A case investigation of a patient with extensively drug-resistant tuberculosis (XDR-TB), X District, Songkhla Province, Thailand, 2019
Keywords:
extensive drug-resistant tuberculosis, XDR-TB, Songkhla, case investigationAbstract
Background: On October 9, 2019, the situation awareness team of the office of Disease Prevention and Control region 12 (ODPC12) received notification of a confirmed extensive drug-resistant tuberculosis (XDR-TB) case from the 12th Regional Tuberculosis Center. The investigation team of ODPC12, 12th Regional Tuberculosis Center, and Songkhla provincial public health office jointly investigated on 10–11 October 2019. We aimed to identify the source of the infection and risk factors for XDR-TB, find close contacts and give recommendations for prevention and control.
Methods: Descriptive studies were done by reviewing medical records, chest x-ray, laboratory data, and drug susceptibility testing (DST) at the hospital. We interviewed the case to identify the source of infection and find close contacts. Laboratory studies were done, including CXR, sputum for Acid-Fast Bacillus, and DST. The environmental health study surveyed hospitals, housing, and communities of a confirmed case.
Results: The patient is a Thai man, 49 years old, a construction worker, who was first diagnosed with tuberculosis on August 11, 2012, as a polydrug-resistant strain. The suspected source of infection might come from a migrant worker who worked closely together in 2011. Inappropriate treatment is a significant factor in becoming XDR-TB at last. We met three household contacts, and two were close contacts. Laboratory results showed one of the household contacts had a TB infection without drug resistance. We found the confirmed case lived alone in a high-TB prevalence slum. The turbulence of air circulation inside the TB clinic is a risk of TB transmission in the hospital.
Conclusion: The confirmed case was initially polydrug-resistant, and he might have gotten the infection from a migrant worker. He was becoming XDR-TB due to improper treatment. We met one TB-infected household contact. He stays alone in a well-ventilated home. Inside TB clinics, facing bad air circulation. The healthcare team should regularly review the treatment of TB cases and improve the hospital environment to prevent TB transmission. Disease prevention teams should work with the multidisciplinary section to improve TB surveillance in high-risk communities.
References
World Health Organization. Global tuberculosis report 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2021 Feb 2]. Available from: https://www.who.int/news-room/fact-sheets/detail/tuberculosis
Centers for Disease Control and Prevention. Basic TB Facts [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2012 [cited 2021 Feb 2]. Available from: http://www.cdc.gov/tb/topic/basics/default.htm
กองวัณโรค กรมควบคุมโรค กระทรวงสาธารณสุข. แนวทางการ ควบคุมวัณโรคประเทศไทย 2561 [อินเทอร์เน็ต]. กรุงเทพฯ: กองวัณโรค กรมควบคุมโรค; 2561 [เข้าถึงเมื่อวันที่ 28 พ.ย. 2563 ]. เข้าถึงได้จาก: https://www.tbthailand.org/download/Manual/NTP2018.pdf
กองวัณโรค กรมควบคุมโรค กระทรวงสาธารณสุข. แนวทาง ปฏิบัติป้องกันควบคุมวัณโรคดื้อยาหลายขนานชนิดรุนแรงมาก [อินเทอร์เน็ต]. กรุงเทพฯ: กองวัณโรค กรมควบคุมโรค; 2561 [เข้าถึงเมื่อวันที่ 28 พ.ย. 2563]. เข้าถึงได้จาก: https://www.tbthailand.org/download/Manual/วัณโรคดื้อยาหลาย ขนาน_final_forweb.pdf
Truzyan N, Crape B, Grigoryan R, Martirosyan H, Petrosyan V. Increased risk for multidrug-resistant tuberculosis in migratory workers, Armenia [Internet]. Emerging infectious diseases; 2015 [cited 2021 Jan 3]. p.474–6. Available from: https://doi.org/10.3201/eid2103.140474
Hemhongsa P, Tasaneeyapan T, Swaddiwudhipong W, Danyuttapolchai J, Pisuttakoon K, Rienthong S, et al. TB, HIV-associated TB and multidrug-resistant TB on Thailand’s border with Myanmar, 2006-2007 [Internet]. Tropical Medicine and International Health. 2008 [cited 2021 Jan 1]; 13(10): 1288–96 p. Available from: https://doi.org/10.1111/j.1365-3156.2008.02139.x
Yi Hu, Sven H, Weili J, Weibing W, Biao X. Extensive transmission of isoniazid resistant M. tuberculosis and its association with increased multidrug-resistant TB in two rural counties of eastern China: A molecular epidemiological study [Internet]. BMCInfectDis; 2010 [cited 2021 Feb 3]. p. 10–43. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846942/
Htun YM, Khaing TMM, Aung NM, Yin Y, Myint Z, Aung ST, et al. Delay in treatment initiation and treatment outcomes among adult patients with multidrugresistant tuberculosis at Yangon Regional Tuberculosis Centre, Myanmar: A retrospective study [Internet]. PLoS One; 2018 [cited 2021 Jan 20]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312206/
Division of Tuberculosis Elimination. Drug-Resistant TB [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2017 [cited 2021 Jan 28]. Available from: https://www.cdc.gov/tb/topic/drtb/default.htm
Cookson ST, Jarvis WR. Prevention of nosocomial transmission of Mycobacterium tuberculosis [Internet]. Infectious Disease Clinics of North America; June 1997 [cited 2021 Feb 23]. 385-409 p. Available from: https://doi.org/10.1016/s0891-5520(05)70362-7
Singh S, Bhutani H, Mariappan TT, Kaur H, Bajaj M, Pakhale SP. Behavior of uptake of moisture by drugs and excipients under accelerated conditions of temperature and humidity in the absence and the presence of light. 1. Pure anti-tuberculosis drugs and their combinations. Int J Pharm; 2002 [cited 2021 Jan 28]. 37–44 p. Available from: https://doi.or/g/10.1016/s0378-5173(02)00340-x
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