title: Drug susceptibility of Mycobacterium tuberculosis isolates from recent Haitian migrants: correlation with clinical response.
abstract: Between November 1991 and June 1993, approximately 11,000 Haitian migrants were screened for active tuberculosis and human immunodeficiency virus type 1 (HIV-1) infection at the U.S. Naval Base in Guantánamo Bay, Cuba. Cultures of specimens from 37 of these patients yielded Mycobacterium tuberculosis; eight (22%) of these isolates were resistant to standard medications, including isoniazid (22%), rifampin (0), ethambutol (3%), and streptomycin (3%). Two isolates (5.4%) were resistant to two drugs simultaneously. All but one of 340 patients who were treated for presumptive active tuberculosis and who were followed up for about 1 month had a favorable initial clinical response to a standard four-drug regimen. Among 259 HIV-1-infected patients who had normal findings on screening chest radiographs and who received prophylaxis with isoniazid, there were 1.8 incident cases of active tuberculosis per 100 person-years; this rate was 76% lower than that (reported by others) among HIV-1-infected Haitian patients who were not treated with isoniazid. No serious toxic effects due to standard four-drug regimens or to prophylaxis with isoniazid were observed. These data suggest that standard empirical therapeutic interventions for tuberculosis are adequate and well tolerated in Haitian migrants.
authors.affiliation: Infectious Diseases Division, National Naval Medical Center, Bethesda, Maryland 20889-5600.
authors.forename: J L
authors.initials: JL
authors.lastname: Malone
authors.forename: S F
authors.initials: SF
authors.lastname: Paparello
authors.forename: J D
authors.initials: JD
authors.lastname: Malone
authors.forename: H E
authors.initials: HE
authors.lastname: Hill
authors.forename: K A
authors.initials: KA
authors.lastname: Conrad
authors.forename: J W
authors.initials: JW
authors.lastname: Myers
authors.forename: S R
authors.initials: SR
authors.lastname: Lillibridge
authors.forename: P J
authors.initials: PJ
authors.lastname: Weiss
mesh_terms: D004352:Drug Resistance, Microbial; D006205:Haiti; D006801:Humans; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D014171:Transients and Migrants