Clinical and Tuberculosis (TB) Treatment Outcomes Among Extensively Drug-resistant-TB (XDR-TB) in Israel, 2008-2016

Background: Israel is a low-endemic country for Tuberculosis with gratuitous treatment regardless of citizenship. Israel is particularly vulnerable to the increase of multiple or extensively drug-resistant-TB (MDR/XDR-TB) due to migration from high-endemic countries. During the period 2008-2016, 4% of all 2,676 bacteriological confirmed TB cases notified in Israel were MDR/XDR-TB.

Objective: To analyze clinical and treatment outcomes of all XDR-TB cases living in Israel during 2008-2016.

Methods: All XDR-TB cases registered at the National TB Registry during the period 2008-2016, were cross-referenced with data from the National MycobacteriumReference Laboratory using drug resistance and whole genome sequencing, and from the National TB ward. Clinical and TB treatment outcome data were analyzed and classified by WHO definition. All XDR-TB cases underwent an epidemiological investigation, and all of their close contacts were followed through March 2018.

Results: Out of 2,676 bacteriological confirmed cases notified in Israel, 107 (4%) were MDR/XDR-TB. Nine were XDR-TB. Age ranged between 20 to 65 years old (mean: 35, SD: 13.8). All but one case were pulmonary TB; none were HIV positive. All seven foreign born (FB) cases were defined as ‘Beijing family,’ differing from the 2 Israeli-born cases. Prior immigration treatment was reported in 71.4% of FB cases. No epidemiological link was found between all FB XDR-TB cases, neither between their close contacts. All cases were hospitalized (average: 5 months; SD: 3.5). Treatment regimens were personalized. Full evaluation was performed on 8 patients: three completed successful treatment, three failed, two died. The last case remains in treatment (17 months). None of the cases with failed treatment died. Follow up of the close contacts were a total of 386 person-years (mean: 4.75; SD: 2.7).

Conclusions: Israel has a relatively few XDR-TB cases. Outcomes for treatment have been found more successful than usual for XDR-TB cases, especially concerning mortality.