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Free Content Case series of the long-term psychosocial impact of drug-resistant tuberculosis in HIV-negative medical doctors

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BACKGROUND: Health care workers (HCWs) are at greater risk for tuberculosis (TB), including multidrug-resistant TB (MDR-TB), compared to the general population. The psychosocial impact of nosocomial TB on HCWs has received little attention in the literature.

METHODS: A retrospective medical record review from 1999 to 2003 found 15 HCWs who were treated for drug-resistant TB at a specialist hospital in South Africa. Five human immunodeficiency virus (HIV) negative doctors with no predisposing factors for drug resistance are included in this case series. We collectively present their clinical case histories based on medical records from 2000 to 2005, and explore the long-term psychosocial impact of TB from interviews conducted in 2009.

RESULTS: Four doctors had primary MDR-TB and one had primary resistance to multiple first-line drugs. Time from symptom onset to commencement of effective treatment ranged from 8 to 39 weeks. Time for bacteriological confirmation of drug-resistant TB ranged from 6 to 24 weeks. All were cured within 3 years of initial presentation. Content analysis of follow-up interviews revealed five main themes: 1) prolonged morbidity, 2) psychological impact, 3) poor infection control, 4) weak support structures and 5) attrition from the field.

CONCLUSION: Themes emergent from this case series encourage prioritisation of TB infection control education and practice to minimise HCW morbidity and prevent HCW attrition from high-burden resource-constrained settings.

Keywords: South Africa; drug-resistant tuberculosis; health care workers; infection control; psychosocial impact

Document Type: Regular Paper

Affiliations: 1: Centre for AIDS Programme of Research in South Africa (CAPRISA), and Department of Community Health, Nelson R Mandela School of Medicine, Durban, South Africa 2: Centre for AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, Durban, South Africa; and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada 3: Centre for AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, Durban, South Africa 4: Department of Cardio-Thoracic Surgery, Inkosi Albert Luthuli Central Hospital, Durban, South Africa 5: King George V Hospital, Durban, South Africa

Publication date: 2010-08-01

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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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