Journal Article

A Comparison of Outbreak- and Nonoutbreak-Related Multidrug-Resistant Tuberculosis Among Human Immunodeficiency Virus-Infected Patients in a South African Hospital

Leonard V. Sacks, Stella Pendle, Dragana Orlovic, Lucille Blumberg and Constantinos Constantinou

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 29, issue 1, pages 96-101
Published in print July 1999 | ISSN: 1058-4838
Published online July 1999 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/520189
A Comparison of Outbreak- and Nonoutbreak-Related Multidrug-Resistant Tuberculosis Among Human Immunodeficiency Virus-Infected Patients in a South African Hospital

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Nosocomial multidrug-resistant tuberculosis (MDR-TB) in human immunodeficiency virus (HIV)—infected people is recognized in Europe and America. We report the first such outbreak in South Africa. Six hospitalized women, identified by DNA fingerprinting, were infected with an outbreak strain of MDR-TB while receiving treatment for drug-susceptible tuberculosis. The putative source case was identified as an HIV-positive woman who underwent prolonged hospitalization for chronic cavitary tuberculosis. Compared with other HIV-positive patients in the hospital, outbreak patients were more immunocompromised, had fewer cavitary lung changes, and were less likely to have been treated before. They had high fevers, infiltrative patterns on chest radiographs, and a mean survival of 43 days. When individual isolation is not possible, separating highly immunocompromised patients with first-time tuberculosis from previously treated patients with cavitary lesions and from those with established drug resistance may reduce nosocomial transmission.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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