Rapid impact of effective treatment on transmission of multidrug-resistant tuberculosis

dc.contributor.authorDharmadhikari, Ashwin S.
dc.contributor.authorMphahlele, M.T. (Matsie Theodora)
dc.contributor.authorVenter, Karien
dc.contributor.authorStoltz, Anton Carel
dc.contributor.authorMathebula, R.
dc.contributor.authorMasotla, T.
dc.contributor.authorVan der Walt, M.
dc.contributor.authorPagano, M.
dc.contributor.authorJensen, P.
dc.contributor.authorNardell, Edward Anthony
dc.date.accessioned2014-09-30T11:35:31Z
dc.date.issued2014-09
dc.description.abstractBACKGROUND: Effective treatment for drug-susceptible tuberculosis (TB) rapidly renders patients noninfectious, long before conversion of sputum acid-fast smear or culture to negative. Multidrug-resistant TB (MDR-TB) patients on treatment are currently assumed to remain infectious for months. While the resources required for prolonged hospitalization are a barrier to the scale-up of MDR-TB treatment, the safety of community treatment is clear. OBJECTIVES : To estimate the impact of treatment on infectiousness among MDR-TB patients. METHODS: A series of five human-to-guinea pig TB transmission studies was conducted to test various interventions for infection control. Guinea pigs in adjacent chambers were exposed to exhaust air from a hospital ward occupied by mostly sputum smear- and culture-positive MDR-TB patients. The guinea pigs then underwent tuberculin skin testing for infection. Only the control groups of guinea pigs from each study (no interventions used) provide the data for this analysis. The number of guinea pigs infected in each study is reported and correlated with Mycobacterium tuberculosis drug susceptibility relative to treatment. RESULTS : Despite exposure to presumably infectious MDR-TB patients, infection percentages among guinea pigs ranged from 1% to 77% in the five experiments conducted. In one experiment in which guinea pigs were exposed to 27 MDR-TB patients newly started on effective treatment for 3 months, there was minimal transmission. In four other experiments with greater transmission, guinea pigs had been exposed to patients with unsuspected extensively drug-resistant tuberculosis who were not on effective treatment. CONCLUSIONS : In this model, effective treatment appears to render MDR-TB patients rapidly noninfectious. Further prospective studies on this subject are needed.en_US
dc.description.librarianhb2014en_US
dc.description.sponsorshipNIOSH R01OH009050en_US
dc.description.urihttp://www.ingentaconnect.com/content/iuatld/ijtlden_US
dc.identifier.citationDharmadhikari, AS, Mphahlele, M, Venter, K, Stoltz, A, Mathebula, R, Masotla, T, Van Der Walt, M, Pagano, M, Jensen, P & Nardell, E 2014, 'Rapid impact of effective treatment on transmission of multidrug-resistant tuberculosi', International Journal of Tuberculosis and Lung Disease, vol. 18, no. 9, pp. 1019-1025.en_US
dc.identifier.issn1027-3719 (print)
dc.identifier.issn1815-7920 (online)
dc.identifier.other10.5588/ijtld.13.0834
dc.identifier.urihttp://hdl.handle.net/2263/42155
dc.language.isoenen_US
dc.publisherInternational Union Against Tuberculosis and Lung Diseaseen_US
dc.rightsInternational Union Against Tuberculosis and Lung Diseaseen_US
dc.subjectImpact of treatmenten_US
dc.subjectTransmissionen_US
dc.subjectExtensively drug-resistant tuberculosis (XDR-TB)en_US
dc.subjectTuberculosis (TB)en_US
dc.subjectMultidrug-resistant tuberculosis (MDR-TB)en_US
dc.titleRapid impact of effective treatment on transmission of multidrug-resistant tuberculosisen_US
dc.typeArticleen_US

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