Universidad Peruana Cayetano Heredia

Transmission of Multidrug-Resistant and Drug-Susceptible Tuberculosis within Households: A Prospective Cohort Study

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dc.contributor.author Grandjean, Louis
dc.contributor.author Gilman, Robert Hugh
dc.contributor.author Martin, Laura
dc.contributor.author Soto, Esther
dc.contributor.author Castro, Beatriz
dc.contributor.author Lopez, Sonia
dc.contributor.author Coronel, Jorge
dc.contributor.author Castillo, Edith
dc.contributor.author Alarcon, Valentina
dc.contributor.author Lopez, Virginia
dc.contributor.author San Miguel, Angela
dc.contributor.author Quispe, Neyda
dc.contributor.author Asencios, Luis
dc.contributor.author Dye, Christopher
dc.contributor.author Moore, David Alexander James
dc.date.accessioned 2019-02-06T14:53:08Z
dc.date.available 2019-02-06T14:53:08Z
dc.date.issued 2015
dc.identifier.uri https://hdl.handle.net/20.500.12866/5380
dc.description.abstract BACKGROUND: The "fitness" of an infectious pathogen is defined as the ability of the pathogen to survive, reproduce, be transmitted, and cause disease. The fitness of multidrug-resistant tuberculosis (MDRTB) relative to drug-susceptible tuberculosis is cited as one of the most important determinants of MDRTB spread and epidemic size. To estimate the relative fitness of drug-resistant tuberculosis cases, we compared the incidence of tuberculosis disease among the household contacts of MDRTB index patients to that among the contacts of drug-susceptible index patients. METHODS AND FINDINGS: This 3-y (2010-2013) prospective cohort household follow-up study in South Lima and Callao, Peru, measured the incidence of tuberculosis disease among 1,055 household contacts of 213 MDRTB index cases and 2,362 household contacts of 487 drug-susceptible index cases. A total of 35/1,055 (3.3%) household contacts of 213 MDRTB index cases developed tuberculosis disease, while 114/2,362 (4.8%) household contacts of 487 drug-susceptible index patients developed tuberculosis disease. The total follow-up time for drug-susceptible tuberculosis contacts was 2,620 person-years, while the total follow-up time for MDRTB contacts was 1,425 person-years. Using multivariate Cox regression to adjust for confounding variables including contact HIV status, contact age, socio-economic status, and index case sputum smear grade, the hazard ratio for tuberculosis disease among MDRTB household contacts was found to be half that for drug-susceptible contacts (hazard ratio 0.56, 95% CI 0.34-0.90, p = 0.017). The inference of transmission in this study was limited by the lack of genotyping data for household contacts. Capturing incident disease only among household contacts may also limit the extrapolation of these findings to the community setting. CONCLUSIONS: The low relative fitness of MDRTB estimated by this study improves the chances of controlling drug-resistant tuberculosis. However, fitter multidrug-resistant strains that emerge over time may make this increasingly difficult. en_US
dc.language.iso eng
dc.publisher Public Library of Science
dc.relation.ispartofseries PLoS Medicine
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Male en_US
dc.subject Peru/epidemiology en_US
dc.subject Prospective Studies en_US
dc.subject Incidence en_US
dc.subject Family Characteristics en_US
dc.subject Antitubercular Agents/therapeutic use en_US
dc.subject Tuberculosis, Multidrug-Resistant/drug therapy/epidemiology/transmission en_US
dc.subject Tuberculosis/drug therapy/epidemiology/transmission en_US
dc.title Transmission of Multidrug-Resistant and Drug-Susceptible Tuberculosis within Households: A Prospective Cohort Study en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1371/journal.pmed.1001843
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#1.06.03
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#1.06.01
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#2.08.00
dc.relation.issn 1549-1676


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