Multidrug-resistant tuberculosis in a low-incidence region shows a high rate of transmission.
OBJECTIVE
To describe the characteristics of patients with multidrug-resistant tuberculosis (MDR-TB), a descriptive prospective study was carried out applying a combination of exhaustive conventional epidemiology with molecular genotyping.


METHODS
All patients diagnosed with MDR-TB in Galicia, Spain, between 1998 and 2004 were included in the study.


METHODS
Of 9895 diagnosed cases of TB, 58 were MDR-TB (0.59%). The site of disease was pulmonary in 56 cases and 46 were smear-positive. Only two cases were co-infected with the human immunodeficiency virus (HIV) and seven were immigrants. Twenty-five (43%) had received previous TB treatment. These cases presented more risk factors for treatment default and a lower frequency of contact with cases of MDR-TB.


RESULTS
Genotyping analysis was performed in 57 patients, showing evidence of four clusters (30 patients, 52.6%), each with identical genetic patterns. The patients included in the clusters were younger, and most had primary forms or had had contact with another case of MDR-TB, especially in hospital. Neither the Beijing/W nor the B strain was identified.


CONCLUSIONS
There is a low prevalence of MDR-TB in Galicia. Unlike previous studies, there was a high rate of transmissibility, including nosocomial transmission. Transmission is not associated with HIV or previously reported strains with a high capacity for transmission.
Vázquez-Gallardo
R
R
Galician Committee for the Management of MDR-TB, Santiago de Compostela, Spain. rafavg@gmail.com
Anibarro
L
L
Fernández-Villar
A
A
Díaz-Cabanela
D
D
Cruz-Ferro
E
E
Pérez del Molino
M L
ML
Túñez
V
V
Samper
S
S
Iglesias
M J
MJ
D000328:Adult; D016000:Cluster Analysis; D005260:Female; D005838:Genotype; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D012150:Polymorphism, Restriction Fragment Length; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000235:genetics / Q000635:transmission*