title: Extensively drug resistant tuberculosis in a high income country: a report of four unrelated cases.
abstract: BACKGROUND
  Multi drug resistance of Mycobacterium tuberculosis (M. tuberculosis) remains a major threat to public health, reinforced by recent reports about the clinical course of patients infected with extensively drug resistant (XDR) strains in South Africa. There is little information about the clinical course of XDR tuberculosis patients in industrialised countries.
  
  
  METHODS
  We evaluated all isolates of M. tuberculosis, in which drug susceptibility testing was performed at our institution since 1997, for multi and extensive drug resistance. Clinical courses of patients infected by strains fulfilling the recently revised criteria for XDR tuberculosis were analysed.
  
  
  RESULTS
  Four XDR M. tuberculosis isolates were identified. All patients had immigrated to Germany from Russia, Georgia, and former Yugoslavia and none were infected by the human immunodeficiency virus. All patients where treated for tuberculosis for 5.5 to 15 years and for XDR tuberculosis for 1.9 to 2.5 years. They received inhospital treatment in Germany for 11 months, 4.5 years and twice for 6 years. Non-compliance was an important factor in all four patients, three patients had to be treated in Germanys only locked facility for tuberculosis treatment. One patient with XDR tuberculosis died, one patient had still open pulmonary tuberculosis at last contact and 2 patients were cured.
  
  
  CONCLUSIONS
  Cases of XDR tuberculosis have been treated in our region for several years. Even in a high income setting, XDR tuberculosis has a tremendous impact on quality of live, outcome and the total cost. All reasonable efforts to prevent the spread of XDR tuberculosis must be made and maintained.
authors.affiliation: Department of Internal Medicine I, Regensburg University, Regensburg, Germany. stefan.blaas@klinik.uni-regensburg.de
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Blaas
authors.forename: Ralf
authors.initials: R
authors.lastname: Mütterlein
authors.forename: Johannes
authors.initials: J
authors.lastname: Weig
authors.forename: Albert
authors.initials: A
authors.lastname: Neher
authors.forename: Bernd
authors.initials: B
authors.lastname: Salzberger
authors.forename: Norbert
authors.initials: N
authors.lastname: Lehn
authors.forename: Ludmila
authors.initials: L
authors.lastname: Naumann
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004641:Emigration and Immigration; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy* / Q000208:ethnology / Q000382:microbiology; D005846:Georgia (Republic) / Q000208:ethnology; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D012426:Russia / Q000208:ethnology; D012923:Social Class; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy; D015022:Yugoslavia / Q000208:ethnology
chemical_list: D000995:Antitubercular Agents