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Florida TB case most extensively drug-resistant yet in U.S.
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A 19-year old patient with extremely drug-resistant tuberculosis is the first to be identified in the United States, and among only a handful of cases reported worldwide, highlighting the growing problem of emerging drug resistance.
Oswaldo Juarez, of Peru, was resistant to all first- and second-line therapies commonly used to treat TB, according to reports from the Associated Press, and spent 19 months in treatment at the A.G. Holley State Hospital in Lantana, Fla.
The case has not yet been reported in a peer-reviewed journal and was uncovered as part of a general investigation by AP into emerging drug resistance. The treating physician, David Ashkin, MD, medical director at the hospital was unable to be reached for comment.
“This is the new class that people are not really talking too much about. These are the ones we really fear because I’m not sure how we treat them,” Ashkin was quoted as saying in the AP report.
CDC guidelines state that physicians should treat suspected cases of simple TB with a regimen consisting of isoniazid, rifampin (Rifadin, Sanofi-Aventis), ethambutol (Myambutol, X-Gen) and pyrazinamide for two months, followed by isoniazid and rifampin for another four months.
Although isoniazid and rifampin are ineffective against multidrug-resistant TB, second-line therapies are available and include fluoroquinolones (levofloxacin, moxifloxacin, or gatifloxacin); amikacin, kanamycin , or capreomycin (Capastat, Lilly), with or without an additional oral drug.
CDC defines extensively-drug resistant TB as strains resistant to isoniazid, rifampin, any fluoroquinolone and at least one second-line injectable drug, including amikacin, kanamycin or capreomycin.
The Florida case is one of only a few with a newly proposed designation, XXDR-TB, which is resistant to all first- and second-line drugs with activity against tuberculosis.
Juarez recovered after almost two years of treatment, the AP reported, but the two other known cases of XXDR-TB resulted in death. Both occurred in European women aged younger than 50 years and were reported in the May 17, 2007 issue of Eurosurveillance.
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