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 journalArticlepeer-review

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

Keywords

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

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology

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