Multidrug-resistant tuberculosis outbreak in an Italian prison: Tolerance of pyrazinamide plus levofloxacin prophylaxis and serial interferon gamma release assays

A. Bedini, Elisa Garlassi, C. Stentarelli, S. Petrella, Marialuisa Meacci, Barbara Meccugni, Marianna Meschiari, E. Franceschini, S. Cerri, A. Brasacchio, F. Rumpianesi, Luca Richeldi, C. Mussini

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)45-51
Number of pages7
JournalNew Microbes and New Infections
Volume12
DOIs
Publication statusPublished - Jul 1 2016

Fingerprint

Interferon-gamma Release Tests
Pyrazinamide
Multidrug-Resistant Tuberculosis
Levofloxacin
Prisons
Disease Outbreaks
Gold
Latent Tuberculosis
Therapeutics
Tuberculin Test
Skin Tests
Tuberculosis
Prisoners
Gastritis
Pulmonary Tuberculosis
Italy
Hepatitis
Diarrhea

Keywords

  • Hepatotoxicity
  • Latent tuberculosis infection
  • Levofloxacin
  • Multidrug-resistant tuberculosis
  • Pyrazinamide
  • QuantiFERON-TB Gold In-Tube

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology

Cite this

Multidrug-resistant tuberculosis outbreak in an Italian prison : Tolerance of pyrazinamide plus levofloxacin prophylaxis and serial interferon gamma release assays. / Bedini, A.; Garlassi, Elisa; Stentarelli, C.; Petrella, S.; Meacci, Marialuisa; Meccugni, Barbara; Meschiari, Marianna; Franceschini, E.; Cerri, S.; Brasacchio, A.; Rumpianesi, F.; Richeldi, Luca; Mussini, C.

In: New Microbes and New Infections, Vol. 12, 01.07.2016, p. 45-51.

Research output: Contribution to journalArticle

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 2016, 'Multidrug-resistant tuberculosis outbreak in an Italian prison: Tolerance of pyrazinamide plus levofloxacin prophylaxis and serial interferon gamma release assays', New Microbes and New Infections, vol. 12, pp. 45-51. https://doi.org/10.1016/j.nmni.2016.03.010
Bedini, A. ; Garlassi, Elisa ; Stentarelli, C. ; Petrella, S. ; Meacci, Marialuisa ; Meccugni, Barbara ; Meschiari, Marianna ; Franceschini, E. ; Cerri, S. ; Brasacchio, A. ; Rumpianesi, F. ; Richeldi, Luca ; Mussini, C. / Multidrug-resistant tuberculosis outbreak in an Italian prison : Tolerance of pyrazinamide plus levofloxacin prophylaxis and serial interferon gamma release assays. In: New Microbes and New Infections. 2016 ; Vol. 12. pp. 45-51.
@article{c97cba622e244a9393e18e74f53c0048,
title = "Multidrug-resistant tuberculosis outbreak in an Italian prison: Tolerance of pyrazinamide plus levofloxacin prophylaxis and serial interferon gamma release assays",
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.",
keywords = "Hepatotoxicity, Latent tuberculosis infection, Levofloxacin, Multidrug-resistant tuberculosis, Pyrazinamide, QuantiFERON-TB Gold In-Tube",
author = "A. Bedini and Elisa Garlassi and C. Stentarelli and S. Petrella and Marialuisa Meacci and Barbara Meccugni and Marianna Meschiari and E. Franceschini and S. Cerri and A. Brasacchio and F. Rumpianesi and Luca Richeldi and C. Mussini",
year = "2016",
month = "7",
day = "1",
doi = "10.1016/j.nmni.2016.03.010",
language = "English",
volume = "12",
pages = "45--51",
journal = "New Microbes and New Infections",
issn = "2052-2975",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Multidrug-resistant tuberculosis outbreak in an Italian prison

T2 - Tolerance of pyrazinamide plus levofloxacin prophylaxis and serial interferon gamma release assays

AU - Bedini, A.

AU - Garlassi, Elisa

AU - Stentarelli, C.

AU - Petrella, S.

AU - Meacci, Marialuisa

AU - Meccugni, Barbara

AU - Meschiari, Marianna

AU - Franceschini, E.

AU - Cerri, S.

AU - Brasacchio, A.

AU - Rumpianesi, F.

AU - Richeldi, Luca

AU - Mussini, C.

PY - 2016/7/1

Y1 - 2016/7/1

N2 - 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.

AB - 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.

KW - Hepatotoxicity

KW - Latent tuberculosis infection

KW - Levofloxacin

KW - Multidrug-resistant tuberculosis

KW - Pyrazinamide

KW - QuantiFERON-TB Gold In-Tube

UR - http://www.scopus.com/inward/record.url?scp=84966392107&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84966392107&partnerID=8YFLogxK

U2 - 10.1016/j.nmni.2016.03.010

DO - 10.1016/j.nmni.2016.03.010

M3 - Article

AN - SCOPUS:84966392107

VL - 12

SP - 45

EP - 51

JO - New Microbes and New Infections

JF - New Microbes and New Infections

SN - 2052-2975

ER -