Mehta J, Diaz C, Guha B, Harvill L, Krishnaswamy G
Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City 37614-0622.
South Med J. 1995 Jan;88(1):60-4. doi: 10.1097/00007611-199501000-00008.
Drug-resistant tuberculosis (DRTB) is a growing national health concern in both urban populations and rural areas and is exacerbated by the growing epidemic of human immunodeficiency virus (HIV) infection. Between 1989 and 1992, 7 cases of DRTB (5 with multidrug-resistance) were diagnosed in an eight-county region of East Tennessee. During 1990 and 1991 alone, 5 of 100 patients with tuberculosis had drug-resistant strains (5%). All 7 patients with DRTB had 100% resistance to isoniazid; 5 also had resistance to streptomycin, 2 to rifampin, and 1 to pyrazinamide and ethambutol. All patients were white, U.S.-born, and without evidence of HIV infection. Contact investigation revealed that more contacts of patients with DRTB (13 of 74, 18%) were infected than were contacts of patients with drug-sensitive tuberculosis (46 of 290, 16%). Our study demonstrates that DRTB is not confined to geographically distinct areas, but may be a subtle and easily missed diagnosis in presumably low-risk rural populations.
耐多药结核病（DRTB）在城市和农村地区日益引起全国卫生领域的关注，而人类免疫缺陷病毒（HIV）感染的流行加剧了这一问题。1989年至1992年期间，在田纳西州东部的一个八县地区诊断出7例耐多药结核病（5例对多种药物耐药）。仅在1990年和1991年，100例结核病患者中有5例（5%）感染了耐药菌株。所有7例耐多药结核病患者对异烟肼均有100%的耐药性；5例对链霉素也有耐药性，2例对利福平有耐药性，1例对吡嗪酰胺和乙胺丁醇有耐药性。所有患者均为美国出生的白人，且无HIV感染证据。接触者调查显示，耐多药结核病患者的接触者中被感染的比例（74人中的13人，18%）高于药物敏感结核病患者的接触者（290人中的46人，16%）。我们的研究表明，耐多药结核病并非局限于特定地理区域，在原本被认为风险较低的农村人群中可能是一种难以察觉且容易漏诊的疾病。
