title: Case series of the long-term psychosocial impact of drug-resistant tuberculosis in HIV-negative medical doctors.
abstract: BACKGROUND
  Health care workers (HCWs) are at greater risk for tuberculosis (TB), including multidrug-resistant TB (MDR-TB), compared to the general population. The psychosocial impact of nosocomial TB on HCWs has received little attention in the literature.
  
  
  METHODS
  A retrospective medical record review from 1999 to 2003 found 15 HCWs who were treated for drug-resistant TB at a specialist hospital in South Africa. Five human immunodeficiency virus (HIV) negative doctors with no predisposing factors for drug resistance are included in this case series. We collectively present their clinical case histories based on medical records from 2000 to 2005, and explore the long-term psychosocial impact of TB from interviews conducted in 2009.
  
  
  RESULTS
  Four doctors had primary MDR-TB and one had primary resistance to multiple first-line drugs. Time from symptom onset to commencement of effective treatment ranged from 8 to 39 weeks. Time for bacteriological confirmation of drug-resistant TB ranged from 6 to 24 weeks. All were cured within 3 years of initial presentation. Content analysis of follow-up interviews revealed five main themes: 1) prolonged morbidity, 2) psychological impact, 3) poor infection control, 4) weak support structures and 5) attrition from the field.
  
  
  CONCLUSIONS
  Themes emergent from this case series encourage prioritisation of TB infection control education and practice to minimise HCW morbidity and prevent HCW attrition from high-burden resource-constrained settings.
authors.affiliation: Department of Community Health, Nelson R Mandela School of Medicine, Centre for AIDS Programme of Research in South Africa, Durban, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: Padayatchi
authors.forename: A
authors.initials: A
authors.lastname: Daftary
authors.forename: T
authors.initials: T
authors.lastname: Moodley
authors.forename: R
authors.initials: R
authors.lastname: Madansein
authors.forename: A
authors.initials: A
authors.lastname: Ramjee
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D024881:Drug Resistance, Bacterial; D005260:Female; D005500:Follow-Up Studies; D018023:HIV Seronegativity; D006801:Humans; D015994:Incidence; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D010820:Physicians / Q000523:psychology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000523:psychology* / Q000635:transmission
chemical_list: D000995:Antitubercular Agents