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Posted on Jun 08, 2005, 10 a.m.
By Bill Freeman
NEW YORK (Reuters Health) - In California, the majority of patients with tuberculosis resistant to multiple drugs are immigrants, a finding that highlights the need for both local and global control strategies to prevent the spread of this microbe, according to new report in the Journal of the American Medical Association.
Authors of a second paper in the Journal report that in the Samara region of Russia, most of the TB is a type that is at risk for becoming multidrug resistant (MDR).
Dr. Reuben M. Granich, while at the Centers for Disease Control and Prevention in Atlanta, and colleagues analyzed data for 407 MDR-TB patients identified from 28,712 tested for resistance to standard TB drugs in California between 1994 and 2003.
Individuals with a previous diagnosis were seven times more likely than their counterparts to develop MDR-TB, the authors report. Non-US-born TB patients were twice as likely to have MDR-TB compared with US-born patients.
These findings emphasize the importance of preventing MDR development and transmission abroad, and the need to expand overseas TB screening programs, the authors note. They also advise that "adherence to recommended TB treatment guidelines must be improved to ensure that poor case management does not contribute to further cases of MDR within California."
In the second study, Dr. Francis Drobniewski, at Queen Mary's School of Medicine in London, and colleagues analyzed TB specimens taken from 880 civilians and prisoners being treated in the Samara Region of Russia.
They found that 66.6 percent of specimens were of the Beijing strain, which has a heightened risk of being MDR. Imprisonment raised the risk of being infected with this strain, whereas living in one's own apartment and experiencing night sweats seemed to lower the risk.
"The high prevalence of drug-resistant Beijing-associated TB and increasing rates of both legal and illegal migration from Russia to the United States and Western Europe makes this study relevant to all physicians treating patients with TB," Drobniewski's team notes.
"Multidrug resistance in the United States is inextricably linked to resistance in the rest of the world," Dr. Mary D. Nettleman, at Michigan State University in East Lansing, observes in a related editorial. "Therefore, to control resistance in the United States, areas where resistance is epidemic must receive assistance and exquisite care must be taken not to create new problems on continents like Africa."
SOURCE: Journal of the American Medical Association, June 8, 2005.
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