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XDR tuberculosis in Lisbon health region

Abstract number: 1733_1112

Brum L., Macedo R., Cristovão P., Reis L., Fernandes E., Pereira E., Garcia A.

Introduction: Portugal is still the European country with the highest incidence of notified tuberculosis cases (31/100,000 in 2005 compared to 12.8/100,00 habitants in Central and Eastern E.U.). Despite MDR-TB strains isolated in hospital and public health laboratories being currently notified to Portuguese Health authorities, the true magnitude of this problem remains unknown. In fact, even though only 17 MDR-TB cases were notified in 2003, the National Institute of Health Dr. Ricardo Jorge in Lisbon, usually receives around 80 MDR-TB strains per year from the Health Region of Lisboa e Vale do Tejo (which represent 6–8% of the total of isolated strains in this region).

Recently it has been described MDR-TB strains that have mutated into an even stronger forms designated as extremely drug resistant tuberculosis (XDR-TB). This form of TB is defined as resistance to both isoniazid and rifampicin (definition of MDR-TB) in addition to resistance to any fluoroquinolone and to at least one of the three injectable second-line anti-TB drugs used in treatment (capreomycin, kanamicin and amikacin).

Material and Methods: In this study we evaluated the prevalence of XDR-TB strains among strains isolated in Lisbon laboratories and hospitals, in the years 2002 to 2006.

Susceptibility testing to first line drugs (Isoniazid, rifampicin, ethambutol, pyrazinamid, streptomycin) and second line drugs (ethionamide, capreomycine, ofloxacyn, kanamycin, amikacin and PAS), was performed in Bactec 460 Tb in the critical concentrations indicated in the Bactec manual or according to Pfyffer et al.

Results: Among the MDR-TB strains isolated in our laboratory we found that about half of them are also XDR-TB (table 1).

Table 1. Number of XDR/MDR patients per year

YearNo. of XDRNo. of MDR%(XDR/MDR)
2002418648
2003508757
2004498657
2005499452
2006a184639
aData until September 2006.

Conclusion: These numbers are extremely high comparing to other European countries such as France, Belgium or UK that have 3–11% of XDR-TB cases. This problem is particularly worse for the HIV population as the rate death for HIV/AIDS patients with XDR-TB is nearly 100%.

The emergence of XDR-TB calls for a vigorous international response to fully implement proper TB control, to limit their public health impact and to ensure that countries at risk from the disease are prepared for it.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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