Amber Arnold1, Adam A Witney2, Stephania Vergnano3, Anita Roche4, Catherine A Cosgrove5, Angela Houston6, Katherine A Gould7, Jason Hinds8, Peter Riley9, Derek Macallan10, Philip D Butcher11, Tom S Harrison12. 1. Institute for Infection and Immunity, St. George's University of London, London, SW17 0RE, United Kingdom; Infection Care Group, St George's Healthcare NHS Trust, London, United Kingdom. Electronic address: amber.arnold@doctors.org.uk. 2. Institute for Infection and Immunity, St. George's University of London, London, SW17 0RE, United Kingdom. Electronic address: awitney@sgul.ac.uk. 3. Institute for Infection and Immunity, St. George's University of London, London, SW17 0RE, United Kingdom. Electronic address: stev@doctors.org.uk. 4. Public Health England, London, United Kingdom. Electronic address: anita.roche@phe.gov.uk. 5. Institute for Infection and Immunity, St. George's University of London, London, SW17 0RE, United Kingdom; Infection Care Group, St George's Healthcare NHS Trust, London, United Kingdom. Electronic address: ccosgrov@sgul.ac.uk. 6. Infection Care Group, St George's Healthcare NHS Trust, London, United Kingdom. Electronic address: angela.houston@stgeorges.nhs.uk. 7. Institute for Infection and Immunity, St. George's University of London, London, SW17 0RE, United Kingdom. Electronic address: kgould@sgul.ac.uk. 8. Institute for Infection and Immunity, St. George's University of London, London, SW17 0RE, United Kingdom. Electronic address: jhinds@sgul.ac.uk. 9. Infection Care Group, St George's Healthcare NHS Trust, London, United Kingdom. Electronic address: peter.riley@stgeorges.nhs.uk. 10. Institute for Infection and Immunity, St. George's University of London, London, SW17 0RE, United Kingdom; Infection Care Group, St George's Healthcare NHS Trust, London, United Kingdom. Electronic address: macallan@sgul.ac.uk. 11. Institute for Infection and Immunity, St. George's University of London, London, SW17 0RE, United Kingdom. Electronic address: butercherp@sgul.ac.uk. 12. Institute for Infection and Immunity, St. George's University of London, London, SW17 0RE, United Kingdom; Infection Care Group, St George's Healthcare NHS Trust, London, United Kingdom. Electronic address: tharriso@sgul.ac.uk.
Abstract
OBJECTIVES: We describe the first published cluster of extensively drug resistant Tuberculosis (XDR-TB) in the UK and show how early whole genome sequencing (WGS) of Mtb can assist in case management and contact investigations. METHODS: We describe the contact tracing investigation undertaken after the presentation of an adult with XDR-TB. Active cases were treated with an XDR-TB drug regimen and contacts underwent a programme of follow-up for 2 years. All isolates of Mycobacterium tuberculosis (Mtb) were assessed early using whole genome sequencing (WGS) as well as routine drug susceptibility testing (DST). RESULTS: Thirty-three contacts were screened. In the first year one confirmed and one probable case were identified through contact tracing. A further possible case was identified through epidemiological links. Two confirmed cases were identified through WGS 2 years later. Twenty-five (80%) contacts without evidence of tuberculosis were adherent to 1 year of follow-up and 14 (45%) were adherent to 2 years of follow-up. WGS of Mtb was used to guide drug choices, rapidly identify transmission events, and alter public health management. CONCLUSION: WGS of Mtb enabled rapid effective individualized treatment and facilitated public health interventions by early identification of transmission events.
OBJECTIVES: We describe the first published cluster of extensively drug resistant Tuberculosis (XDR-TB) in the UK and show how early whole genome sequencing (WGS) of Mtb can assist in case management and contact investigations. METHODS: We describe the contact tracing investigation undertaken after the presentation of an adult with XDR-TB. Active cases were treated with an XDR-TB drug regimen and contacts underwent a programme of follow-up for 2 years. All isolates of Mycobacterium tuberculosis (Mtb) were assessed early using whole genome sequencing (WGS) as well as routine drug susceptibility testing (DST). RESULTS: Thirty-three contacts were screened. In the first year one confirmed and one probable case were identified through contact tracing. A further possible case was identified through epidemiological links. Two confirmed cases were identified through WGS 2 years later. Twenty-five (80%) contacts without evidence of tuberculosis were adherent to 1 year of follow-up and 14 (45%) were adherent to 2 years of follow-up. WGS of Mtb was used to guide drug choices, rapidly identify transmission events, and alter public health management. CONCLUSION: WGS of Mtb enabled rapid effective individualized treatment and facilitated public health interventions by early identification of transmission events.
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