Drug resistant TB - the too hard basket?

Studies from Africa indicate that drug resistant TB is proving to be difficult to pin down. By following MDR-TB and XDR-TB patients in South Africa researchers were able to build up some data on their contacts and the results are not good;

Approximately half of adult household contacts of drug resistant TB cases had resistance profiles that differed from the index case of TB.

This indicates that in these communities drug resistant TB infection is easily transmitted by contact outside the family unit.

The CDC report on a South African goldmine

Using a combination of clinical, epidemiologic, and molecular data, we showed that drug-resistance was primarily transmitted in this mine setting

A bad situation made worse by

a large proportion of patients who had a previous documented episode of TB were reinfected with a circulating MDR TB strain.

In Malawi it was found that HIV accelerated the rate of reinfection

Reinfections accounted for 1/16 recurrences in HIV-negative and 12/23 in HIV-positive individuals

It would appear that HIV fosters drug resistant TB and facilitates transmission.

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