CONTEXT: Worldwide emergence of extensively drug-resistant tuberculosis (XDR-TB) has raised global public health concern, given the limited therapy options and high mortality. OBJECTIVES: To describe the epidemiology of XDR-TB in the United States and to identify unique characteristics of XDR-TB cases compared with multidrug-resistant TB (MDR-TB) and drug-susceptible TB cases. DESIGN, SETTING, AND PATIENTS: Descriptive analysis of US TB cases reported from 1993 to 2007. Extensively drug-resistant TB was defined as resistance to isoniazid, a rifamycin, a fluoroquinolone, and at least 1 of amikacin, kanamycin, or capreomycin based on drug susceptibility test results from initial and follow-up specimens. MAIN OUTCOME MEASURES: Extensively drug-resistant TB case counts and trends, risk factors for XDR-TB, and overall survival. RESULTS: A total of 83 cases of XDR-TB were reported in the United States from 1993 to 2007. The number of XDR-TB cases declined from 18 (0.07% of 25 107 TB cases) in 1993 to 2 (0.02% of 13 293 TB cases) in 2007, reported to date. Among those with known human immunodeficiency virus (HIV) test results, 31 (53%) were HIV-positive. Compared with MDR-TB cases, XDR-TB cases were more likely to have disseminated TB disease (prevalence ratio [PR], 2.06; 95% confidence interval [CI], 1.19-3.58), less likely to convert to a negative sputum culture (PR, 0.55; 95% CI, 0.33-0.94), and had a prolonged infectious period (median time to culture conversion, 183 days vs 93 days for MDR-TB; P < .001). Twenty-six XDR-TB cases (35%) died during treatment, of whom 21 (81%) were known to be HIV-infected. Mortality was higher among XDR-TB cases than among MDR-TB cases (PR, 1.82; 95% CI, 1.10-3.02) and drug-susceptible TB cases (PR, 6.10; 95% CI, 3.65-10.20). CONCLUSION: Although the number of US XDR-TB cases has declined since 1993, coinciding with improved TB and HIV/AIDS control, cases continue to be reported each year.
CONTEXT: Worldwide emergence of extensively drug-resistant tuberculosis (XDR-TB) has raised global public health concern, given the limited therapy options and high mortality. OBJECTIVES: To describe the epidemiology of XDR-TB in the United States and to identify unique characteristics of XDR-TB cases compared with multidrug-resistant TB (MDR-TB) and drug-susceptible TB cases. DESIGN, SETTING, AND PATIENTS: Descriptive analysis of US TB cases reported from 1993 to 2007. Extensively drug-resistant TB was defined as resistance to isoniazid, a rifamycin, a fluoroquinolone, and at least 1 of amikacin, kanamycin, or capreomycin based on drug susceptibility test results from initial and follow-up specimens. MAIN OUTCOME MEASURES: Extensively drug-resistant TB case counts and trends, risk factors for XDR-TB, and overall survival. RESULTS: A total of 83 cases of XDR-TB were reported in the United States from 1993 to 2007. The number of XDR-TB cases declined from 18 (0.07% of 25 107 TB cases) in 1993 to 2 (0.02% of 13 293 TB cases) in 2007, reported to date. Among those with known human immunodeficiency virus (HIV) test results, 31 (53%) were HIV-positive. Compared with MDR-TB cases, XDR-TB cases were more likely to have disseminated TB disease (prevalence ratio [PR], 2.06; 95% confidence interval [CI], 1.19-3.58), less likely to convert to a negative sputum culture (PR, 0.55; 95% CI, 0.33-0.94), and had a prolonged infectious period (median time to culture conversion, 183 days vs 93 days for MDR-TB; P < .001). Twenty-six XDR-TB cases (35%) died during treatment, of whom 21 (81%) were known to be HIV-infected. Mortality was higher among XDR-TB cases than among MDR-TB cases (PR, 1.82; 95% CI, 1.10-3.02) and drug-susceptible TB cases (PR, 6.10; 95% CI, 3.65-10.20). CONCLUSION: Although the number of US XDR-TB cases has declined since 1993, coinciding with improved TB and HIV/AIDS control, cases continue to be reported each year.
Authors: Karen R Jacobson; Dylan B Tierney; Christie Y Jeon; Carole D Mitnick; Megan B Murray Journal: Clin Infect Dis Date: 2010-07-01 Impact factor: 9.079
Authors: N Sarita Shah; Sara C Auld; James C M Brust; Barun Mathema; Nazir Ismail; Pravi Moodley; Koleka Mlisana; Salim Allana; Angela Campbell; Thuli Mthiyane; Natashia Morris; Primrose Mpangase; Hermina van der Meulen; Shaheed V Omar; Tyler S Brown; Apurva Narechania; Elena Shaskina; Thandi Kapwata; Barry Kreiswirth; Neel R Gandhi Journal: N Engl J Med Date: 2017-01-19 Impact factor: 91.245
Authors: G B Migliori; G Sotgiu; N R Gandhi; D Falzon; K DeRiemer; R Centis; M G Hollm-Delgado; D Palmero; C Pérez-Guzmán; M H Vargas; L D'Ambrosio; A Spanevello; M Bauer; E D Chan; H S Schaaf; S Keshavjee; T H Holtz; D Menzies Journal: Eur Respir J Date: 2012-10-11 Impact factor: 16.671
Authors: V Balaji; Peter Daley; Alok Azad Anand; Thambu Sudarsanam; Joy Sarojini Michael; Rani Diana Sahni; Poorvi Chordia; Ige Abraham George; Kurien Thomas; Alka Ganesh; K R John; Dilip Mathai Journal: PLoS One Date: 2010-03-04 Impact factor: 3.240