Fræðigrein

Background: Multidrug resistant tuberculosis (MDR-TB) is a growing health problem in the world. Treatment outcomes are poorer, duration longer and costs higher. We report three cases of MDR-TB diagnosed in Iceland in a six year period, 2003-8.

Case descriptions: The first case was a 23-year-old immigrant with a prior history of latent TB infection treated with isoniazid. He was admitted two years later with peritoneal MDR-TB. He was treated for 18 months and improved. The second case was a 23-year-old immigrant diagnosed with pulmonary MDR-TB after having dropped out of treatment in his country of origin. Clinical and microbiological response was achieved and two years of treatment were planned. The third case involved a 27-year-old asymptomatic woman diagnosed with MDR-TB on contact tracing, because of her brother´s MDR-TB. 18 months of treatment were planned.

Conclusions: Clustering of cases of MDR-TB in the last six years, accounting for almost 5% of all Icelandic TB cases in the period, suggests that an increase in incidence might be seen in Iceland in coming years. The infection poses a health risk to the patients and the general public as well as a financial burden on the health care system. Emphasis should be put on rapid diagnosis and correct treatment, together with appropriate immigration screening and contact tracing.

Table I. Overview of the four MDR-TB case.

Table II. Results of drug susceptibility testings of the four MDR-TB cases, shown in relation to classes of anti-TB drugs.

Figure 1. Estimated TB incidence rate by country in 2006. The incidence was highest in sub-Saharan Africa and Central and Southeast Asia. (Reproduced with permission from WHO).

Figure 2. MDR-TB among new TB cases 1994-2007. The incidence of MDR-TB was highest in Eastern Europe and Central Asia, but increases rapidly in sub-Saharan Africa. (Reproduced with permission from WHO).

Figure 3. Chest X-ray at a) admission and b) discharge almost seven months later.

a) Diffuse nodular densities with cavitations are seen, the largest one laterally to the right hilus (arrow). Note the consolidation along with left sided pleural effusion.

b) A clear improvement, however the largest cavity can still be seen laterally to the right hilus (arrow).

Figure 4. Chest CT on admission (a), and discharge (b).

a) Bilateral nodular densities can be seen, many with air filled cavities.

The largest one is situated apically in the right lower lobe (arrow).

b) A regress of the cavitary densities, which however can still clearly be seen.

 

Icel Med J 2009; 95: 499-507