APPEARANCE OF DRUG-RESISTANT TUBERCULOSIS IN RURAL TENNESSEE

Drug-resistant tuberculosis (DRTB) is a growing national health concer n in both urban populations and rural areas and is exacerbated by the growing epidemic of human immunodeficiency virus (HIV) infection, Betw een 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 st rains (5%). All 7 patients with DRTB had 100% resistance to isoniazid; 5 also had resistance to streptomycin, 2 to rifampin, and 1 to pyrazi namide and ethambutol. All patients were white, U.S.-born, and without evidence of HIV infection. Contact investigation revealed that more c ontacts 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 d istinct areas, but may be a subtle and easily missed diagnosis in pres umably low-risk rural populations.