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Extensively Drug Resistant Tuberculosis

Introduction

Tuberculosis refers to a bacterial infection that affects the lungs, and its mode of transmission is via air droplets released during coughing, spitting, sneezing, or talking. Dormant TB germs affect one out of every three in a population worldwide and when the bacteria are active that is when we say that someone is ill with TB. Furthermore, XDR-TB affects people whose immunity is low or who have respiratory problems. A healthy and normal person is only infected with TB when he/she is exposed to the bacteria.

Extensive drug-resistant TB (XDR-TB) can be defined as a multi-drug resistant TB that offers resistance to three or more of the six classes of second-line injectable drugs which include amikacin, capreomycin, and kanamycin. The description of XDR-TB was coined in late 2005 and used for the first time in early 2006, due to a joint survey conducted by WHO and the Centers for Disease Control in the US. The main cause of resistance to anti-TB drugs is poorly managed TB care which encompasses an erratic supply of drugs or poor quality drugs, incorrect prescription of drugs by providers, and non-adherence by patients.

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More recent findings as shown in a survey jointly conducted by WHO and CDC from 2000 – 2004 revealed that XDR-TB is present in all regions of the world but is most common in the countries of the former Soviet Union and Asia. According to those statistics, 4% Multi-Drug Resistant (MDR-TB) cases met the criteria for XDR-TB while in Latvia a similar situation was represented by 19%. Other data concerning a recent outbreak of XDR-TB in an HIV-positive population in Kwazulu – Natal in South Africa reported very high mortality rates. 544 patients formed the subject of study of which 221 had MDR-TB.

Of these MDR-TB cases, 53 were positively identified as XDR-TB. Out of the 53 patients, 44 of them were tested for HIV and all turned out to be HIV-Positive. Among the 53 patients, 52 of them died on an approximated average of within 25 days in addition to those who were placed under antiretroviral drugs. On the other hand, data collected from Africa regarding drug resistance demonstrate that the population prevalence of drug resistant TB is relatively lower than in Eastern Europe and Asia, even though drug resistance in the region is on the rise.

Main body

XDR-TB, therefore, poses a great public health threat more so in populations where HIV is prevalent and where health care resources are in short supply. An alternative way to cure XDR-TB, therefore, is by preventing it. In doing so, the disease can easily be reduced and eventually eliminated. WHO recommends several preventive precautions for the disease which include: Strengthening basic TB care to avoid the emergence of drug resistance, the diagnosis, and treatment of drug-resistant cases should be done promptly to cure existing cases and prevent further transmission of the disease, there should be an increased group effort between TB and HIV control programs so that co-infected patients can receive necessary prevention and care; there should be more investment made in laboratory infrastructures to ensure better recognition and management of the prevalence of resistant cases.

The epidemiology and the partial genotypic data currently available indicate that this is not a single strain, but rather expansively drug-resistant strains are prone to have emerged in many different places and on multiple instances. Ironically, this is both comforting and alarming. It is encouraging because the surfacing of extensively drug-resistant tuberculosis in manifold strains suggests that the mutations responsible are specific for drug resistance rather than reflecting an indispensable change in the behavior of the organism. On the other hand, it is disturbing because it also suggests that extensively drug-resistant tuberculosis probably arises fairly frequently and is already scattered.

Drug resistance that occurs in tuberculosis is a result of poorly managed care and the means used to control the disease. Bad prescription practices, low drug quality, and low adherence by the patient can all contribute to this. Bacilli are exposed to a high drug range and exposure to mono-therapy manipulates the growth of mutations that give resistance. In such a case the optimal management includes four drugs to which the organism is sensitive; where a single drug should never form part of a failing regimen.

Extensive drug-resistant TB (XDR-TB) can be defined as a multi-drug resistant TB that offers resistance to three or more of the six classes of second-line injectable drugs which include amikacin, capreomycin, and kanamycin. The description of XDR-TB was coined in late 2005 and used for the first time in early 2006, due to a joint survey conducted by WHO and the Centers for Disease Control in the US. The main cause of resistance to anti-TB drugs is poorly managed TB care which encompasses an erratic supply of drugs or poor quality drugs, incorrect prescription of drugs by providers, and non-adherence by patients.

More recent findings as shown in a survey jointly conducted by WHO and CDC from 2000 – 2004 revealed that XDR-TB is present in all regions of the world but is most common in the countries of the former Soviet Union and Asia. According to those statistics, 4% Multi-Drug Resistant (MDR-TB) cases met the criteria for XDR-TB while in Latvia a similar situation was represented by 19%. Other data concerning a recent outbreak of XDR-TB in an HIV-positive population in Kwazulu – Natal in South Africa reported very high mortality rates. 544 patients formed the subject of study of which 221 had MDR-TB.

Of these MDR-TB cases, 53 were positively identified as XDR-TB. Out of the 53 patients, 44 of them were tested for HIV and all turned out to be HIV-Positive. Among the 53 patients, 52 of them died on an approximated average of within 25 days in addition to those who were placed under antiretroviral drugs. On the other hand, data collected from Africa regarding drug resistance demonstrate that the population prevalence of drug resistant TB is relatively lower than in Eastern Europe and Asia, even though drug resistance in the region is on the rise.

Main body

XDR-TB, therefore, poses a great public health threat more so in populations where HIV is prevalent and where health care resources are in short supply. An alternative way to cure XDR-TB, therefore, is by preventing it. In doing so, the disease can easily be reduced and eventually eliminated. WHO recommends several preventive precautions for the disease which include: Strengthening basic TB care to avoid the emergence of drug resistance, the diagnosis, and treatment of drug-resistant cases should be done promptly to cure existing cases and prevent further transmission of the disease, there should be an increased group effort between TB and HIV control programs so that co-infected patients can receive necessary prevention and care; there should be more investment made in laboratory infrastructures to ensure better recognition and management of the prevalence of resistant cases.

The epidemiology and the partial genotypic data currently available indicate that this is not a single strain, but rather expansively drug-resistant strains are prone to have emerged in many different places and on multiple instances. Ironically, this is both comforting and alarming. It is encouraging because the surfacing of extensively drug-resistant tuberculosis in manifold strains suggests that the mutations responsible are specific for drug resistance rather than reflecting an indispensable change in the behavior of the organism. On the other hand, it is disturbing because it also suggests that extensively drug-resistant tuberculosis probably arises fairly frequently and is already scattered.

Drug resistance that occurs in tuberculosis is a result of poorly managed care and the means used to control the disease. Bad prescription practices, low drug quality, and low adherence by the patient can all contribute to this. Bacilli are exposed to a high drug range and exposure to mono-therapy manipulates the growth of mutations that give resistance. In such a case the optimal management includes four drugs to which the organism is sensitive; where a single drug should never form part of a failing regimen.

References

Division of Tuberculosis Elimination. Web.

The emergence of XDR TB on 2008. Web.

Extensively drug-resistant tuberculosis on 2008. Web.

Shah NS, Wright A, Bai G-H, Barrera L, Boulahbal F, Martín-Casabona N, et al. Worldwide emergence of extensively drug-resistant tuberculosis. Web.

World Health Organization: Emergence of XDR-TB. WHO concern over extensive drug-resistant TB strains that are virtually untreatable. Web.