Extensively drugresistant tuberculosis xdrtb is a form of tuberculosis caused by bacteria that are resistant to some of the most effective antitb drugs. Tuberculosis remains a vital lifethreatening diseases and posing the expanding global health crisis that mandates new therapeutic strategies. Extensively drugresistant xdr tb refers to mdrtb strains that are resistant to fluoroquinolones and secondline injectable drugs. Extensively drug resistant tb xdr tb is a rare type of multidrugresistant tuberculosis mdr. Extensively drugresistant tuberculosis xdr tb center by. Any mans death diminishes me because i am involved in mankind, and therefore never send to know for whom the bell tolls. Multidrugresistant tuberculosis mdrtb 2017 update the latest anti tb drug resistance surveillance data show that 4. The main mechanism of generating drug resistance in m.
Chapter 2 transmission and pathogenesis of tuberculosis. P d o davies for 2 weeks in january, india coughed and the rest of the world paid. To conclude, the authors provide their opinions on potential interventions of the most pressing concerns in the control of the epidemic. Extensively drugresistant tb xdrtb is defined as tb that has evolved. Mdr and xdr tuberculosis case study vernonibulldog2015. South africa is ranked as a high burden mdrtb country with an estimated,000 cases being diagnosed in 2008. In a nationwide survey in south africa in 2008, 20. Pdf pdf icon 37k multidrugresistant tuberculosis mdr tb what is tuberculosis tb. Overall, onethird of the worlds population is currently infected with the tb bacillus, the bacterium that causes. It is resistant to almost all drugs used to treat tb, including the two best firstline drugs. Tb that is resistant to isoniazid and rifampin, plus any. Once created, xdr tb can spread from one person to another.
In addition, we present a critical view of the most controversial issues, as well as a speculative 5year future prediction of the mdrxdr epidemic. Mycobacterium tuberculosis strains with resistance to at least. Tuberculosis is one of the leading causes of death globally and now emergence of extensive drug resistant tuberculosis xdr tb stain creates threat for health care system as well as general population. Multi drug and extensive drug resistant tuberculosis mxdrtb has been. Xdr extensively drugresistant and prexdr tuberculosis tb seriously compromise prognosis and treatment possibilities, and inevitably require the use of. Is the xdr form of tuberculosis as dangerous as the media made it out to be in the recent episode of the man who traveled by air after being told not to. Tuberculosis tb is a bacterial infectious disease, caused by the obligate human pathogen, mycobacterium tuberculosis m tb. Initiator of the clinical trials against tb using combined regimens in the early 1950s. Overall, 20% of the 17,690 isolates examined were mdr m.
Extensively drugresistant tuberculosis xdrtb is an emerging health problem that threatens tuberculosis tb control worldwide, since suitable treatment for this disease has not yet been found. This can occur when antitb drugs are misused or mismanaged. While focusing on mdrxdr tb, many of the research priorities identified in this document also relate to drugsensitive tuberculosis. Only when the bacteria become active do people become ill with tb. Xdr tb was defined as tb resistant to isoniazid and rifampin and at least 3 of the. Tuberculosis tb is a disease caused by bacteria that are spread from person to person through the air. Extensively drugresistant tuberculosis xdrtb is taking a toll on india especially its poorest residents.
Radiological signs associated with pulmonary multidrug resistant. Rapid diagnosis of mdr and xdr tuberculosis with the meltpro tb assay in china. Development of sequence based molecular diagnostic test. The national institute of allergy and infectious diseases niaid, a component of the national institutes of health nih, today released its niaid research agenda for multidrugresistant mdr and extensively drugresistant xdr tuberculosis tb. Multidrug and extensively drugresistant tb world health. Rapid communications a surge of mdr and xdr tuberculosis. Xdr tb is also resistant to the best secondline medications. Comparison of ct findings between mdrtb and xdrtb epos.
Innovation to accelerate global tuberculosis elimination position in the panacea drug trial consortium, longstanding collaborations in tb highincidence countries and access to drugresistant m. Multidrugresistant tuberculosis mdrtb is tb that does not respond to at least isoniazid and rifampicin, the two most powerf. Mdrtb has been shown to be almost twice as common in tb patient living with hiv as compared to tb patient without hiv 12 to resolve the. When people who are sick with tb in their lungs cough, sneeze, talk or spit, they propel tb germs into the air, and a person needs only to breathe in a small number of these to be infected. The global threat of xdr tuberculosis has great significance for the public health field.
This study determined treatment outcomes among a cohort of mdrtb and xdrtb patients in hunan. Mdr tb xdr tb the laboratory a clinicians perspective. Detection in 2017, 24% of new and 70% of previously treated tb patients notified globally were tested for mdr rr tb up from 12% and 53% respectively in 2015. Xdrtb strains have arisen after the mismanagement of individuals with multidrugresistant tb mdrtb almost one in four people in the world is infected with tb bacteria. The social factors that contributed to the spread of this disease are many. Davis endowed chair in thoracic surgery professor and chief, general thoracic surgery department of surgery university of colorado school of medicine tb course, national jewish health april 7, 2018 property of presenter not for reproduction. Tb can usually be treated with a course of four standard, or firstline, antitb drugs. Transmission of mdr and xdr tuberculosis in shanghai, china. See all formats and editions hide other formats and editions. High mortality rates have been reported for patients coinfected with extensively drugresistant tuberculosis xdrtb and hiv, but treatment outcomes have not been reported. Xdr tuberculosis implications for global public health. Because xdr tb is resistant to the most potent tb drugs, patients are left with treatment. Nowhere is this threat more pressing than in south africa, where drugresistant tb and hiv have converged in a deadly syndemic defined by increased incidences of tb and hiv, endemic transmission of drugresistant tb strains, high mortality rates, and poor treatment outcomes. Extensively drugresistant tb xdr tb is defined as resistance to isoniazid and rifampin, plus resistance to any fluoroquinolone and at least one of three injectable secondline antitb drugs 0 2 4.
Surgery for mdrxdr tuberculosis national jewish health. Multi drug and extensively drugresistant tb clinical epidemiology. Persons who have tb disease are usually infectious and may spread the bacteria to other people. Pdf preextensive drug resistant tuberculosis prexdr. The global epicenter of the xdr tb and hiv syndemic. First series of patients with xdr and prexdr tb treated with. Mario raviglione and ian smith write that its very existence is a reflection of weaknesses in tubercul. We report treatment outcomes for adult xdr tb patients in kwazulunatal province, south africa. Multicountry cluster of extensively drugresistant tuberculosis xdr. Extensively drugresistant tb xdr tb is defined as m. In 2010, who estimated that 440,000 people develop mdrtb annually and that over.
With the selection pressure of antitb drugs, mutations accumulate in the m. Initial data were obtained retrospectively, and outcomes were obtained prospectively during 24 months of treatment. Definition of xdr tb 41 countries with xdr tb to date tuberculosis xdr tb the facts extensively drugresistant tb xdr tb is a form of tb caused by germs resistant to all the most effective anti tb drugs, and emerges through mismanagement of mdr tb treatment. Remembering sir john crofton 19122009 giant in the history of tb control. If these drugs are misused or mismanaged, multidrugresistant tb mdrtb. Mycobacterium tuberculosis, pcr, dna sequencing, mdr, xdr. Extensively drugresistant tuberculosis xdr tb is a relatively rare type of multidrugresistant tuberculosis mdr tb. The bacteria that cause tuberculosis tb can develop resistance to the antimicrobial drugs used to cure the disease. Multidrugresistant mdr and extensively drugresistant tuberculosis xdrtb still represent a challenge for clinicians and staff. Any information contained in this pdf file is automatically generated from digital. Multidrugresistant tuberculosis mdrtb is defined as a disease caused by. Multidrugresistant tuberculosis mdrtb is an emerging lifethreatening disease and is caused by. Extensively drugresistant tuberculosis xdr tb article. Cdc tb hoja informativas tuberculosis multirresistente.
The bacteria that cause tuberculosis tb can develop resistance to the antimicrobial drugs used to. Multidrugresistant and extensively drugresistant tuberculosis. The progression from ltbi to tb disease may occur at any time, from soon to many years later. Radiological signs associated with pulmonary multidrug. In 2016, an estimated 600 000 new cases of mdr rr tb emerged globally. In 2016, an estimated 600 000 new cases of mdrrrtb emerged. Comparison of ct findings of between mdrtb and xdrtb. Extensively drug resistant tb xdr tb is a rare type of mdr tb that is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable secondline drugs i. Tb usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine.
As mdr tb and xdr tb have become more prevalent, our. Xdr tuberculosis, the new international health regulations, and human rights philippe calain and david p. Preliminary findings have shown that approximately 20% of mdrtb patients had resistance to one or more of the most important secondline drugs, and more than 5% had xdrtb. This happens when tb control programmes are poorly managed, for example when patients are not properly supported to complete. Extensively drug resistant tb xdr tb is a rare type of multidrugresistant tuberculosis mdr tb that is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable secondline drugs i. Xdr tb case count defined on initial dst by year, 1993 2010 6 8 10 12 s e count drug susceptibility test updated as of july 21, 2011 note. Note that these estimates are based on the initial cdcwho definition ofxdrtb developed 24 march 2006. This represents a dramatic increase 3fold since 2002, when it was shown that 3. Drugresistant tuberculosis tb is a critical threat to tb control and global public health. Before the widespread use of antibiotics, drugresistant strains of m. Body fluid or tissue from the disease site should be collected for afb smear and culture see chapter 5, treatment for latent tuberculosis infection. Extensively drug resistant xdrtb is defined as mdrtb plus additional resistance to a fluoroquinolone and a 2. Management of contacts of mdr tb and xdr tb patients. The worldwide emergence of multidrugresistant tuberculosis mdrtb and extensively drugresistant tuberculosis xdrtb has posed additional challenges for global tuberculosis tb control efforts, as limited treatment options are available and treatment outcomes are often suboptimal.
A surge of mdr and xdr tuberculosis in france among patients born in the former soviet union c bernard christine. By march 20, 84 countries had reported at least one xdr tb case. Fidler extensively drugresistant tuberculosis xdrtb is the latest emerging disease recognized as a global health threat. The present study was planned to study the presence of prexdr and xdr mycobacterium tuberculosis and their genotypes in clinical isolates obtained from previously treated cases of pulmonary tb. The most drugresistant form of tb, extensively drugresistant tuberculosis xdr tb 8 has been reported in 70 countries and comprises an increasing proportion of drugresistant tb cases 1. In many countries a steady increase has occurred in recent years, driven by the. Multi drug resistant tuberculosis mdrtb is a contagious disease, which spreads as a droplet. And the indian government is struggling to provide the necessary diagnoses and.
Rapid diagnosis of mdr and xdr tuberculosis with the. Emergence and treatment of multidrug resistant mdr and. Multidrugresistant tuberculosis and extensively drugresistant. Tuberculosis tb is a pulmonary bacterial infectious disease that spreads through the air. Who consolidated guidelines on drugresistant tuberculosis.
Mdrtb and hiv mdrtb and xdrtb are associated with an extremely high mortality, especially in the hiv co infected person 14 according to the 4th who report 2008 on anti tuberculosis drug resistance. We believe you are referring to the andrew speaker case, which has global ramifications andrew speaker was diagnosed in march 2007 with tuberculosis. Every person who has xdr tb infects about 15 people with their disease every year. Extensively drugresistant tuberculosis xdr tb is a rare form of multidrugresistant tuberculosis mdr tb thats transmitted when tb germs are expelled into the air by sneezing, speaking, singing, or coughing. Thus, xdrtb may overall appear even more aggressive. Xdr tuberculosis, the new international health regulations. Socioeconomic factors contributing to multidrugresistant tuberculosis mdrtb saira zai1, tyaba haroon1, khawaja tahir mehmood2 1department of pharmacy, lahore college for women university. Prevalence of selected imaging signs in pulmonary nmdrtb vs. Professor bengal college of pharmaceutical sciences and research 2. People who live in poverty and in tight quarters are more likely to contract the disease. Socioeconomic factors contributing to multidrugresistant. Transmission of mdr and xdr tuberculosis in shanghai, china article pdf available in plos one 42. Treatment outcomes of patients with multidrugresistant.
1208 1168 1167 261 1092 46 1071 414 391 606 1016 1269 415 680 34 296 200 680 1252 393 303 561 1403 769 832 296 333 594 1006 292 121 1146