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Free Content Clinical and programmatic mismanagement rather than community outbreak as the cause of chronic, drug-resistant tuberculosis in Buenaventura, Colombia, 1998

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SETTING: Buenaventura, Colombia.

OBJECTIVE: To assess whether antituberculosis drug resistance was generated by poor management or community transmission.

DESIGN: Treatment-failure and new tuberculosis (TB) patients identified between May 1997 and June 1998 were interviewed and their treatment histories reviewed. Bacteriologic testing, including drug susceptibility profiles (DSP) and DNA fingerprinting by restriction fragment length polymorphism (RFLP), was performed and human immunodeficiency virus (HIV) testing was offered.

RESULTS: DSP and RFLP fingerprints were obtained for isolates from 34 of 64 treatment-failure patients; 25 (74%) were resistant to ≥ one drug. Fifteen of the 25 patients consented to HIV testing; none were positive. An average of 2.8 major treatment errors per patient was identified. RFLP from the treatment-failure patients revealed 20 unique isolates and six clusters (isolates with identical RFLP); 4/6 clusters contained isolates with different DSP. Analysis of the RFLP from both treatment-failure and new patients revealed that 44/111 (40%) isolates formed 18 clusters. Four of 47 (9%) new patients had multidrug-resistant TB (MDR-TB). Eleven isolates belonged to the Beijing family, related to the MDR strain W.

CONCLUSION: Drug resistance in Buenaventura results from both poor management and community transmission. Dependence on DSP to identify TB transmission is inadequate when programmatic mismanagement is common.
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Keywords: Beijing family; Colombia; DNA fingerprinting; RFLP; multidrug resistance; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia 2: Division of AIDS, STD, and TB Laboratory Research, National Center for Infectious Diseases, CDC, Atlanta, Georgia, USA 3: Secretaría de Salud Departamental del Valle del Cauca, Cali, Colombia 4: Secretaría de Salud Municipal de Buenaventura, Buenaventura, Colombia 5: Division of TB Elimination, National Center for HIV, STD, and TB Prevention, Atlanta, Georgia, USA

Publication date: 2000-07-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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