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Volume 31, Number 3—March 2025
Dispatch

Outbreak Caused by Multidrug-Resistant Mycobacterium Tuberculosis with Unusual Combination of Resistance Mutations, Northern Argentina, 2006–2022

Roxana Paul1, Federico Lorenzo1, Beatriz López, María Gabriela Alegre, David Couvin, Nalin Rastogi, Laura Pérez-Lago, Darío García de Viedma, Ana Gamberale, Norma González, Domingo Palmero, Silvia Altabe, Norberto Simboli, and Noemí Kaoru YokoboriComments to Author 
Author affiliation: Author affiliations: Instituto Nacional de Enfermedades Infecciosas, ANLIS “Dr. C. G. Malbrán,” Buenos Aires, Argentina (R. Paul, F. Lorenzo, B. López, N. Simboli, N.K. Yokobori); Programa de Control de Tuberculosis, Chaco, Argentina (M.G. Alegre, S. Altabe); Université des Antilles, Guadeloupe, France (D. Couvin); Institut Pasteur de Guadeloupe, Abymes, Guadeloupe (D. Couvin, N. Rastogi); Hospital General Universitario Gregorio Marañón, Madrid, Spain (L. Pérez-Lago, D. García de Viedma); Instituto de Investigaciòn Sanitaria Gregorio Marañón, Madrid (L. Pérez-Lago, D. García de Viedma); Instituto de Salud Carlos III, Madrid (D. García de Viedma); Hospital Muñiz, Buenos Aires (A. Gamberale, D. Palmero); Instituto Vaccarezza, Buenos Aires (A. Gamberale, D. Palmero); Hospital General de Niños “Pedro de Elizalde,” Buenos Aires (N. González); National Scientific and Technical Research Council, Buenos Aires (N.K. Yokobori)

Main Article

Table 1

Characteristics of patients at time of diagnosis of MDR-TB infection with Ch strain, Argentina, 2006–2022*

ID Residence Year Age, y/sex DR profile† DR status HIV status Comments
1
 Resistencia, Chaco
 2006
 57/M
 STR, INH, RIF, EMB, PZA, ETH
 MDR
 Unknown
 Index case-patient. No previous treatment records. Died 2 months after diagnosis. Treatment was with INH, RIF, PZA, EMB, and STR.
2
 Resistencia, Chaco
 2008
 NA/F
 STR, INH, RIF, EMB, PZA, ETH
 MDR
 Negative
 Mother of patients 3, 4, and 9. Worked as a nurse at hospital where patient 1 was assisted. Self-administered the second-line drugs. Smear positive for AFB until 2011.
3
 Resistencia, Chaco
 2010
 14/M
 STR, INH, RIF, EMB, PZA, ETH (2LI, FLQ)
 MDR (pre-XDR)
 Negative
 Son of patient 2. Hepatotoxicity associated with TB drugs. Poor adherence to treatment. Problematic substance use. Died in 2016.
4
 Resistencia, Chaco
 2010
 16/M
 STR, INH, RIF, EMB, PZA, ETH
 MDR
 Negative
 Son of patient 2. Hepatotoxicity associated with TB drugs.
5
 Resistencia, Chaco
 2014
 66/M
 STR, INH, RIF, EMB, PZA, ETH
 Pre-XDR
 Unknown
 Grandfather of patient 6. Repeated treatment changes, suboptimal treatment.
6
 Resistencia, Chaco
 2014
 15/F
 STR, INH, RIF, EMB, PZA, ETH, FLQ (LZD‡)
 Pre-XDR (XDR)
 Negative
 Granddaughter of patient 5. Her mother, who had lupus, and brother died of TB (Appendix 2). Discharged in 2016 after sputum tested negative. Relapsed in 2017. Referred to a hospital that specialized in DR-TB in Buenos Aires in 2019. Poor adherence to treatment. Smoker.
7
 Corrientes, Corrientes
 2014
 52/M
 STR, INH, RIF, EMB, PZA, ETH
 MDR
 Positive
 Died in 2015.
8
 Resistencia, Chaco
 2017
 43/F
 STR, INH, RIF, EMB, PZA, ETH
 MDR
 Unknown
 TB diagnosed in 2016. Had contact with a TB patient in 1999, but the association with the outbreak is unknown.
9
 Resistencia, Chaco
 2017
 18/F
 STR, INH, RIF, EMB, PZA, ETH (CAP, ETH)
 MDR
 Negative
 Daughter of patient 2. Irregular treatment and poor adherence. Died in 2021.
10
 Resistencia, Chaco
 2018
 16/F
 STR, INH, RIF, EMB, PZA, ETH, FLQ (CFZ, BDQ§)
 Pre-XDR (XDR)
 Negative
 Friend of patient 6. who visited her frequently. Repeated treatment changes. Admitted to a pediatric hospital in Buenos Aires in 2019, where she received CFZ/BDQ. Patient complied with treatment; her condition improved, and she was discharged in December 2019. Relapsed and died in 2020 during social isolation because of COVID-19 pandemic.
11
 Resistencia, Chaco
 2020
 24/F
 STR, INH, RIF, EMB, PZA, ETH
 MDR
 Negative
 Irregular treatment. Problematic substance use.
12 Del Viso, Buenos Aires 2021 21/M STR, INH, RIF, EMB, PZA, ETH MDR Unknown Patient was unavailable for follow-up until mid-2022 when he started second-line treatment. Former resident of Resistencia and declared the same address of patient 2 and her family, but their exact relationship is unknown.

*BDQ, bedaquiline; CAP, capreomycin; CFZ, clofazimine; DR, drug resistance; EMB, ethambutol; ETH, ethionamide; FLQ, fluoroquinolone; INH, isoniazid; NA, not available; MDR, multidrug-resistant; pre-XDR, pre–extensively drug-resistant; PZA, pyrazinamide; RIF, rifampin; STR, streptomycin; XDR, extensively drug-resistant.; 2LI, second-line injectable drugs. †Consolidated DR profiles based on phenotypic and molecular test results. STR was tested phenotypically in all isolates until 2017. The DR profile and DR status of the last isolate are indicated between brackets. ‡Confirmed phenotypically. §Tested retrospectively after the detection of the Rv0678_114duplC mutation by whole-genome sequencing.

Main Article

1These first authors contributed equally to this article.

Page created: February 04, 2025
Page updated: February 21, 2025
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