J Korean Med Sci.  2017 Jul;32(7):1105-1110. 10.3346/jkms.2017.32.7.1105.

Characteristics of Drug Resistant Tuberculosis in Sanatoria of North Korea

• Jung J
• Jegal Y
• Ki M
• Shin YJ
• Kim CT
• Shim TS
• Sung N

• KMID: 2379604
• DOI: http://doi.org/10.3346/jkms.2017.32.7.1105

Abstract

Although several reports about drug-resistant tuberculosis (TB) in North Korea have been published, a nationwide surveillance on this disease remains to be performed. This study aims to analyze the drug resistance patterns of Mycobacterium tuberculosis among the patients in the sanatoria of North Korea, especially during the period when second-line drugs (SLDs) had not yet been officially supplied to this country. The Eugene Bell Foundation (EBF) transferred 947 sputum specimens obtained from 667 patients from 2007 to 2009 to the Clinical Research Center, Masan National Tuberculosis Hospital (MNTH), South Korea. Four hundred ninety-two patients were culture positive for TB (73.8%). Drug susceptibility test (DST) was performed for the bacilli isolated from 489 patients. Over 3 quarters of the cases (76.9%) were multidrug-resistant (MDR)-TB. Additionally, 2 patients had extremely drug-resistant (XDR)-TB. Very high resistance to first-line drugs and low resistance to fluoroquinolones (FQs) and injectable drugs (IDs) except for streptomycin (S) were detected. A small but significant regional variation in resistance pattern was observed. Big city regions had higher rate of MDR-TB, higher resistance to FQs and IDs than relatively isolated regions. In conclusion, significant number of drug-resistant TB was detected in North Korean sanatoria, and small but significant regional variations in resistance pattern were noticeable. However, the data in this study do not represent the nationwide drug resistance pattern in North Korea. Further large-scale evaluations are necessary to estimate the resistance pattern of TB in North Korea.

Keyword

Drug Resistance; North Korea; Tuberculosis

MeSH Terms

Democratic People's Republic of Korea*
Drug Resistance
Fluoroquinolones
Hospitals, Chronic Disease
Humans
Korea
Mycobacterium tuberculosis
Sputum
Streptomycin
Tuberculosis*
Tuberculosis, Multidrug-Resistant
Fluoroquinolones
Streptomycin

Figure

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  Fig. 1 Antituberculosis drug resistance rate (%) and pattern in sanatoria of North Korea: (A) patients (n = 489) in all sanatoria analyzed in this study, (B) patients (n = 263) in region A, (C) patients (n = 108) in sanatoria located in region B, and (D) patients (n = 118) in region C. M. tuberculosis strains were isolated from the first sputum samples of each patient and used for DST as described in the text. Region A = the capital city area, Region B = North Pyongan Province, Region C = South Pyongan and Hwanghae Provinces, DST = drug susceptibility test, TB = tuberculosis, INH = isoniazid, RIF = rifampicin, EMB = ethambutol, PZA = pyrazinamide, S = streptomycin, Km = kanamycin, Am = amikacin, Cm = capreomycin, Ofx = ofloxacin, Mfx = moxifloxacin, PAS = para-aminosalicylic acid, Eto = ethionamide, Cs = cycloserine.

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