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Free Content Extensively drug-resistant tuberculosis (XDR-TB) among health care workers in South Africa

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Abstract:

Summary Objective  To determine the clinical profile and outcomes of health care workers (HCWs) with extensively drug resistant tuberculosis (XDR-TB) in the Eastern and Western Cape Provinces of South Africa. Method  Retrospective case record review of 334 patients with XDR-TB reported during the period 1996–2008 from Western and Eastern Cape Province, Cape Town, South Africa. Case records of HCWs with XDR-TB were analysed for clinical and microbiological features, and treatment outcomes. Results  From 334 case records of patients with XDR-TB, 10 HCWs were identified. Eight of ten were HIV-uninfected, and four of 10 had died of XDR-TB despite treatment. All 10 HCWs had received an average of 2.4 courses of TB treatment before being diagnosed as XDR-TB. Conclusions  In the Eastern and Western Cape provinces of South Africa XDR-TB affects HCWs, is diagnosed rather late, does not appear to be related to HIV status and carries a high mortality. There is an urgent need for the South African government to implement WHO infection control recommendations and make available rapid drug susceptibility testing for HCWs with suspected multidrug-resistant (MDR)/XDR-TB. Further studies to establish the actual risk and sources of infection (nosocomial or community) are required.

French
Objectif: 

Déterminer la prévalence de la TB-UR chez les agents des soins de santé en Afrique du Sud. Méthode: 

Revue rétrospective des dossiers de cas portant sur 334 cas de TB-UR signalés au cours de la période de 1996 à 2008 dans l’ouest et l’est de la province du Cap, Cape Town, Afrique du Sud. Les dossiers des cas de TB-UR chez les agents de la santé ont été analysés pour les caractéristiques microbiologiques et cliniques et les résultats du traitement. Résultats: 

Sur 334 dossiers de cas de patients à TB-UR, 10 agents de la santé ont été identifiés. 8 des 10 n’étaient pas infectés par le VIH et 4 des 10 sont morts de TB-UR malgré le traitement. Tous les 10 agents de la santé avaient reçu une moyenne de 2,4 régimes de traitement antituberculeux avant d’être diagnostiqués comme TB-UR. Conclusions: 

A Cape Town, la TB-UR affecte les agents des soins de santé, est diagnostiquée assez tard, ne semble pas être liée au statut VIH et comporte une forte mortalité. Il est urgemment nécessaire que le gouvernement d’Afrique du Sud implémente les recommandations de l’OMS pour la prévention des infections et rende disponible des tests rapides de sensibilité pour les patients et les agents de la santé ayant une suspicion de TB-MDR/UR. D’autres études pour établir le risque réel et les sources d’infection (nosocomiale ou communautaire) sont nécessaires.

Keywords: agent de la santé; extensively drug-resistant; health worker; tb ampliamente resistente; trabajador sanitario; tuberculose; tuberculosis; ultra-résistante

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2010.02590.x

Affiliations: 1:  University of Calgary, Calgary, Canada 2:  Boston University School of Medicine, Boston, MA, USA 3:  South African Medical Research Council, Tygerberg, South Africa 4:  South African Medical Research Council, Pretoria, South Africa 5:  Lung Infection and Immunity Unit, Department of Medicine, University of Cape Town, South Africa 6:  Centre for Infectious Diseases and International Health, University College London Medical School, UK

Publication date: October 1, 2010

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