A case investigation of extensively drug–resistant tuberculosis (XDR–TB) in Phuket Province, Thailand, April 2018

Abstract

Background: According to extensive–drug resistant Tuberculosis (XDR–TB) is dangerous communicable disease because it has high potency of spreading and low treatment success rate. On 5th April 2018 BoE was notified that there was a confirmed XDR–TB case admitted in Hospital A, Phuket Province. Joint investigation team conducted investigation aiming to identify magnitude of transmission, determine potential factor of drug resistance of index case, and provide prevention and control measure.
Methods: Descriptive study was performed to describe about index case and determine potential factor of drug resistance by interviewing, reviewing her medical record, TB registration database and environmental study. Active case finding was performed among contact those who had stayed closely with the index case during 3 months prior to diagnosis until investigation. Contact was categorized as household and closed contact. Presumptive case was defined as who had at least one symptom of chronic cough ≥ 2 weeks or hemoptysis. For those who had cough less than 2 weeks, concurrent fever or weight loss was considered. Probable and Confirmed case was who diagnosed as TB by physician. All contacts were performed chest radio imaging and requested sputum for Xpert MTB/RIF.
Results: Index case was a 28–year–old Thai woman with no other medical condition. Isoniazid mono–resistant TB was detected from sputum culture when treatment was start. Father in law of her ex–husband was probably source of infection. Possible factors contributing to secondary drug resistance were delayed treatment, high amount of organism, poor drug compliance, drug prescription and drug storage. Eighteen household contacts and 27 closed contacts were identified whereas no one was ill. Index case had delayed treatment and low self– awareness of disease transmission that might promote to disease spreading.
Conclusions: Due to patient had low awareness of prevent disease transmission hence she should be isolated and treated using XDR–TB regimen until TB–culture negative sputum was confirmed. Local hospital was recommended to establish the contact registration. To prevent further drug resistant TB cases, contact should be followed up firmly under the guideline of Division of tuberculosis.