A Multijurisdictional Investigation of Resistant Highly Infectious TB in Asian Immigrants

In July 2007, a Vietnamese immigrant presented with hemoptysis and was put in airborne isolation. The chest X-ray and computed tomography scan demonstrated abnormalities but no cavitary lesions. The AFB smear was negative, after follow up tests she was discharged. In late September 2007, the Greene County Health Department was notified that her bronchoscopy specimen was positive for Mycobacterium tuberculosis. She was started on a 4 drug regimen, isolated and directly observed therapy (DOT) was initiated. The strain was resistant to isoniazid and streptomycin; so isoniazid was stopped. Her isolation ended after 3 weeks of treatment with ongoing DOT. Her infectious period was over 6 months. 210 contacts were identified among: a dialysis clinic, hospital, close contacts, and work. 179 persons were skin tested, 16 met the criteria for latent TB infection (LTBI): All LTBI cases were close contacts (n=5) or work contacts (n=11). In this investigation the odds ratio of foreign birth if diagnosed with LTBI was 391 (46 to 16410 Fishers Exact 95% Confidence Interval). This investigation suggests that public health 'intervention and cross jurisdictional coordination' of resistant highly infectious TB is critical and that foreign birth may be of significant concern.