Tuberculosis in Thai prisons: magnitude, transmission and drug susceptibility
Abstract:BACKGROUND: Because of the human immunodeficiency virus (HIV) epidemic, tuberculosis has reemerged as a major public health problem in Thailand. Prison inmates are at high risk for developing tuberculosis because of the high prevalence of HIV infection.
OBJECTIVES: To determine the magnitude, transmission, and drug susceptibility of tuberculosis in Thai prisons.
SETTINGS: Four provincial prisons in Southern Thailand.
DESIGN: Cross-sectional, descriptive, clinical and molecular study.
RESULTS: Miniature chest roentgenograms were performed on 304 (6.4%) of 4751 inmates screened for a ≥2 week history of chronic cough and fever. At least 17 (35%) of 49 inmates who had a miniature chest roentgenogram compatible with tuberculosis were HIV-positive. The prevalence of smear-positive pulmonary tuberculosis was 568 per 100000 inmates, which was eight times higher than that in the general population. Eight (38%) of 21 culture-positive Mycobacterium tuberculosis isolates had DNA fingerprints matching those of another inmate who was housed in the same room or in the same dormitory unit; 39% of the M. tuberculosis isolates were resistant to isoniazid; three of these isolates were also borderline resistant to rifampicin.
CONCLUSION: The prevalence of pulmonary tuberculosis in these prisons was high. A substantial proportion were acquired in the prisons. Isoniazid (INH) resistance was common, and theoretically precludes the use of INH-preventive therapy for contacts of these cases. Active case finding should be done and directly observed therapy implemented to prevent the spread of tuberculosis into the community.
Document Type: Regular Paper
Affiliations: 1: Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand 2: Department of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand 3: Department of Microbiology, Faculty of Science, Mahidol University, Bangkok, Thailand 4: Department of Biochemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Thailand 5: Department of Microbiology, Faculty of Science, Prince of Songkla University, Hat Yai, Thailand
Publication date: March 1, 2002
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