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Encyclopedia > Extensively drug resistant tuberculosis

Extensively drug-resistant tuberculosis (XDR-TB) is defined as MDR-TB that is resistant to quinolones and also to any one of kanamycin, capreomycin, or amikacin.[1] The old case definition of XDR-TB is MDR-TB that is also resistant to three or more of the six classes of second-line drugs.[2] This definition should no longer be used, but is included here because many older publications refer to it. Tuberculosis (abbreviated as TB for Tubercle Bacillus) is a common and deadly infectious disease that is caused by mycobacteria, primarily Mycobacterium tuberculosis. ... Multi-drug resistant tuberculosis (MDR-TB) is defined as TB that is resistant at least to INH and RMP. Isolates that are multiply-resistant to any other combination of anti-TB drugs but not to INH and RMP are not classed as MDR-TB. A 1997 survey of 35 countries... Nalidixic acid Ciprofloxacin Levofloxacin Trovafloxacin The quinolones are a family of broad-spectrum antibiotics. ... Kanamycin (marketed under the brand name Kantrex®) is an aminoglycoside antibiotic, available in both oral and intravenous forms, and used to treat a wide variety of infections. ... A peptide Antibiotic which is given in combination with other antibiotics in tuberculosis adverse effects includes nephrotoxicity and 8th cranial nerve toxicity. ... Amikacin is an aminoglycoside antibiotic used to treat different types of bacterial infections. ...


The principles of treatment for MDR-TB and for XDR-TB are the same. The main difference is that XDR-TB is associated with a much higher mortality rate than MDR-TB, because of a reduced number of effective treatment options.[2] The epidemiology of XDR-TB is currently not well studied, but it is believed that XDR-TB does not transmit easily in healthy populations, but is capable of causing epidemics in populations which are already stricken by HIV and therefore more susceptible to TB infection.[3]

Contents

Epidemiology of drug-resistant TB

A 1997 survey of 35 countries found rates above 2% in about a third of the countries surveyed. The highest rates were in the former USSR, the Baltic states, Argentina, India and China, and was associated with poor or failing national Tuberculosis Control programmes. Likewise, the appearance of high rates of MDR-TB in New York city the early 1990s was associated with the dismantling of public health programmes by the Reagan administration.[4][5] Ronald Wilson Reagan (February 6, 1911 – June 5, 2004) was the 40th President of the United States (1981 – 1989) and the 33rd Governor of California (1967 – 1975). ...


MDR-TB can develop in the course of the treatment of fully sensitive TB and this is always the result of patients missing doses or failing to complete a course of treatment.


Thankfully, MDR-TB strains appear to be less fit and less transmissible. It has been known for many years that INH-resistant TB is less virulent in guinea pigs, and the epidemiological evidence is that MDR strains of TB do not dominate naturally. A study in Los Angeles found that only 6% of cases of MDR-TB were clustered. This should not be a cause for complacency: it must be remembered that MDR-TB has a mortality rate comparable to lung cancer. It must also be remembered that people who have weakened immune systems (because of diseases such as HIV or because of drugs) are more susceptible to catching TB.


South African epidemic

This article documents a current event.
Information may change rapidly as the event progresses.

There is currently an epidemic of XDR-TB South Africa. The outbreak was first reported as a cluster of 53 patients in a rural hospital in KwaZulu-Natal of whom 52 died.[3] What was particularly worrying was that the mean survival from sputum specimen collection to death was only 16 days and that the majority of patients had never previously received treatment for tuberculosis. This is the epidemic for which the acronym XDR-TB was first used, and although TB strains that fulfill the current definition have been identified retrospectively,[6][7] this was the largest group of linked cases ever found. Since the initial report in September 2006,[8] cases have now been reported in most provinces in South Africa. As of 16 March 2007, there were 314 cases reported, with 215 deaths.[9] It is clear that the spread of this strain of TB is closely associated with a high prevalence of HIV and poor infection control; in other countries where XDR-TB strains have arisen, drug-resistance has arisen from mismanagement of cases or poor patient compliance with drug treatment instead of being transmitted from person to person.[10] This strain of TB does not respond to any of the drugs currently available in South Africa for first- or second-line treatment. It is now clear that the problem has been around for much longer than health department officials have suggested, and is far more extensive.[11] By 23 Nov 2006, 303 cases of XDR-TB had been reported, of which 263 were in KwaZulu-Natal.[12] Serious thought has been put to isolation procedures that may deny some patients their human rights, but which may be necessary to prevent further spread of this strain of TB.[13] Image File history File links Current_event_marker. ... KwaZulu-Natal (often referred to as KZN) is a province of South Africa. ... Species Human immunodeficiency virus 1 Human immunodeficiency virus 2 Human immunodeficiency virus (HIV) is a retrovirus that causes acquired immunodeficiency syndrome (AIDS, a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections). ...


See also

The standard short course treatment for tuberculosis (TB) is isoniazid, rifampicin, pyrazinamide and ethambutol for two months, then isoniazid and rifampicin alone for a further four months. ... The speedy deletion of this page is contested. ... Organisms are said to be drug-resistant when they are no longer affected by drugs that are meant to neutralize them. ... Antibiotic resistance is the ability of a micro-organism to withstand the effects of an antibiotic. ... MRSA, or methicillin-resistant Staphylococcus aureus, is a bacterium that has developed antibiotic resistance, first to penicillin in 1947, and later to methicillin. ... SEM micrograph of vancomycin-resistant enterococci. ...

References

  1. ^ World Health Organisation. WHO Global Task Force outlines measures to combat XDR-TB worldwide. Retrieved on 2006-10-21.
  2. ^ a b Center for Disease Control (2006). "Emergence of Mycobacterium tuberculosis with Extensive Resistance to Second-Line Drugs — Worldwide, 2000–2004". MMWR Weekly 55 (11): 301–305. 
  3. ^ a b Sarah McGregor. New TB strain could fuel South Africa AIDS toll. Reuters. Retrieved on 2006-09-17.
  4. ^ Frieden TR, Sterling T, Pablos-Mendez A, et al. (1993). "The emergence of drug-resistant tuberculosis in New York City". N Engl J Med 328 (8): 521–56. PMID 8381207. 
  5. ^ Laurie Garrett (2000). Betrayal of trust: the collapse of global public health. New York: Hyperion, 268ff. ISBN 0786884407. 
  6. ^ Shah NS, Wright A, Drobniewski F, et al. (2005). "Extreme drug resistance in tuberculosis (XDR-TB): global survey of supranational reference laboratories for _Mycobacterium tuberculosis_ with resistance to second-line drugs". Int J Tuberc Lung Dis 9(Suppl 1): S77. 
  7. ^ Centers for Diseases Control (2006). "Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs-worldwide, 2000-2004". Morb Mort Wkly Rep 55: 301–5. 
  8. ^ Gandhi NR, Moll A, Sturm AW, et al. (2006). "Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa". Lancet 368: 1575–80. 
  9. ^ Angela Quintal. 314 XDR-TB cases reported in SA. Cape Times. Retrieved on 2007-04-04.
  10. ^ Migliori GB, Ortmann J, Girardi E, et al. (2007). "Extensively drug-resistant tuberculosis, Italy and Germany" 13 (5). 
  11. ^ Sidley P. (2006). "South Africa acts to curb spread of lethal strain of TB". Brit Med J 333: 825. 
  12. ^ News24. 300+ cases of killer TB in SA. Retrieved on 2006-11-23.
  13. ^ Singh JA, Upshur R, Padayatchi N. (2007). "XDR-TB in South Africa: No Time for Denial or Complacency.". PLoS Med 4 (1): e50. DOI:10.1371/journal.pmed.0040050. 

 
 

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