Objectives We describe the first published cluster of extensively drug resistant Tuberculosis (XDR-TB) in the UK and show how early whole genome sequencing (WGS) of Mtb can assist in case management and contact investigations. Methods We describe the contact tracing investigation undertaken after the presentation of an adult with XDR-TB. Active cases were treated with an XDR-TB drug regimen and contacts underwent a programme of follow-up for 2 years. All isolates of Mycobacterium tuberculosis (Mtb) were assessed early using whole genome sequencing (WGS) as well as routine drug susceptibility testing (DST). Results Thirty-three contacts were screened. In the first year one confirmed and one probable case were identified through contact tracing. A further possible case was identified through epidemiological links. Two confirmed cases were identified through WGS 2 years later. Twenty-five (80%) contacts without evidence of tuberculosis were adherent to 1 year of follow-up and 14 (45%) were adherent to 2 years of follow-up. WGS of Mtb was used to guide drug choices, rapidly identify transmission events, and alter public health management. Conclusion WGS of Mtb enabled rapid effective individualized treatment and facilitated public health interventions by early identification of transmission events.
Bibliographical noteFunding Information:
All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: AA has received a research studentship funding from The Jefferiss Charitable Trust , PB is funded by INNOVATE UK (UK Government Agency) in collaboration with QuantuMDx Ltd, UK, outside the submitted work, Dr. Hinds reports grants from GSK Biologicals , grants from Pfizer , grants from Sanofi Pasteur , outside the submitted work; no other relationships or activities that could appear to have influenced the submitted work.
© 2016 The British Infection Association
- Contact tracing
- Disease outbreaks
- Drug resistance
- Pathology, molecular