Appearance of drug-resistant tuberculosis in rural Tennessee.
Drug-resistant tuberculosis (DRTB) is a growing national health concern in both urban populations and rural areas and is exacerbated by the growing epidemic of human immunodeficiency virus (HIV) infection. Between 1989 and 1992, 7 cases of DRTB (5 with multidrug-resistance) were diagnosed in an eight-county region of East Tennessee. During 1990 and 1991 alone, 5 of 100 patients with tuberculosis had drug-resistant strains (5%). All 7 patients with DRTB had 100% resistance to isoniazid; 5 also had resistance to streptomycin, 2 to rifampin, and 1 to pyrazinamide and ethambutol. All patients were white, U.S.-born, and without evidence of HIV infection. Contact investigation revealed that more contacts of patients with DRTB (13 of 74, 18%) were infected than were contacts of patients with drug-sensitive tuberculosis (46 of 290, 16%). Our study demonstrates that DRTB is not confined to geographically distinct areas, but may be a subtle and easily missed diagnosis in presumably low-risk rural populations.
Mehta
J
J
Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City 37614-0622.
Diaz
C
C
Guha
B
B
Harvill
L
L
Krishnaswamy
G
G
D000328:Adult; D000368:Aged; D002675:Child, Preschool; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D012189:Retrospective Studies; D012424:Rural Population; D013307:Streptomycin / Q000494:pharmacology; D013714:Tennessee / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology*
D007538:Isoniazid; D013307:Streptomycin