Factors contributing to drug-resistant tuberculosis in the Luton, UK

Background Luton is a high risk area for Mycobacterium tuberculosis (TB). In 2009 there were 51 cases/100,000 population (national average 15.5). Drug resistance is common in patients with past history of TB, born outside the UK and under 45 years of age. We reviewed factors related to drug resistance in 2003-10. Methods Details of patients with drug resistant TB were identified from microbiology data, case notes and TB notification and analysed Results There were 22 single drug resistant cases (isoniazid 15, streptomycin 4, pyrazinamide 2), 1 combined resistant case (isoniazid and pyrazinamide) and no MDR/XDR case. Age was 22-66 years (mean 39). 16(73%) were born outside the UK (Africa 5, Bangladesh 4, Pakistan 4, India 2 and Jamaica 1), 1 was white British, 4 were HIV negative, 3 positive, 2 declined test, 13 had no documented status. None had previous TB. Discussion 8% had resistance TB to at least one first line drug (national average 7.5%). Reflecting the worldwide trend, isoniazid resistance was seen in 15 (68%). Majority were non-UK born with 10(45%) from Asia (Pakistan/India/Bangladesh) corresponding with the known distribution of cases worldwide. 16(73%) were in the high risk age group (15-44). Despite previous TB being a risk factor for resistance, none of our cases had this. Though TB is strongly associated with HIV, there is conflicting evidence regarding a link with drug resistant TB and HIV. Of the 7 tested for HIV 4 were positive. Due to small sample we are unable to comment on a link between drug resistant TB and HIV in our cohort. The trends for drug resistant TB in Luton are similar to national data. Further investigation into factors such as drug abuse, homeless, prisoners and HIV status is needed.