title: Evidence of primary transmission of multidrug-resistant tuberculosis in the Western Province of Papua New Guinea.
abstract: OBJECTIVE
  To review patient outcomes and the molecular epidemiology of multidrug-resistant tuberculosis (MDR-TB) strains isolated from patients living in the Western Province of Papua New Guinea (PNG) seeking treatment in Australia.
  
  
  METHODS
  Review of all cases of MDR-TB among people living in the open border region between the Western Province of PNG and the Torres Strait Islands of Australia who presented to health clinics in the region between 2000 and 2006. All cases of suspected TB were bacteriologically confirmed at the time of presentation by the Mycobacterium Reference Laboratory in Brisbane.
  
  
  METHODS
  Drug resistance patterns; drug use and duration; molecular typing of TB strains; patient outcomes.
  
  
  RESULTS
  Between 2000 and 2006, 60 patients from the Western Province of PNG were diagnosed with TB, of which 15 had MDR-TB. Mortality was high, although no patient who was able to maintain access to supervised therapy died. All 15 MDR-TB isolates were Beijing-family strains showing the same unique mycobacterial interspersed repetitive unit (MIRU) profile, with the exception of a single strain that differed by a single repeat at one locus. Restriction fragment length polymorphism (RFLP) typing on 10 of these strains further differentiated them into two distinct clusters.
  
  
  CONCLUSIONS
  Transmission of MDR-TB is occurring in the Western Province of PNG. Additional resources are urgently needed to interrupt the ongoing transmission of MDR-TB from the Western Province of PNG to the Torres Strait Islands. Good supervision and management of patient treatment, which includes ensuring a regular supply of second-line anti-TB drugs, are essential elements of TB control.
authors.affiliation: Mycobacterium Reference Laboratory, Pathology Queensland, Brisbane, QLD, Australia. chris_gilpin@health.qld.gov.au
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Gilpin
authors.forename: Graham
authors.initials: G
authors.lastname: Simpson
authors.forename: Stephen
authors.initials: S
authors.lastname: Vincent
authors.forename: Terry P
authors.initials: TP
authors.lastname: O'Brien
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Knight
authors.forename: Maria
authors.initials: M
authors.lastname: Globan
authors.forename: Christopher
authors.initials: C
authors.lastname: Coulter
authors.forename: Anastasios
authors.initials: A
authors.lastname: Konstantinos
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D015153:Blotting, Western; D018562:Disease Transmission, Infectious; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification*; D010219:Papua New Guinea / Q000453:epidemiology; D012150:Polymorphism, Restriction Fragment Length; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000382:microbiology / Q000635:transmission*
chemical_list: D000995:Antitubercular Agents