AIDSWEEKLY Plus, 23 September 1996
Salynn Boyles, Senior Editor

Researcher Valerie Schwoebel and colleagues from Paris' Institut Pasteur found that foreign origin was associated with both secondary and primary multidrug-resistant tuberculosis (MDR-TB) in France.

The researcher presented the findings at the XI International Conference on AIDS, held July 7-12, 1996 in Vancouver, British Columbia, Canada.

Between 1992 and 1994 Schwoebel et al. conducted a national mail survey in French microbiology laboratories covering all regional, district and large municipal hospitals and main private hospitals in France.

Each year, bacteriological, demographic, clinical and therapeutic information was collected on all patients with at least one positive culture of isoniazid and rifampin resistant Mycobacterium tuberculosis complex.

Resistance was defined as secondary if the patient had received tuberculosis drugs for one month or more before the first MDR-TB isolate, and primary if no treatment or less than one month of treatment had been received. DNA fingerprinting was performed by the Restriction Fragment Length Polymorphism method on multidrug resistant strains isolated since 1993. Data on MDR-TB cases reported during the three-year survey were compared with data on all TB cases notified in France in 1994.

During the three-year period a total of 146 MDR-TB cases were reported in 125 patients. Among the 125 patients, 115 had pulmonary TB with a positive sputum smear in 66 percent of the cases. Ninety-one patients (73 percent) had secondary resistance and 31 (25 percent) had primary resistance (treatment history was unknown for three). Primary resistant cases were younger than secondary resistant cases (38 versus 46 years, P = 0.02), whereas prevalence in secondary MDR-TB cases was not significantly different from the estimate in notified cases.

DNA fingerprinting of multidrug-resistant strains isolated from 66 patients revealed a pattern similarity for two HIV infected patients who had been hospitalized simultaneously in the same ward. The strain, originating from New York where the index cases had lived for several years, exhibited the widely reported "W" pattern.

The researchers concluded that the prevalence of MDR-TB appeared to be low in France during the study period, and that transmission of multidrug-resistant strains was also low, as evidenced by the small number of primary resistant cases and the single case of nosocomial transmission confirmed by DNA fingerprinting.

The corresponding author for this study is Valerie Schwoebel, National Reference Center for Tuberculosis Surveillance, Hopital Pitie-Salpetriere, 47-83 boulevard de l'Hopital, 75013 Paris, France.

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