Survey of tuberculosis drug resistance among Tibetan refugees in India

F. Salvo, K. Dorjee, K. Dierberg, W. Cronin, T. D. Sadutshang, G. B. Migliori, C. Rodrigues, F. Trentini, C. Di Serio, R. Chaisson, D. M. Cirillo

Research output: Contribution to journalArticlepeer-review


SETTING: Tuberculosis (TB) is a major health problem among Tibetans living in exile in India. Although drug-resistant TB is considered common in clinical practice, precise data are lacking. OBJECTIVE: To determine the proportion of drug-resistant cases among new and previously treated Tibetan TB patients. DESIGN: In a drug resistance survey in five Tibetan settlements in India, culture and drug susceptibility testing (DST) for first-line drugs were performed among all consecutive new and previously treated TB cases from April 2010 to September 2011. DST against kanamycin (KM), ethionamide, para-aminosalicylic acid and ofloxacin (OFX) was performed on multidrug-resistant TB (MDR-TB) isolates. RESULTS: Of 307 patients enrolled in the study, 264 (193 new and 71 previously treated) were culture-positive and had DST available. All patients tested for the human immunodeficiency virus (n = 250) were negative. Among new TB cases, 14.5% had MDR-TB and 5.7% were isoniazid (INH) monoresistant. Among previously treated cases, 31.4% had MDR-TB and 12.7% were INH-monoresistant. Of the MDR-TB isolates, 28.6% of new and 26.1% of previously treated cases were OFX-resistant, while 7.1% of new cases and 8.7% of previously treated cases were KM-resistant. Three patients had extensively drug-resistant TB. CONCLUSIONS: MDR-TB is common in new and previously treated Tibetans in India, who also show additional complex resistance patterns. Of particular concern is the high percentage of MDR-TB strains resistant to OFX, KM or both.

Original languageEnglish (US)
Pages (from-to)655-662+i-iii
JournalInternational Journal of Tuberculosis and Lung Disease
Issue number6
StatePublished - Jun 1 2014


  • Drug resistance survey
  • MDR-TB
  • Tibetan refugees
  • Tuberculosis in refugees

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases


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