0
Chest Infections |

Multidrug Resistant Tuberculosis: Closer to Home Than You May Think

Brian Walsh*, DO; Cynthia Tsai, DO; Gregory Benkovic, MD
Author and Funding Information

Geisinger Medical Center, Danville, PA


Chest. 2012;142(4_MeetingAbstracts):236A. doi:10.1378/chest.1387928
Text Size: A A A
Published online

Abstract

SESSION TYPE: Infectious Disease Student/Resident Case Report Posters I

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Primary multidrug resistant tuberculosis (MDR-TB) is defined as tuberculosis resistant to both isoniazid and rifampicin in a patient with no previous history of tuberculosis (TB). According to the Centers for Disease Control (CDC), there were 14 cases of MDR-TB in United States (US)-borne persons in the US in 2010.

CASE PRESENTATION: A 68-year-old man presented with complaint of a dry cough with occasional sputum production, fatigue, and malaise for the past year. Patient had a history of asthma and gastroesophageal reflux disease. He lived in rural Pennsylvania, denied ever smoking, being in prison or the military. He did have an extensive travel history within the United States, Canada, and Western Europe. Physical exam did not reveal wheezes, rhonchi, or rales. Imaging of the chest revealed patchy tree-in-bud appearance with peribronchovascular nodularity. Acid-fast bacillus (AFB) culture grew Mycobacterium tuberculosis(M. tuberculosis). Patient was started on rifampicin (RMP), isoniazid (INH), ethambutol (EMB), and pyrazinamide (PZA). Drug sensitivities later indicated the patient was resistant to INH, RMP, and PZA. EMB was continued and patient was started on capreomycin, cycloserine, para-aminosalicylic acid, and moxifloxacin. Within 3 weeks, AFB cultures converted to negative. Patient is currently continuing with multi-drug treatment to complete a total of 18 months post conversion to negative cultures.

DISCUSSION: MDR-TB is more common among foreign-borne persons in the US and those with prior treatment for TB. The highest proportion of MDR-TB is found in the former Soviet Union and China, with the majority of new cases in China and India. Because of the slow growth of M. tuberculosis, drug sensitivity by culture takes 4 to 8 weeks. Molecular detection of drug resistance (MDDR) can reveal sensitivities in one to two days. Currently, MDDR testing is only available under certain circumstances: high-risk (previous TB, MDR-TB exposure, foreign-borne), high-profile (nurse, daycare worker), known RMP resistance, and on a case-by-case basis. However, as we have presented a case of MDR-TB in a US-borne patient in central Pennsylvania with no identifiable risk factors for TB or drug-resistance, there is an increased need for MDDR testing.

CONCLUSIONS: Universal testing with MDDR can provide earlier identification of MDR-TB in patients similar to the case presented. With early detection of MDR-TB, we can potentially reduce time of contagiousness, incidence of MDR-TB cases, morbidity/mortality, and health care costs.

1) Reported Tuberculosis in the United States, 2010. Atlanta, GA: U.S. Department of Health and Human Services, CDC, October 2011.

2) Anti-tuberculosis drug resistance in the world : fourth global report. Geneva, Switzerland: World Health Organization, 2008.

3) Report of Expert Consultations on Rapid Molecular Testing to Detect Drug-Resistant Tuberculosis in the United States. Atlanta, GA: Centers for Disease Control and Prevention, 2009.

DISCLOSURE: The following authors have nothing to disclose: Brian Walsh, Cynthia Tsai, Gregory Benkovic

No Product/Research Disclosure Information

Geisinger Medical Center, Danville, PA

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543