Multidrug-resistant tuberculosis outbreak in an Italian prison: tolerance of pyrazinamide plus levofloxacin prophylaxis and serial interferon gamma release assays. (July 2016)

• Record Type: Journal Article
• Authors: Bedini, A.; Garlassi, E.; Stentarelli, C.; Petrella, S.; Meacci, M.; Meccugni, B.; Meschiari, M.; Franceschini, E.; Cerri, S.; Brasacchio, A.; Rumpianesi, F.; Richeldi, L.; Mussini, C.
• Is Part Of: New microbes and new infections. Volume 12(2016)
• Page Start: 45
• Page End: 51
• Publication Date: 2016-07
• Subjects: Hepatotoxicity -- latent tuberculosis infection -- levofloxacin -- multidrug-resistant tuberculosis -- pyrazinamide -- QuantiFERON-TB Gold In-Tube; Medical microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; Microbiology -- Periodicals; Communicable Diseases -- Periodicals; Infection -- Periodicals; 616.9041
• DOI: 10.1016/j.nmni.2016.03.010
• Languages: English
• ISSNs: 2052-2975

Abstract

Abstract: The optimal treatment for latent tuberculosis infection (LTBI) in subjects exposed to multidrug-resistant (MDR) tuberculosis (TB) remains unclear, and the change in response of the QuantiFERON-TB Gold In-Tube (QTB-IT) test during and after treatment is unknown. Between May 2010 and August 2010, 39 prisoners at the 'Casa Circondariale' of Modena, Italy, were exposed to a patient with active pulmonary MDR TB. All contacts were tested with the tuberculin skin test and QTB-IT. Upon exclusion of active TB, subjects positive to both tests were offered 6 months' treatment with pyrazinamide (PZA) and levofloxacin (LVX). QTB-IT testing was repeated at 3 and 6 months after initial testing in all subjects who were offered LTBI treatment. Seventeen (43.5%) of 39 subjects tested positive to both tuberculin skin test and QTB-IT test, and 12 (70.5%) agreed to receive therapy with PZA and LVX at standard doses. Only five (41.6%) of 12 subjects completed 6 months' treatment. Reasons for discontinuation were asymptomatic hepatitis, gastritis and diarrhoea. The QTB-IT values decreased in all subjects who completed the treatment, in two (33%) of six of those who received treatment for less than 3 months and in one (50%) of two patients who discontinued therapy after 3 months. The QTB-IT test results never turned negative. Despite the small number of subjects, the study confirmed that PZA plus LVX is a poorly tolerated option for MDR LTBI treatment. We observed a large degree of variation in the results of the QTB-IT test results among participants. The study confirmed that the interferon gamma release assay is not a reliable tool for monitoring the treatment of MDR LTBI in clinical practice.