Published Date: 2008-04-12 16:00:19
Subject: PRO/AH/EDR> Tuberculosis, MDR, XDR - Peru
Archive Number: 20080412.1337

TUBERCULOSIS, MDR, XDR - PERU
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Date: Fri 11 Apr 2008
From: Juan Carlos Celis-Salinas, MD
<dr_jcelis@gipeit.com> [trans. ESP Mod. JG, edited]


The Mycobacteria Laboratory of the Peruvian
Institute of Health (Instituto Nacional de Salud,
INS) implemented susceptibility testing for 1st-
and 2nd-line antituberculous drugs using the agar
plate method, according to international
standards, under the supervision of the Public
Health Laboratory in Massachusetts, USA, one of
the supranational laboratories currently working
with the World Health Organization (WHO).

Because of the occurrence of resistance to
2nd-line antituberculous drugs, defined as
extensively resistant TB (XDR TB, _M.
tuberculosis _ strains simultaneously resistant
to isoniazid, rifampin, a fluoroquinolone and a
parenteral 2nd-line drug), during 2007 INS has
been performing susceptibility tests for 1st- and
2nd-line antituberculous drugs for all _M.
tuberculosis_ isolates received from the Public
Health Laboratory Network, according to the
regulations issued by the Sanitary Strategy for TB Prevention and Control.

Here are the results issued by the National
_Mycobacteria_ reference laboratory for the 1st
half of 2007 with respect to the occurrence of
XDR TB and its resistance patterns for different antituberculous drugs.

From January to June 2007, 2235 results of
susceptibility tests of isolates from 1895
patients throughout Peru were assessed. Of these,
698 (36.8 percent) had multidrug resistant TB
(MDR, defined as resistance at least to rifampin
and isoniazid); and 45 were reported as XDR TB
(2.4 percent of the total number of patients and
6.4 percent of all MDR TB patients).

The 45 patients with MDR TB came from the
following regions: Lima City: 16 (35.6 percent),
Eastern Lima: 14 (31.1 percent), Callao: 6 (13.3
percent), Southern Lima: 3 (6.75 percent), Ica: 2
(4.45 percent), Ancash-Chimbote: 2 ( 4.4
percent), Lima provinces: 1 (2.2 percent), and 1
(2.2 percent). Seventeen (38 percent) were women.
There was a difference in the age of occurrence
of XDR TB with respect to sex, its frequency was
lower in women (24.4 years, range: 7 to 45)
compared to that in men (33.5 years, range: 21 to
58, P<0.05). Resistance to antituberculous drugs
in XDR TB isolates was 78 percentfor ethambutol,
58 percent for pyrazinamide (using the
pyrazinaminidase technique), 84 percent for
capreomycin, 84 percent for streptomycin, 78
percent for kanamycin, 69 percent for
ethionamide, 20 percent for PAS, and 4 percent for cycloserine.

XDR TB is a form of the disease produced by
bacteria resistant to all effective
antituberculous drugs, and it is generally
resistant to every 1st-line drug and to most
2nd-line drugs, as this report describes. The
occurrence of XDR TB strains reflects the
deficiency of resistant TB control and therapy
programs. The high mortality rates associated
with these strains, particularly in those places
with a high prevalence of HIV infection, as it is
the case for South Africa, has led international
sanitary authorities to declare a worldwide alert
because of the emergence of these microorganisms,
and recommendations for their control have been issued.

Such measures include strengthening the
laboratory services in order to perform _M.
tuberculosis_ susceptibility testing in places
with a high incidence of MDR TB, such as Lima and
Calao, as well as in come cities in the Peruvian
coast and jungle. This is the reason why the INS
will soon transfer tests for a rapid diagnosis of
MDR TB to the regions where this disease is highly prevalent.

Since MDR TB represents a threat for public
health in Peru, it is urgent to implement the
measures recommended by WHO, including isolation
of these patients in safe places until their
infectiousness state is controlled.

[Originally published in Revista Peruana de Investigacion y Salud Publica
<http://www.ins.gob.pe/insvirtual/images/revista/pdf/Revista%20243.pdf>
Evidencia de tuberculosis con resistencia
extendida a drogas de segunda linea (TB XDR) en el Peru
Alberto Mendoza-Ticona, Luis Asencios-Solís,
Neyda Quispe-Torres, Elena Leo-Hurtado]

--
Communicated by:
Celis Salinas Juan Carlos
Médico Infectólogo
Grupo de Investigación Peruano de Enfermedades Infecciosas y Tropicales
<dr_jcelis@gipeit.com>

[We thank Dr. Juan Carlos Celis-Salinas for the
above report on the current status of MDR and
XDR-TB in Peru. Access to a TB diagnostic
laboratory such as the Mycobacteria Laboratory of
the Peruvian Institute of Health (Instituto
Nacional de Salud, INS) is an essential component
in a TB control program (see ProMED-mail post
Tuberculosis, XDR - UK (Scotland) ex Somalia 20080322.1094). - Mod.ML]

See Also

Tuberculosis, XDR - Namibia 20080403.1231
Tuberculosis, XDR - UK (Scotland) ex Somalia 20080322.1094
Tuberculosis, MDR, XDR - Worldwide: WHO 20080228.0813
Tuberculosis, MDR - South Africa 20080208.0521
Tuberculosis, MDR - Papua New Guinea 20080206.0478
Tuberculosis, XDR - Botswana, South Africa 20080118.0222
2007
---
Tuberculosis, XDR, MDR: genome sequences 20071122.3780
Tuberculosis - Uganda (02): MDR, susp. RFI 20071004.3284
Tuberculosis - Uganda: deadly strain, RFI 20071002.3255
Tuberculosis, XDR - South Africa (11): fugitives 20071002.3251
Tuberculosis, XDR - South Africa (10): Western Cape 20070627.2071
Tuberculosis, XDR - worldwide (02) 20070623.2034
Tuberculosis, XDR - South Africa (09): Western Cape 20070604.1805
Tuberculosis, XDR, airplane exposure - multicountry (03) 20070601.1778
Tuberculosis, XDR, airplane exposure -
multicountry (USA, France, Canada, Czech Rep.) 20070529.1738
Tuberculosis, XDR - South Africa (08): Western Cape 20070425.1349
Tuberculosis, XDR, 2003-2006 - Europe (Germany, Italy) 20070403.1132
Tuberculosis, XDR - South Africa (07): Eastern Cape 20070326.1044
Tuberculosis, XDR, 1993-2006 - USA 20070322.1005
Tuberculosis, XDR - South Africa (06) 20070319.0959
Tuberculosis, XDR, 1991-2003 - Spain 20070302.0738
Tuberculosis, XDR - South Africa (05) 20070228.0717
Tuberculosis, XDR - South Africa (04) 20070220.0638
Tuberculosis, XDR - South Africa (03) 20070209.0504
Tuberculosis, XDR - worldwide 20070205.0456
Tuberculosis, XDR - South Africa (02) 20070128.0375
Tuberculosis, XDR - South Africa: interventions 20070126.0349
....................ml/ejp/dk

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