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Surveillance of multi-drug resistant tuberculosis in france in 1992
Tubercle and Lung Disease: Supplement to problems of sensitivity and specificity. In order to contribute to this discussion, we studied antibodies to Ag A60 (excluding borderline values) in three groups of subjects, comparing them with the results of microscopic examination and culture of sputum. Group 1 consisted of 37 patients with active TB, group 2 of 23 ex-TB patients and group 3 of 37 subjects with non-tubercular lung diseases. In group 1,21 (56.7 %) patients were positive for Ag A60, 14 (37.8 %) for sputum microscopic examination and 17 (46%) for sputum culture. Eight patients (21.6%) were positive and 8 (21.6%) were negative for all three tests. Antigen A60 alone enabled the identification of 9 (24.3%) patients who were negative to the other two tests, compared with 2 (5.4%) identified by sputum culture alone. Patients negative to all three tests (21.6 %) consisted of 2 pleural TB, 2 cavitary TB, 1 miliary TB, 2 nodular TB and 1 lymphatic TB. However in one patient with pleural TB, there were borderline values of the antibody. All group 2 patients were negative to the sputum tests but 5 (21%) were positive to Ag A60. In group 3 patients had negative sputum microscopic examination and culture, and 9 (24.3 %) were positive to Ag A60. Of these, 2 had sarcoidosis, 3 lung fibrosis, 1 lung embolism, 2 pneumonia and 1 chronic bronchitis. In conclusion, anti Ag A60 antibodies identified 56.7% of TB patients in our population as against 46 % identified by sputum microscopic examination and culture combined. This value would be even higher if IgM were also used in addition to the IgG type antibodies used by us. The three methods combined identified 78,4% of TB patients. The investigation of antibodies against Ag A60, associated with other tests, in therefore useful in the clinical study of tuberculosis, but is at present limited by the possibility of false positives.
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66 SURVEILLANCE OF MULTI-DRUG RESISTANT TUBERCULOSIS IN FRANCE IN 1992. Schwoebel, V., Papillon, F., Haeghebaert, S., 7?uffot-Pernot, C., Grosset, J.; Centre National de Reference pour la Surveillance de la Tuberculose, Paris, France
Introduction:
Since 1988, several epidemics of multi-drug resistant tuberculosis (MDR-TB) mainly concerning HIVinfected people have been reported in the United States. One such epidemic occurred in a Parisian hospital in 1990-1991. No survey on drug resistance of M. tuberculosis has been conducted in France since the 70’s. Methods:
A mail survey of French hospital microbiology laboratories (all regional, district and large municipal hospitals, main private hospitals, Pasteur Institutes) was conducted in 1992. Laboratories were asked to report the total number of patients with at least one culture positive for M. tuberculosis complex and to provide information about all MDR-TB, i.e. cases with bacilli resistant to isoniazid (H) and rifampicin (R) diagnosed during the year 1992. Results:
Response rate was 94% among the 348 laboratories surveyed. A total of 8521 patients with at least one positive culture in 1992 were reported, among whom 48, i.e. 0.5 %, had bacilli resistant to both H and R. Among the 48 MDR-TB cases reported, 43 were pulmonary TB. Resistance was presumed to be secondary in 37 patients, among which 19 (51%) were foreign-born patients and 2 were HIV-infected. Eight cases were diagnosed in previously untreated patients, among whom 3 were reported to be HIV-infected. Nosocomial transmission was demonstrated for one of the patients with presumably primary MDR-TB. Conclusion:
65 RFLP FOR EPIDEMIOLOGICAL
OF BOVINE TUBERCULOSIS DEER IN SWEDEN
TYPING IN FARMED
Szewzyk, R., Hoffner, S., Bolske, G., Kiillenius, G., Svenson, S. B.; Swedish Institute for Infectious Disease Control, S-1052/ Stockholm, and National Veterinary Institute, Uppsala, Sweden
During the last years tuberculosis caused by Mycobacterium bovis has been diagnosed in farmed deer in Sweden. Up to 1993 altogether seven herds have been affected. The epidemiological spread of M. bovis among the deer has been investigated, and for that purpose epidemiological subtyping of the M. bovis isolates was performed. The strains were characterized by restriction fragment length polymorphism (RFLP) using the insertion element IS986 as a probe. All isolates studied (derived from five different herds) showed an identical banding pattern, comprising seven bands. Most M. bovis isolates have previously been reported to contain one or very few copies of IS986; thus the present pattern seems to be highly characteristic of these isolates, which accordingly appear to be identical. RFLP is a simple, specific method which was epidemiologically very useful for demonstrating the identity of isolates from the different outbreaks of bovine tuberculosis in farmed deer. This method should be suitable for identification of spread of tuberculosis (bovine as well as human) in husbandry as well as in wild animals.
The rate of multi-drug resistance was low (0.5 %) in France in 1992. Half of the secondary MDR-TB cases are likely to have acquired resistance abroad. yet other cases indicate failures in the management of TB in France. The report of 8 potential cases of primary MDRTB may indicate active transmission of MDR bacilli, particularly in HIV-infected patients. Surveillance of MDR-TB and investigations around primary MDR-TB cases are warranted.
67 THE TREATMENT OF MULTIDRUGRESISTANCE TUBERCULOSIS DEVELOPING COUNTRY: TURKEY (PRELIMINARY REPORT) Tahaoglu, K., Ktzktn, 6., Karagoz, T., Yllmaz. M.. GGnen, H., Partal, M., Bagiizdemir, N., Sadoglu, T.; Siireyyapaga Gti@s Hastahklan ve Gd@s Cerrahisi Merkezi 81554 Maltepe Istanbul Turkey
From January 1990 to October 1993 28 HIV negative pulmonary tuberculosis patients with secondary multidrug resistance who were retreated for 18-24 month were presented in this study. The average age was 35.5 years (range, 23-63). On the average 8.25 years passed from the time active tuberculosis was diagnosed (range 2-18). The drugs which the patients had previously received or hadn’t received (clean drugs) were determined by reviewing the previous medications and showing the drugs to the patients. The drugs which the patients had received previously were classified as “susceptible” or “resistant” according to radiological and bacteriological findings. When it
19
66 SURVEILLANCE OF MULTI-DRUG RESISTANT TUBERCULOSIS IN FRANCE IN 1992. Schwoebel, V., Papillon, F., Haeghebaert, S., 7?uffot-Pernot, C., Grosset, J.; Centre National de Reference pour la Surveillance de la Tuberculose, Paris, France
Introduction:
Since 1988, several epidemics of multi-drug resistant tuberculosis (MDR-TB) mainly concerning HIVinfected people have been reported in the United States. One such epidemic occurred in a Parisian hospital in 1990-1991. No survey on drug resistance of M. tuberculosis has been conducted in France since the 70’s. Methods:
A mail survey of French hospital microbiology laboratories (all regional, district and large municipal hospitals, main private hospitals, Pasteur Institutes) was conducted in 1992. Laboratories were asked to report the total number of patients with at least one culture positive for M. tuberculosis complex and to provide information about all MDR-TB, i.e. cases with bacilli resistant to isoniazid (H) and rifampicin (R) diagnosed during the year 1992. Results:
Response rate was 94% among the 348 laboratories surveyed. A total of 8521 patients with at least one positive culture in 1992 were reported, among whom 48, i.e. 0.5 %, had bacilli resistant to both H and R. Among the 48 MDR-TB cases reported, 43 were pulmonary TB. Resistance was presumed to be secondary in 37 patients, among which 19 (51%) were foreign-born patients and 2 were HIV-infected. Eight cases were diagnosed in previously untreated patients, among whom 3 were reported to be HIV-infected. Nosocomial transmission was demonstrated for one of the patients with presumably primary MDR-TB. Conclusion:
65 RFLP FOR EPIDEMIOLOGICAL
OF BOVINE TUBERCULOSIS DEER IN SWEDEN
TYPING IN FARMED
Szewzyk, R., Hoffner, S., Bolske, G., Kiillenius, G., Svenson, S. B.; Swedish Institute for Infectious Disease Control, S-1052/ Stockholm, and National Veterinary Institute, Uppsala, Sweden
During the last years tuberculosis caused by Mycobacterium bovis has been diagnosed in farmed deer in Sweden. Up to 1993 altogether seven herds have been affected. The epidemiological spread of M. bovis among the deer has been investigated, and for that purpose epidemiological subtyping of the M. bovis isolates was performed. The strains were characterized by restriction fragment length polymorphism (RFLP) using the insertion element IS986 as a probe. All isolates studied (derived from five different herds) showed an identical banding pattern, comprising seven bands. Most M. bovis isolates have previously been reported to contain one or very few copies of IS986; thus the present pattern seems to be highly characteristic of these isolates, which accordingly appear to be identical. RFLP is a simple, specific method which was epidemiologically very useful for demonstrating the identity of isolates from the different outbreaks of bovine tuberculosis in farmed deer. This method should be suitable for identification of spread of tuberculosis (bovine as well as human) in husbandry as well as in wild animals.
The rate of multi-drug resistance was low (0.5 %) in France in 1992. Half of the secondary MDR-TB cases are likely to have acquired resistance abroad. yet other cases indicate failures in the management of TB in France. The report of 8 potential cases of primary MDRTB may indicate active transmission of MDR bacilli, particularly in HIV-infected patients. Surveillance of MDR-TB and investigations around primary MDR-TB cases are warranted.
67 THE TREATMENT OF MULTIDRUGRESISTANCE TUBERCULOSIS DEVELOPING COUNTRY: TURKEY (PRELIMINARY REPORT) Tahaoglu, K., Ktzktn, 6., Karagoz, T., Yllmaz. M.. GGnen, H., Partal, M., Bagiizdemir, N., Sadoglu, T.; Siireyyapaga Gti@s Hastahklan ve Gd@s Cerrahisi Merkezi 81554 Maltepe Istanbul Turkey
From January 1990 to October 1993 28 HIV negative pulmonary tuberculosis patients with secondary multidrug resistance who were retreated for 18-24 month were presented in this study. The average age was 35.5 years (range, 23-63). On the average 8.25 years passed from the time active tuberculosis was diagnosed (range 2-18). The drugs which the patients had previously received or hadn’t received (clean drugs) were determined by reviewing the previous medications and showing the drugs to the patients. The drugs which the patients had received previously were classified as “susceptible” or “resistant” according to radiological and bacteriological findings. When it