title: Initial screening for antituberculous drug resistance at an inpatient facility in Leon, Nicaragua.
abstract: Antituberculous (anti-TB) drug resistance has become a major tuberculosis control issue in the United States, where this situation has closely paralleled the current acquired immunodeficiency syndrome epidemic associated with human immunodeficiency virus type-1 (HIV-1) infections. In less developed countries, especially those like Nicaragua with an apparently low prevalence of known HIV-1 infections, less is known about the epidemiology of antituberculous drug resistance. To understand the potential extent of this problem in Nicaragua, we conducted a cross-sectional prevalence study at Nicaragua's only inpatient tuberculosis treatment facility, located in Leon, Nicaragua. A radiometric method was used during recovery, purification, and drug susceptibility testing of clinical Mycobacterium tuberculosis isolates. Resistance to at least one of the major anti-TB medications was found in 15 (40.5%) of 37 sputum isolates, of which seven (19%) were resistant to either isoniazid alone, or to isoniazid plus another agent other than rifampin. Five were resistant to at least isoniazid and rifampin (i.e., 13.5% demonstrated multidrug resistance). Two isolates were resistant to pyrazinamide alone, and one was resistant to streptomycin alone. These initial results suggest that anti-TB drug resistance is a defined problem for tuberculosis control programs in Nicaragua, a problem that is largely related to individual noncompliance, lack of extensive drug susceptibility testing facilities, and a general unavailability of expensive anti-TB medications for re-treatment. Ongoing surveillance for drug resistance, using the methodology presented here, might assist Nicaraguan public health officials in their tuberculosis control programs.
authors.affiliation: Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: de la Hoz
authors.forename: S
authors.initials: S
authors.lastname: Waycott
authors.forename: D
authors.initials: D
authors.lastname: Garcia
authors.forename: R
authors.initials: R
authors.lastname: Melendez
authors.forename: F J
authors.initials: FJ
authors.lastname: Bia
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology*; D003430:Cross-Sectional Studies; D018432:Drug Resistance, Multiple; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D009527:Nicaragua / Q000453:epidemiology; D015995:Prevalence; D011718:Pyrazinamide / Q000494:pharmacology; D011874:Radiometry; D012293:Rifampin / Q000494:pharmacology; D013183:Sputum / Q000382:microbiology; D013307:Streptomycin / Q000494:pharmacology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D011718:Pyrazinamide; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin