INITIAL SCREENING FOR ANTITUBERCULOUS DRUG-RESISTANCE AT AN INPATIENTFACILITY IN LEON, NICARAGUA

Antituberculous (anti-TB) drug resistance has become a major tuberculo sis control issue in the United States, where this situation has close ly paralleled the current acquired immunodeficiency syndrome epidemic associated with human immunodeficiency virus type-1 (HIV-1) infections . In less developed countries, especially those like Nicaragua with an apparently low prevalence of known HIV-1 infections, less is known ab out the epidemiology of antituberculous drug resistance. To understand the potential extent of this problem in Nicaragua, we conducted a cro ss-sectional prevalence study at Nicaragua's only inpatient tuberculos is treatment facility, located in Leon, Nicaragua. A radiometric metho d was used during recovery, purification, and drug susceptibility test ing of clinical Mycobacterium tuberculosis isolates. Resistance to at least one of the major anti-TB medications was found in 15 (40.5%) of 37 sputum isolates, of which seven (19%) were resistant to either ison iazid alone, or to isoniazid plus another agent other than rifampin. F ive were resistant to at least isoniazid and rifampin (i.e., 13.5% dem onstrated multidrug resistance). Two isolates were resistant to pyrazi namide alone, and one was resistant to streptomycin alone. These initi al results suggest that anti-TB drug resistance is a defined problem f or tuberculosis control programs in Nicaragua, a problem that is large ly related to individual noncompliance, lack of extensive drug suscept ibility testing facilities, and a general unavailability of expensive anti-TB medications for re-treatment. Ongoing surveillance for drug re sistance, using the methodology presented here, might assist Nicaragua n public health officials in their tuberculosis control programs.