence of primary multidrug resistant tuberculosis in persons with no known risk factors

(2011) PLOS ONE. 6(10).
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Abstract
Introduction: In high multidrug resistant (MDR) tuberculosis (TB) prevalence areas, drug susceptibility testing (DST) at diagnosis is recommended for patients with risk factors for MDR. However, this approach might miss a substantial proportion of MDR-TB in the general population. We studied primary MDR in patients considered to be at low risk of MDR-TB in Lima, Peru. Methods: We enrolled new sputum smear-positive TB patients who did not report any MDR-TB risk factor: known exposure to a TB patient whose treatment failed or who died or who was known to have MDR-TB; immunosuppressive co-morbidities, ex prison inmates; prison and health care workers; and alcohol or drug abuse. A structured questionnaire was applied to all enrolled participants to confirm the absence of these factors and thus minimize underreporting. Sputum from all participants was cultured on Lowenstein-Jensen media and DST for first line drugs was performed using the 7H10 agar method. Results: Of 875 participants with complete data, 23.2% (203) had risk factors for MDR-TB elicited after enrolment. Among the group with no reported risk factors who had a positive culture, we found a 6.3% (95% CI 4.4-8.3) (37/584) rate of MDR-TB. In this group no epidemiological characteristics were associated with MDR-TB. Thus, in this group, multidrug resistance occurred in patients with no identifiable risk factors. Conclusions: We found a high rate of primary MDR-TB in a general population with no identifiable risk factors for MDR-TB. This suggests that in a high endemic area targeting patients for MDR-TB based on the presence of risk factors is an insufficient intervention.

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Chicago
Otero, Larissa, Fiorella Krapp, Cristina Tomatis, Carlos Zamudio, Francine Matthys, Eduardo Gotuzzo, Patrick Van Der Stuyft, and Carlos Seas. 2011. “High Prevalence of Primary Multidrug Resistant Tuberculosis in Persons with No Known Risk Factors.” Plos One 6 (10).
APA
Otero, Larissa, Krapp, F., Tomatis, C., Zamudio, C., Matthys, F., Gotuzzo, E., Van Der Stuyft, P., et al. (2011). High prevalence of primary multidrug resistant tuberculosis in persons with no known risk factors. PLOS ONE, 6(10).
Vancouver
1.
Otero L, Krapp F, Tomatis C, Zamudio C, Matthys F, Gotuzzo E, et al. High prevalence of primary multidrug resistant tuberculosis in persons with no known risk factors. PLOS ONE. 2011;6(10).
MLA
Otero, Larissa et al. “High Prevalence of Primary Multidrug Resistant Tuberculosis in Persons with No Known Risk Factors.” PLOS ONE 6.10 (2011): n. pag. Print.
@article{2023249,
  abstract     = {Introduction: In high multidrug resistant (MDR) tuberculosis (TB) prevalence areas, drug susceptibility testing (DST) at diagnosis is recommended for patients with risk factors for MDR. However, this approach might miss a substantial proportion of MDR-TB in the general population. We studied primary MDR in patients considered to be at low risk of MDR-TB in Lima, Peru. 
Methods: We enrolled new sputum smear-positive TB patients who did not report any MDR-TB risk factor: known exposure to a TB patient whose treatment failed or who died or who was known to have MDR-TB; immunosuppressive co-morbidities, ex prison inmates; prison and health care workers; and alcohol or drug abuse. A structured questionnaire was applied to all enrolled participants to confirm the absence of these factors and thus minimize underreporting. Sputum from all participants was cultured on Lowenstein-Jensen media and DST for first line drugs was performed using the 7H10 agar method. 
Results: Of 875 participants with complete data, 23.2% (203) had risk factors for MDR-TB elicited after enrolment. Among the group with no reported risk factors who had a positive culture, we found a 6.3% (95% CI 4.4-8.3) (37/584) rate of MDR-TB. In this group no epidemiological characteristics were associated with MDR-TB. Thus, in this group, multidrug resistance occurred in patients with no identifiable risk factors. 
Conclusions: We found a high rate of primary MDR-TB in a general population with no identifiable risk factors for MDR-TB. This suggests that in a high endemic area targeting patients for MDR-TB based on the presence of risk factors is an insufficient intervention.},
  articleno    = {e26276},
  author       = {Otero, Larissa and Krapp, Fiorella and Tomatis, Cristina and Zamudio, Carlos and Matthys, Francine and Gotuzzo, Eduardo and Van Der Stuyft, Patrick and Seas, Carlos},
  issn         = {1932-6203},
  journal      = {PLOS ONE},
  language     = {eng},
  number       = {10},
  pages        = {5},
  title        = {High prevalence of primary multidrug resistant tuberculosis in persons with no known risk factors},
  url          = {http://dx.doi.org/10.1371/journal.pone.0026276},
  volume       = {6},
  year         = {2011},
}

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