Multiple drug resistance tuberculosis in patients with AIDS (kinetics of nosocomial outbreak of multiple drug resistance tuberculosis in patients with AIDS and its possible transformation in an endemic condition)

The increase in the incidence of AIDS-related tuberculosis over the last de cades has fueled the dissemination of multiple drug resistance tuberculosis (including resistant strains to INH and rifampin). This has now been recog nized in a variety of settings including hospitals, prisons and shelters We have identified a nosocomial epidemic at the Muniz Hospital in the city of Buenos Aires Argentina. This has evolved as one of the largest institution al outbreaks yet to be recognized. The purpose of this paper is to characte rize the evolution of this outbreak which at the end of 1997 had involved i n excess of 500 cases. Among the 3 322 patients discharged at the Muniz Hos pital during the years 1996-1997 with the diagnosis of tuberculosis, 440 (1 3,24 %) were discharged with the diagnosis of multiple drug resistance tube rculosis. The immediate mortality (during the ensuing four months following the bacteriological diagnosis) was of 91,3 % of cases in 1995 and decrease d progressively to 65,9 % in 1996 and 55, 9 % in 1997. The bacteriological confirmation confirmation of the diagnosis was made after the patients deat h in a decreasing number of cases, going from 72,5 % of the cases in 1995 t o 28,3 % of the cases in 1997. Despite the significant progress achieved wi th regard to the diagnosis and treatment of multiple drug resistance tuberc ulosis the measures undertaken to decrease the spread of the cases have had limited succes. This is chiefly attributable to the inability to isolate c ases This has continued to promote nosocomial spread of multiple drug resis tance tuberculosis in our environment.