Drug-Resistant Tuberculosis A SURVIVAL GUIDE FOR CLINICIANS 2ND EDITION Arnold Schwarzenegger, Governor STATE OF CALIFORNIA S. Kimberly Belshé, Secretary CALIFORNIA HEALTH & HUMAN SERVICES AGENCY Mark B Horton, MD, MSPH, Director DEPARTMENT OF PUBLIC HEALTH Drug-Resistant Tuberculosis A SURVIVAL GUIDE FOR CLINICIANS 2ND EDITION Arnold Schwarzenegger, Governor STATE OF CALIFORNIA S. Kimberly Belshé, Secretary CALIFORNIA HEALTH & HUMAN SERVICES AGENCY Mark B Horton, MD, MSPH, Director DEPARTMENT OF PUBLIC HEALTH Drug-Resistant Tuberculosis: A Survival Guide for Clinicians, Second Edition was created through a collaboration of the Francis J. Curry National Tuberculosis Center (CNTC) and the State of California Department of Public Health, Tuberculosis Control Branch (CDPH). The Francis J. Curry National Tuberculosis Center is a joint project of the San Francisco Department of Public Health and the University of California, San Francisco, funded by the Centers for Disease Control and Prevention (CDC). The development of the fi rst edi- tion of this Guide was funded through CNTC/CDPH Interagency Agreement 03-75851. The second edition was funded through CDC Cooperative Agreement U52 CCU 900454. Permission is granted for nonprofit educational use and library duplication and distribution. Second printing. Suggested citation: Francis J. Curry National Tuberculosis Center and California Department of Public Health, 2008: Drug-Resistant Tuberculosis: A Survival Guide for Clinicians, Second Edition [inclusive page numbers]. This publication is available on the Francis J. Curry National Tuberculosis Center website: www.nationaltbcenter.ucsf.edu/drtb Design: Edi Berton Design Photographs on page 1 appear courtesy of the World Health Organization Mediacentre. Top row: Katia, Russian Federation WHO/STB/Colors Magazine/J. Mollison; Feng Ming Gueng, Juang Wing Village, Xinyi County, China WHO/STB/Colors Magazine/J. Mollison; Stefania, Italy WHO/STB/Colors Magazine/J. Langvad Bottom row: John, UK WHO/STB/Colors Magazine/K. Robinson; Christine, USA WHO/ STB/Colors Magazine/T. Braganti; Jordan, USA WHO/STB/Colors Magazine/T. Braganti Contributors Jamey Todd Braun, RN, BSN, MPH Ann Raftery, BSN, PHN, RN Tuberculosis Nurse Consultant Nurse Consultant New Mexico Department of Health Tuberculosis Program Francis J. Curry National Tuberculosis Center, Santa Fe, New Mexico San Francisco, California Charles L. Daley, MD Max Salfinger, MD Professor, Department of Medicine Chief, Bureau of Laboratories Chief, Division of Mycobacterial and Respiratory Infections Florida Department of Health, Tallahassee, Florida National Jewish Medical and Research Center, Denver, Colorado Gisela Schecter, MD, MPH Edward P. Desmond, PhD Consultant, Multidrug-Resistant Tuberculosis (MDR-TB) Service Chief, Mycobacteriology and Mycology Section Tuberculosis Control Branch, Division of Communicable Disease Control Division of Communicable Disease Control California Department of Public Health, Richmond, California California Department of Public Health, Richmond, California Jennifer M. Flood, MD, MPH Barbara J. Seaworth, MD Chief, Surveillance and Epidemiology Medical Director, Heartland National Tuberculosis Center Tuberculosis Control Branch, Professor of Medicine, University of Texas at Tyler Division of Communicable Disease Control Medical Consultant, Texas Center for Infectious Disease, California Department of Public Health, Richmond, California San Antonio, Texas L. Masae Kawamura, MD Karen Lee Smith, MD, MPH Tuberculosis Controller and Medical Director Health Officer, Napa County, California Tuberculosis Control Division San Francisco Department of Public Health, California Kay Wallis, MPH Special Projects Manager Ann M. Loeffler, MD Francis J. Curry National Tuberculosis Center, Pediatric Tuberculosis Consultant, San Francisco, California Francis J. Curry National Tuberculosis Center, San Francisco, California Attending Physician—Pediatrics and Infectious Diseases, Editor Legacy Emanuel Children’s Hospital, Portland, Oregon Ann M. Loeffler, MD Sundari R. Mase, MD, MPH Team Lead for Medical Affairs Co-editors Field Services and Evaluation Branch, Division of Tuberculosis Elimination Charles L. Daley, MD National Center for HIV, Hepatitis, STD and TB Prevention Jennifer M. Flood, MD, MPH Centers for Disease Control and Prevention, Atlanta, Georgia Gisela Schecter, MD, MPH Madhukar Pai, MD, PhD Assistant Professor Project Coordinator Department of Epidemiology, Biostatistics & Occupational Health McGill University, Montreal, Canada Kay Wallis, MPH Charles Peloquin, PharmD Director, Infectious Disease Pharmacokinetics Laboratory National Jewish Medical and Research Center, Denver, Colorado CONTRIBUTORS i Review Board Frank Alvarez, MD, MPH Kathleen S. Moser, MD, MPH Tuberculosis Controller, Assistant Health Officer Director, Tuberculosis Control Program Santa Barbara County Public Health Department, California San Diego County Health and Human Services Agency, California David Ashkin, MD, FCCP Carol J. Pozsik, RN, MPH State Tuberculosis Controller, Florida Department of Health Executive Director, National Tuberculosis Controllers Association Medical Executive Director, A.G. Holley Hospital Smyrna, Georgia Visiting Assistant Professor, Division of Pulmonary and Critical Care Medicine Max Salfinger, MD University of Miami School of Medicine, Florida Chief, Bureau of Laboratories Florida Department of Health, Tallahassee, Florida Peter Cegielski, MD, MPH Team Leader, Multidrug-Resistant Tuberculosis Team Barbara J. Seaworth, MD Division of Tuberculosis Elimination Medical Director, Heartland National Tuberculosis Center National Center for HIV/STD/TB Prevention Professor of Medicine, University of Texas at Tyler Centers for Disease Control and Prevention, Atlanta, Georgia Medical Consultant, Texas Center for Infectious Disease, San Antonio, Texas Lisa Chen, MD Medical Director, Training and Medical Consultation Richard Tezak, MD, MPH Francis J. Curry National Tuberculosis Center Tuberculosis Controller Assistant Professor, Monterey County Health Department, California Division of Pulmonary and Critical Care Medicine University of California, San Francisco Mary Ann Ware, MD Sexually Transmitted Diseases/Tuberculosis Medical Director Philip Hopewell, MD Multnomah County Public Health Department, Oregon Professor, Division of Pulmonary and Critical Care Medicine Department of Medicine University of California, San Francisco San Francisco General Hospital Michael D. Iseman, MD Professor of Medicine National Jewish Medical and Research Center, Denver, Colorado L. Masae Kawamura, MD Tuberculosis Controller and Medical Director Tuberculosis Control Division San Francisco Department of Public Health, California Reynard J. McDonald, MD Professor of Medicine, New Jersey Medical School The University of Medicine and Dentistry of New Jersey Newark, New Jersey Sundari R. Mase, MD, MPH Team Lead for Medical Affairs Field Services and Evaluation Branch, Division of Tuberculosis Elimination National Center for HIV, Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention, Atlanta, Georgia ii DRUG-RESISTANT TUBERCULOSIS | A SURVIVAL GUIDE FOR CLINICIANS Acknowledgements We thank Barbara Seaworth, MD (Heartland National Tuberculosis Center) and Annette Nitta, MD (Los Angeles County MDR-TB Unit) for generously sharing their expertise, approaches, and tools during the development of the California Department of Public Health MDR-TB Service. Our appreciation is extended to the following individuals who made special contributions to the development of this Guide: Rocio Agraz Leonid Heifets, MD California Department of Public Health, Mycobacteriology Reference Laboratory, Tuberculosis Control Branch, Richmond, California National Jewish Medical and Research Center, Denver, Colorado Debbie Balchin Fay Hui Legacy Emanuel Children’s Hospital, Portland, Oregon San Francisco Department of Public Health, Tuberculosis Control Division, California Jaime Bayona, MD Socios En Salud Sucursal, Lima, Peru Jim Hunger San Francisco Department of Public Health, Tuberculosis Control David Beall, PhD Division, California Florida Department of Health, Central Laboratory, Mycobacteriology Section, Jacksonville, Florida Moon Kim, MD Los Angeles County Multidrug-Resistant Tuberculosis Unit, John S. Bradley, MD California Children’s Hospital and Health Center, San Diego, California Thomas Krautscheid, RPh Barbara Cole, RN, PHN, MSN Legacy Emanuel Children’s Hospital, Portland, Oregon Disease Control, Riverside County, California Shou-Yean Grace Lin, MS Denise Dunbar, M(ASCP) Mycobacteriology and Mycology Section, Division of Communicable Texas Department of State Health Services, Mycobacteriology/ Disease Control, California Department of Public Health, Mycology Group, Austin, Texas Richmond, California Adeleh Ebrahimzadeh, PhD Sally Liska, DrPH New York City Department of Health, Tuberculosis Laboratory San Francisco Public Health Laboratory, California Vincent E. Escuyer, PhD Andreas Loeffler, MBA Laboratory of Clinical Mycobacteriology, Wadsworth Center, Sun Microsystems, Santa Clara, California New York State Department of Health, Albany, NY Susan Mall, MAcOM Lorna Eusebio Legacy Emanuel Children’s Hospital, Portland, Oregon Los Angeles County Department of Health Services, Tuberculosis Laboratory, California Sienna Mendoza Focus Technologies Reference Laboratory, Cypress, California David Forinash, RPh Legacy Emanuel Children’s Hospital, Portland, Oregon Beverly Metchock, DrPH, D(ABMM) Mycobacteriology