Investigation of the First Case of Extensively Drug-Resistant Tuberculosis, Nakhon Nayok Province, 2015

Abstract

The Office of Disease Prevention and Control Region 2, Saraburi detected the first case of XDR TB in Nakhon Nayok Province on July 2015. The co-investigation with Nakhon Nayok provincial health offices were initiated to verify diagnosis and outbreak, determine source of infection, risk factors and implement control measures. This descriptive study was conducted to review medical record and interview the XDR-TB case; and to review medical record of MDR-TB cases registered in Nakhon Nayok hospital during 2009-2015. Active case finding was conducted among contacts. The suspected case definition was a person who developed those in past 6 months: coughing more than two weeks or hemoptysis in last one month or at least two of following symptoms: coughing less than two weeks, fever, unintentional weight loss, sweating at night. Latent tuberculosis infection (LTBI) was a person without sign and symp tom, no TB lesion on chest x-ray and sputum AFB negative but had positive result of skin test (tuberculin skin test, TST) or blood (interferon-gamma release assay, IGRA) test. The XDR-TB was a Thai monk, 65 years old, thin, no underlying diseases, formerly worked as a bricklayer with history of alcoholic drinking and smoking. In 2010, he was registered as new pulmonary tuberculosis and completed treatment with category I regimen. In 2011, he was registered as relapsed pulmonary tuberculosis and completed treatment with category IV MDR-TB regimen but low adherence. Then he developed XDR-TB in 2015. Altogether 6 of 11 contacts had tuberculosis infection (54.5%). There were totally 14 MDR-TB cases registered, without epidemiologic data linkage. The history of previous TB treatment failure, treatment without directly observed by a healthcare worker and poor adherence were importance risk factors of MDR- or XDR-TB. We recommended to investigate MDR-TB and XDR-TB cases, strictly provide DOTS programs by healthcare worker.