Sacks L V, Pendle S, Orlovic D, Blumberg L, Constantinou C
Sizwe Tropical Diseases Hospital and the South African Institute for Medical Research, Johannesburg.
Clin Infect Dis. 1999 Jul;29(1):96-101. doi: 10.1086/520189.
Nosocomial multidrug-resistant tuberculosis (MDR-TB) in human immunodeficiency virus (HIV)-infected people is recognized in Europe and America. We report the first such outbreak in South Africa. Six hospitalized women, identified by DNA fingerprinting, were infected with an outbreak strain of MDR-TB while receiving treatment for drug-susceptible tuberculosis. The putative source case was identified as an HIV-positive woman who underwent prolonged hospitalization for chronic cavitary tuberculosis. Compared with other HIV-positive patients in the hospital, outbreak patients were more immunocompromised, had fewer cavitary lung changes, and were less likely to have been treated before. They had high fevers, infiltrative patterns on chest radiographs, and a mean survival of 43 days. When individual isolation is not possible, separating highly immunocompromised patients with first-time tuberculosis from previously treated patients with cavitary lesions and from those with established drug resistance may reduce nosocomial transmission.
在欧洲和美洲，医院内感染人类免疫缺陷病毒（HIV）的患者发生耐多药结核病（MDR-TB）的情况已得到确认。我们报告了南非首例此类疫情。通过DNA指纹识别确定的6名住院女性，在接受药物敏感结核病治疗期间感染了耐多药结核病菌株。推测的源头病例被确定为一名HIV阳性女性，她因慢性空洞型肺结核接受了长时间住院治疗。与医院其他HIV阳性患者相比，疫情患者免疫功能更低，肺部空洞改变更少，且此前接受治疗的可能性更小。他们高热，胸部X光片显示浸润性病变，平均存活43天。当无法进行单人隔离时，将初次感染结核病的高度免疫功能低下患者与先前接受过治疗的有空洞病变患者以及已产生耐药性的患者分开，可能会减少医院内传播。
