title: Survey of tuberculosis drug resistance among Tibetan refugees in India.
abstract: METHODS
  Tuberculosis (TB) is a major health problem among Tibetans living in exile in India. Although drug-resistant TB is considered common in clinical practice, precise data are lacking.
  
  
  OBJECTIVE
  To determine the proportion of drug-resistant cases among new and previously treated Tibetan TB patients.
  
  
  METHODS
  In a drug resistance survey in five Tibetan settlements in India, culture and drug susceptibility testing (DST) for first-line drugs were performed among all consecutive new and previously treated TB cases from April 2010 to September 2011. DST against kanamycin (KM), ethionamide, para-aminosalicylic acid and ofloxacin (OFX) was performed on multidrug-resistant TB (MDR-TB) isolates.
  
  
  RESULTS
  Of 307 patients enrolled in the study, 264 (193 new and 71 previously treated) were culture-positive and had DST available. All patients tested for the human immunodeficiency virus (n = 250) were negative. Among new TB cases, 14.5% had MDR-TB and 5.7% were isoniazid (INH) monoresistant. Among previously treated cases, 31.4% had MDR-TB and 12.7% were INH-monoresistant. Of the MDR-TB isolates, 28.6% of new and 26.1% of previously treated cases were OFX-resistant, while 7.1% of new cases and 8.7% of previously treated cases were KM-resistant. Three patients had extensively drug-resistant TB.
  
  
  CONCLUSIONS
  MDR-TB is common in new and previously treated Tibetans in India, who also show additional complex resistance patterns. Of particular concern is the high percentage of MDR-TB strains resistant to OFX, KM or both.
authors.affiliation: Emerging Pathogens Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Salvo
authors.affiliation: Tibetan Delek Hospital, Central Tibetan Administration, Dharamsala, India.
authors.forename: K
authors.initials: K
authors.lastname: Dorjee
authors.affiliation: Division of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: K
authors.initials: K
authors.lastname: Dierberg
authors.affiliation: Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA.
authors.forename: W
authors.initials: W
authors.lastname: Cronin
authors.affiliation: Tibetan Delek Hospital, Central Tibetan Administration, Dharamsala, India.
authors.forename: T D
authors.initials: TD
authors.lastname: Sadutshang
authors.affiliation: WHO Collaborating Centre for TB and Lung Diseases, Fondazione S Maugeri, Care and Research Institute, Tradate, Italy.
authors.forename: G B
authors.initials: GB
authors.lastname: Migliori
authors.affiliation: Department of Microbiology, Parmanand Deepchand Hinduja Hospital and Medical Research Centre, Mumbai, India.
authors.forename: C
authors.initials: C
authors.lastname: Rodrigues
authors.affiliation: University Center for Statistics in the Biomedical Sciences, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Trentini
authors.affiliation: University Center for Statistics in the Biomedical Sciences, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Di Serio
authors.affiliation: Division of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: R
authors.initials: R
authors.lastname: Chaisson
authors.affiliation: Emerging Pathogens Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: D M
authors.initials: DM
authors.lastname: Cirillo
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D004359:Drug Therapy, Combination; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics; D011237:Predictive Value of Tests; D015995:Prevalence; D012036:Refugees; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D018609:Tibet / Q000208:ethnology; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents