Drug-Resistant Mycobacterium tuberculosis and Atypical Mycobacteria Isolated From Patients With Suspected Pulmonary Tuberculosis in Honduras

¹ From the Department of Microbiology, Universidad Nacional Autonoma de Honduras, Tegucigalpa, Honduras; and the Swedish Institute for Infectious Disease Control Stockholm, Sweden
² From the Department of Microbiology, Universidad Nacional Autonoma de Honduras, Tegucigalpa, Honduras
³ From the Instituto Nacional Del Tórax and Physiology Department, School of Medicine, UNAH, Tegucigalpa, Honduras
⁴ From the Swedish Institute for Infectious Disease Control; and the Microbiology and Tumorbiology Center, Karolinska Institute, Stockholm, Sweden

Background: Tuberculosis is a major health problem in Central America. In Honduras, with an incidence rate of 81/100,000, it is an increasingly common cause of morbidity and hospitalization. This study was conducted to examine drug-resistant tuberculosis and prevalence of infection with atypical mycobacteria in Honduran patients with suspected pulmonary tuberculosis.

Methods: Pulmonary specimens from 235 Honduran patients with suspected tuberculosis were examined by acid-fast smears and culture. The 95 mycobacterial strains isolated were identified to species level and drug susceptibility tests were carried out. Resistant Mycobacterium tuberculosis strains were tested for susceptibility to six additional drugs. Their possible relationship was studied by DNA restriction fragment length polymorphism.

Results: Drug-resistant strains were found in 13 of 85 culture-verified tuberculosis patients, including 10 with isolates of multidrug-resistant bacteria. Seven of the patients with multidrug-resistant tuberculosis had smear-positive disease. Nine of them had a history of specific therapy. Two patients with drug-resistant disease were shown to be infected by identical strains. Only one of 11 HIV-positive patients had drug-resistant tuberculosis. Most resistant strains were susceptible to ciprofloxacin, amikacin, kanamycin, and pyrazinamide. Atypical mycobacteria were isolated from 10 patients with suspected tuberculosis. Seven of them were receiving antituberculosis chemotherapy and five had smear-positive samples.

Conclusions: These results illustrate the importance of mycobacterial culture and subsequent species identification and in vitro susceptibility testing for identification of patients with drug-susceptible or drug-resistant tuberculosis and those infected or colonized with other mycobacteria.

Key Words: atypical mycobacteria • drug resistance • Honduras • multidrug-resistant tuberculosis (MDR-TB) • tuberculosis

Submitted on December 12, 1995
Accepted on July 26, 1996

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