Research article

Extensively drug resistant tuberculosis in a high income country: A report of four unrelated cases

Stefan H Blaas^1,2 , Ralf Mütterlein³ , Johannes Weig⁴ , Albert Neher⁵ , Bernd Salzberger¹ , Norbert Lehn^{^ 6} and Ludmila Naumann⁷

¹Department of Internal Medicine I, Regensburg University, Regensburg, Germany

²Center for Pneumology, Donaustauf Hospital, Donaustauf, Germany

³District Hospital (Bezirksklinikum), Parsberg, Germany

⁴Public Health Department, Neustadt/Waldnaab, Germany

⁵Center for Respiratory Medicine and Thoracic Surgery, Asklepios Fachkliniken, München-Gauting, Germany

⁶Institute of Medical Microbiology and Hygiene, Regensburg University, Regensburg, Germany

⁷Division of Infectious Diseases, Bavarian Health and Food Safety Authority, Oberschleissheim, Germany

author email corresponding author email^Deceased

BMC Infectious Diseases 2008, 8:60doi:10.1186/1471-2334-8-60

Published:	2 May 2008

Abstract

Background

Multi drug resistance of Mycobacterium tuberculosis (M. tuberculosis) remains a major threat to public health, reinforced by recent reports about the clinical course of patients infected with extensively drug resistant (XDR) strains in South Africa. There is little information about the clinical course of XDR tuberculosis patients in industrialised countries.

Methods

We evaluated all isolates of M. tuberculosis, in which drug susceptibility testing was performed at our institution since 1997, for multi and extensive drug resistance. Clinical courses of patients infected by strains fulfilling the recently revised criteria for XDR tuberculosis were analysed.

Results

Four XDR M. tuberculosis isolates were identified. All patients had immigrated to Germany from Russia, Georgia, and former Yugoslavia and none were infected by the human immunodeficiency virus. All patients where treated for tuberculosis for 5.5 to 15 years and for XDR tuberculosis for 1.9 to 2.5 years. They received inhospital treatment in Germany for 11 months, 4.5 years and twice for 6 years. Non-compliance was an important factor in all four patients, three patients had to be treated in Germanys only locked facility for tuberculosis treatment. One patient with XDR tuberculosis died, one patient had still open pulmonary tuberculosis at last contact and 2 patients were cured.

Conclusion

Cases of XDR tuberculosis have been treated in our region for several years. Even in a high income setting, XDR tuberculosis has a tremendous impact on quality of live, outcome and the total cost. All reasonable efforts to prevent the spread of XDR tuberculosis must be made and maintained.