(Investigation of multidrug-resistant tuberculosis in an 18-year-old male, Sena district, Phra Nakhon Si Ayutthaya province, March–June 2020

Abstract

Background: Thailand is classified as one of the 14 countries in the world with high burden of tuberculosis (TB), TB with HIV infection and multidrug-resistant (MDR) TB. This report presented MDR-TB investigation in an 18-yearold male living in Ayutthaya province. The investigation was conducted during March–June 2020 to confirm diagnosis; identify the source case, risk factors, and active case finding among contacts; and recommend preventive and control measures.
Methods: A descriptive study was conducted by medical records review and case interview, active TB finding among household and closed contacts of the case during 3 months before TB onset of the case, investigation date, and identification of the possible source case among contacts within 2 years before TB onset.
Results: This index case had onset of cough in January 2019, smear–positive sputum for acid-fast bacilli, and TB treatment in March 2019 (without drug susceptibility testing). He did not take anti-TB drugs regularly and became a defaulter. He was found to have rifampicin-resistant TB by Xpert MTB/RIF in September 2019 and MDR-TB by line probe assay in March 2020. The source case of TB might be his grandfather or friend who had TB within 2 years before him. His grandfather developed TB in Ayutthaya prison in January 2018 and was discharged from the prison after the 6- weeks TB treatment receiving regular TB treatment and being cured (no longer TB transmission). Another possible source case was the index case’s friend who played snooker, had meal and alcohol, and slept together for about 1 year before the his onset of TB. This friend received TB treatment in June 2018 and was found to have MDR-TB. Active TB finding among 8 household and closed contacts of the index case did not detect any TB case. The other 8 friends (in the same snooker group) and possible source cases were under tracing for TB screening.
Conclusions: This MDR-TB case might contact infection from his friend who had MDR-TB. Drug susceptibility testing in new TB cases before treatment, source case detection, and TB screening among source case’s contacts may be helpful for MDR-TB prevention and control.