title: Transmission of multidrug-resistant and extensively drug-resistant tuberculosis in rural Bangladesh: lessons learnt.
abstract: We report community transmission of multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) documented by fingerprinting, with secondary cases appearing over a period of 10 years. The index case failed MDR-TB treatment, with amplification to XDR-TB after refusing treatment when first diagnosed and developing pre-XDR-TB on private treatment. Some of the first MDR-TB patients were not started on appropriate treatment due to delayed diagnosis or to excessively rigid application of National TB Programme guidelines. Early presumptive MDR- and XDR-TB diagnosis and removal of barriers, such as obligatory hospitalisation, could have stopped this trend of resistance amplification and transmission.
authors.affiliation: Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Gumusboga
authors.affiliation: Damien Foundation Bangladesh, Dhaka, Bangladesh.
authors.forename: K J M
authors.initials: KJ
authors.lastname: Aung
authors.affiliation: Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Rigouts
authors.affiliation: Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium ; International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Van Deun
keywords: Bangladesh; MDR-TB; XDR-TB; transmission; tuberculosis