A Multi-institutional Outbreak of Highly Drug-Resistant Tuberculosis

Transmission of multidrug-resistant tuberculosis in the USA: a cross-sectional study

“…However, in these previous studies, 14,18,22 detailed information about interpersonal connections between cases was not available, and thus genotyping results alone were used as a proxy to determine tuberculosis transmission. In a study following the major outbreak of MDR tuberculosis and resurgence of tuberculosis in New York City (NY, USA), 29 about 13% of genotyped MDR tuberculosis cases were epidemiologically linked by medicalrecord review and interview of patients, most of whom were exposed to MDR tuberculosis long before the study. 17 Notably, in our study, half the identified source cases were born outside the USA.…”

Spread of Strain W, a Highly Drug‐Resistant Strain ofMycobacterium tuberculosis, Across the United States

“…This demonstrates that when other immunocompromising conditions (e.g., old age, diabetes, cancer) are present, MDR tuberculosis caused by strain W can be particularly deadly for HIV-negative persons. Early clinical suspicion and detection of MDR tuberculosis as well as prompt initiation of appropriate DOT are critical for successful treatment of this strain [8].…”

“…Most of the patients in these outbreaks were severely immunocompromised because of HIV infection, and mortality rates exceeded 80%. Because of their resistance to all first-line and many second-line antituberculosis medications, these strains are difficult to treat, and early detection and treatment are essential for preventing transmission [8]. This strain is now endemic in New York State and New York City.…”

Epidemiology of Tuberculosis in the United States

“…These strains share a common drug resistance to first-line antituberculosis medications (eg, isoniazid, rifampin, ethambutol, and, at that time, streptomycin) as well as resistance to some second-line medications, making treatment difficult and costly. The majority of strain W TB cases were reported by New York City [57,59], although outbreaks have occurred elsewhere, including one that was attributed to bronchoscope contamination in South Carolina [58]. To facilitate early detection of strain W isolates, the CDC began recommending that health departments notify the CDC of all M. tuberculosis isolates that have strain W -resistance patterns [59].…”