Extensively drug-resistant tuberculosis (XDR-TB) among health care workers in South Africa.
OBJECTIVE
To determine the clinical profile and outcomes of health care workers (HCWs) with extensively drug resistant tuberculosis (XDR-TB) in the Eastern and Western Cape Provinces of South Africa.


METHODS
Retrospective case record review of 334 patients with XDR-TB reported during the period 1996-2008 from Western and Eastern Cape Province, Cape Town, South Africa. Case records of HCWs with XDR-TB were analysed for clinical and microbiological features, and treatment outcomes.


RESULTS
From 334 case records of patients with XDR-TB, 10 HCWs were identified. Eight of ten were HIV-uninfected, and four of 10 had died of XDR-TB despite treatment. All 10 HCWs had received an average of 2.4 courses of TB treatment before being diagnosed as XDR-TB.


CONCLUSIONS
In the Eastern and Western Cape provinces of South Africa XDR-TB affects HCWs, is diagnosed rather late, does not appear to be related to HIV status and carries a high mortality. There is an urgent need for the South African government to implement WHO infection control recommendations and make available rapid drug susceptibility testing for HCWs with suspected multidrug-resistant (MDR)/XDR-TB. Further studies to establish the actual risk and sources of infection (nosocomial or community) are required.
Jarand
Julie
J
Lung Infection and Immunity Unit, Department of Medicine, University of Cape Town, South Africa.
Shean
Karen
K
O'Donnell
Max
M
Loveday
Marian
M
Kvasnovsky
Charlotte
C
Van der Walt
Martie
M
Adams
Shahieda
S
Willcox
Paul
P
O'Grady
Justin
J
Zumla
Alimuddin
A
Dheda
Keertan
K
D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*