• F Salvo, K Dorjee, K Dierberg, W Cronin, T D Sadutshang, G B Migliori, C Rodrigues, F Trentini, C Di Serio, R Chaisson, and D M Cirillo.
• Emerging Pathogens Unit, San Raffaele Scientific Institute, Milan, Italy.
• Int. J. Tuberc. Lung Dis. 2014 Jun 1;18(6):655-62.

SettingTuberculosis (TB) is a major health problem among Tibetans living in exile in India. Although drug-resistant TB is considered common in clinical practice, precise data are lacking.ObjectiveTo determine the proportion of drug-resistant cases among new and previously treated Tibetan TB patients.DesignIn a drug resistance survey in five Tibetan settlements in India, culture and drug susceptibility testing (DST) for first-line drugs were performed among all consecutive new and previously treated TB cases from April 2010 to September 2011. DST against kanamycin (KM), ethionamide, para-aminosalicylic acid and ofloxacin (OFX) was performed on multidrug-resistant TB (MDR-TB) isolates.ResultsOf 307 patients enrolled in the study, 264 (193 new and 71 previously treated) were culture-positive and had DST available. All patients tested for the human immunodeficiency virus (n = 250) were negative. Among new TB cases, 14.5% had MDR-TB and 5.7% were isoniazid (INH) monoresistant. Among previously treated cases, 31.4% had MDR-TB and 12.7% were INH-monoresistant. Of the MDR-TB isolates, 28.6% of new and 26.1% of previously treated cases were OFX-resistant, while 7.1% of new cases and 8.7% of previously treated cases were KM-resistant. Three patients had extensively drug-resistant TB.ConclusionsMDR-TB is common in new and previously treated Tibetans in India, who also show additional complex resistance patterns. Of particular concern is the high percentage of MDR-TB strains resistant to OFX, KM or both.

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