Rise in rifampicin-monoresistant tuberculosis in Western Cape, South Africa

Fidele Kanyimbu Mukinda, D. Theron, G. D. Van Der Spuy, K. R. Jacobson, M. Roscher, E. M. Streicher, A. Musekiwa, G. J. Coetzee, T. C. Victor, B. J. Marais, J. B. Nachega, R. M. Warren, H. Simon Schaaf

Research output: Contribution to journalArticle

Abstract

SETTING: Brewelskloof Hospital, Western Cape, South Africa. OBJECTIVES: To verify the perceived increase in rifampicin monoresistant tuberculosis (RMR-TB) in the Cape Winelands-Overberg region and to identify potential risk factors. DESIGN: A retrospective descriptive study of trends in RMR-TB over a 5-year period (2004-2008), followed by a case-control study of RMR and isoniazid (INH) monoresistant TB cases, diagnosed from April 2007 to March 2009, to assess for risk factors. RESULTS: The total number of RMR-TB cases more than tripled, from 31 in 2004 to 98 in 2008. The calculated doubling time was 1.63 years (95%CI 1.18-2.66). For the assessment of risk factors, 95 RMR-TB cases were objectively verified on genotypic and phenotypic analysis. Of 108 specimens genotypically identified as RMR cases, 13 (12%) were misidentified multidrugresistant TB. On multivariate analysis, previous use of antiretroviral therapy (OR 6.4, 95%CI 1.3-31.8), alcohol use (OR 4.8, 95%CI 2.0-11.3) and age ≥40 years (OR 5.8, 95%CI 2.4-13.6) were significantly associated with RMR-TB. CONCLUSION: RMR-TB is rapidly increasing in the study setting, particularly among patients with advanced human immunodeficiency virus (HIV) disease. Routine drug susceptibility testing should be considered in all TB-HIV co-infected patients, and absence of INH resistance should be confirmed phenotypically if genotypic RMR-TB is detected.

Original languageEnglish (US)
Pages (from-to)196-202
Number of pages7
JournalInternational Journal of Tuberculosis and Lung Disease
Volume16
Issue number2
DOIs
StatePublished - Feb 1 2012

Keywords

  • Monoresistant
  • Rifampicin
  • South Africa
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

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    Mukinda, F. K., Theron, D., Van Der Spuy, G. D., Jacobson, K. R., Roscher, M., Streicher, E. M., Musekiwa, A., Coetzee, G. J., Victor, T. C., Marais, B. J., Nachega, J. B., Warren, R. M., & Schaaf, H. S. (2012). Rise in rifampicin-monoresistant tuberculosis in Western Cape, South Africa. International Journal of Tuberculosis and Lung Disease, 16(2), 196-202. https://doi.org/10.5588/ijtld.11.0116