Nosocomial spread of human immunodeficiency virus-related multidrug-resistant tuberculosis in Buenos Aires

A steep upsurge of human immunodeficiency virus (HIV)-associated multidrug-resistant tuberculosis (MDR-TB) was recently observed at a referral treatment center in Buenos Aires City. Between January 1994 and June 1995, TB isolates resistant to at least five drugs were recovered from 101 of 272 HIV-infected inpatients. Highly resistant isolates from 77 patients underwent restriction fragment length polymorphism study with IS6110. After cross-contamination was eliminated, a single TB strain was found to have caused disease in 68 patients with a history of on-site exposure. The frequency of smear-positive pulmonary disease was higher among these patients than among non-MDR-TB HIV-infected patients (50/68 vs. 60/148, P < .001), and the 1-year survival was dramatically reduced (5/68 vs. 92/148). The strain involved in the outbreak was traced back to patients hospitalized in 1992. Institutional infection control policies were and may still be inadequate to contain the spread of TB among immunodepressed subjects, as is the case in other large urban hospitals in Argentina.

Adverse effects of antituberculosis drugs causing changes in treatment

The adverse effects of drugs which caused changes in therapeutic regimens have been studied in 511 patients with pulmonary tuberculosis, at the Pavilion Koch of Buenos Aires University. In 384 patients who had not received any treatment before, the frequency of such modifications was 6.5%, and in 127 retreated patients it was 15.0%. The characteristics of the adverse effects and the measures aimed at reducing them were studied.