Multidrugresistant tuberculosis mdrtb is a form of tuberculosis tb infection caused by bacteria that are resistant to treatment with at least two of the most powerful firstline antitb medications drugs, isoniazid and rifampin. Yet, the rise of extensively resistant strains paints a picture of a microbe with an impressive adaptive potential. Peru is one of the countries with the highest numbers of cases of xdrtb, which increase every year. Mdrtb plus resistance to any fluoroquinolone and any of the second line antitb injectable drugs. Extensively drugresistant tuberculosis xdrtb is a global problem due to the high morbidity and mortality it causes. Some forms of tb are also resistant to secondline medications, and are called extensively drugresistant tb. Almost 20% of all tb strains worldwide are resistant to at least one major tb drug, including isoniazid. Multidrug resistant tuberculosis and access to essential drugs. Extensively drug resistant tuberculosis xdrtb is a form of tuberculosis caused by bacteria that are resistant to some of the most effective antitb drugs. Fact sheets drugresistant tb extensively drugresistant.
Ppt drugresistant tuberculosis powerpoint presentation. Xdr tb is also resistant to the best secondline medications. May 22, 2010 multidrug resistant and extensively drug resistant tuberculosis. Evolution of extensively drugresistant mycobacterium. Pdf frequency of extensively drugresistant tuberculosis in pakistan increased from 1. Gandhi nr1, nunn p, dheda k, schaaf hs, zignol m, van soolingen d, jensen p, bayona j.
Mdr tb which is also resistant to a fluoroquinolone and any secondline injectable drug, is called xdr tb, which means extensively drug resistant. Multi drug resistant tb mdrtb is defined as resistance to the two most effective firstline tb drugs rifampicin and isoniazid. Multidrug and extensively drug resistant tuberculosis although the incidence of tb is steadily declining in germany, numbers of cases with mdr tb strains are increasing. What is multidrugresistant tuberculosis mdrtb and how do we.
The worldwide emergence of extensively drug resistant tuberculosis xdr tb and a provisional definition for this form of tb were first reported in november 2005. Evolution of extensively drugresistant tuberculosis over. Pdf extensively drugresistant tuberculosis, pakistan. Pdf extensively drug resistant tuberculosis a case report.
Supplemental materials for prevalence, associated factors. It is resistant to almost all drugs used to treat tb, including the two best firstline drugs. Pretomanid and bpal regimen for treatment of highlyresistant. Isoniazid, rifampicin, ethambutol, pyrazinamide, streptomycin, and a fluoroquinolone. Extensively drug resistant tb singapore pdf ppt case. Pandrug resistance pdr, extensive drug resistance xdr. Mxdrtb is mostly a man made problem and its emergence can be checked by prompt diagnosis and effective use of firstline drugs in every new patient. Mdr tb is caused by an organism that is resistant to at least isoniazid and. In the field of infectious diseases, xdr has been used to abbreviate extensively drug resistant mycobacterium tuberculosis, defined by. Multidrug and extensively drug resistant tuberculosis, germany. Jun 01, 2008 the areas that are articulated in the niaid research agenda for multidrug resistant and extensively drug resistant tuberculosis were chosen because they can build on existing efforts supported by the niaid and its collaborators within the complex international network of tb research. Extensively drugresistant tuberculosis xdr tb is a relatively rare type of multidrug resistant tuberculosis mdr tb. What is extensively drug resistant tuberculosis xdr tb.
Extensively drugresistant tuberculosis is a condition where tb bacteria have changed enough to circumvent the two most potent antibiotic medicines, as well as. The areas that are articulated in the niaid research agenda for multidrugresistant and extensively drugresistant tuberculosis were chosen because they can build on existing efforts supported by the niaid and its collaborators within the complex international network of tb research. 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. In 2006, of 3,501 tb cases in germany for which resistance data were available, 78 2.
Represents select group of most severe, worstprognosis. Crosscutting interventions for drug susceptible tb and drug resistant tb. What you need to know about extensively drugresistant. Recent data from a multicountry study found that among 1,278 patients with mdrtb, approximately 7% had xdrtb. Extensively drug resistant tb xdrtb is a subset of mdrtb where the bacilli. The ideal number of drugs needed and treatment duration are crucial issues in the management of multidrug resistant tuberculosis mdrtb. Drug resistance beyond extensively drugresistant tuberculosis. Xdr tb is likewise resistant to the greatest secondline meds. Apr 01, 2008 in our view, when all these issues are considered, the terms pandrug resistance, extensive drug resistance, and multidrug resistance should designate, respectively, resistance of a pathogen to all, resistance to all but 1 or 2, and resistance to. Extensively drug resistant tuberculosis xdr tb is a moderately uncommon kind of multidrug resistant tuberculosis mdr tb. Xdrtb strains have arisen after the mismanagement of individuals with multidrug resistant tb mdrtb almost one in four people in the world is infected with tb bacteria. Tuberculosis tb has been found in mammoth bones and in egyptian mummies. Xdrtb extensively drugresistant tuberculosis z pyrazinamide.
The prevalence of drug resistant tuberculosis tb is a serious problem in the peoples republic of china. It can also occur as a result of biological variations in drug uptake or substandard drugs. Treatment of drug resistant tuberculosis resistance to tuberculosis tb drugs is a formidable obstacle to effective tb care and prevention globally. The coming storm multidrug resistant tuberculosis and access to essential drugs.
Extensively drug resistant tuberculosis xdrtb is a difficulttotreat form of multidrug resistant tuberculosis mdrtb. An overview of drugresistant tb, including its causes, different types, treatment, economic toll, and more. Although tuberculosis control has been effective in some regions of the world, these gains are threatened by the increasing burden of multidrug resistant mdr and extensively drug resistant xdr tuberculosis. From dots to dots strategy 37th union world conference on lung health 31 oct 2006 extensively drugresistant tb xdr tb summary report kenneth g. The definition has applicable clinical value and has allowed for more uniform surveillance in varied international settings. Definition of multidrug resistant tuberculosis multi drug resistant tuberculosis is defined as resistance to isoniazid and rifampicin whether there is resistance to other drugs or not. Apr 01, 2014 extensively drug resistant tb xdrtb is defined as tb caused by a multidrug resistant mdr strain ie, resistant to at least rifampicin and isoniazid that is also resistant to any fluoroquinolone fq and any of the secondline injectable drugs, such as capreomycin, kanamycin, or amikacin.
It is resistant to all drugs used to treat tb, including the two best firstline drugs. Multi drug resistant tuberculosis mdrtb is a form of tuberculosis tb infection caused by bacteria that are resistant to treatment with at least two of the most powerful firstline antitb medications drugs, isoniazid and rifampin. Some forms of tb are also resistant to secondline medications, and are called extensively drug resistant tb. This is exemplified by the largest global outbreak of extensively drug resistant xdr tuberculosis tb identified in tugela ferry, kwazulunatal, south africa, in 2005 that continues today.
Mycobacterium tuberculosis strains that are resistant to an increasing number of secondline drugs used to treat multidrugresistant tuberculosis mdrtb are becoming a threat to public health worldwide. Almost one in four people in the world is infected with tb bacteria. This is exemplified by the largest global outbreak of extensively drugresistant xdr tuberculosis tb identified in tugela ferry, kwazulunatal, south africa, in 2005 that continues today. The coming storm amsterdam, november 2526, 1999 jim yong kim, md, phd partners in health. Who surveillance of drug resistance in tuberculosis. Extensively drugresistant tuberculosis xdr tb is a moderately uncommon kind of multidrugresistant tuberculosis mdr tb. Especially alarming is the increasing prevalence of difficult to treat extensively drug resistant tuberculosis xdrtb.
The epidemiology, pathogenesis, transmission, diagnosis. Extensively drug resistant tb xdrtb is a subset of mdrtb where the bacilli, in addition to being resistant to r and h, are also resistant to any fluoroquinolones and any one of the secondline injectable drugs namely kanamycin, capreomycin, or amikacin. It is unclear whether the emergence of xdrtb in kwazulunatal was due to recent. Multidrugresistant mdr tuberculosis tb resistance to at least isoniazid and rifampicin, with 480 000 cases in 20, 10% of them being affected by extensively drugresistant xdrtb mdr. Extensively drugresistant tb xdrtb is a subset of mdrtb where the bacilli. Extensively drugresistant tb xdrtb is defined as tb due to bacilli resistant to any fluoroquinolone, and at least one of three injectable secondline drugs capreomycin, kanamycin, and amikacin, in addition to isoniazid and rifampicin. Extensively drugresistant tuberculosis xdr tb is a relatively rare type of multidrugresistant tuberculosis mdr tb. Extensively drugresistant tb, xdrtb, is a form of multidrugresistant tb with additional resistance to more antitb drugs that therefore responds. Extensively drug resistant tb xdr tb is a relatively rare type of mdr tb. Xdrtb is of special concern for immunocompromised people e.
China is 1 of 22 countries with the highest incidence of tb 1. Multidrugresistant tuberculosis and extensively drug. It is therefore incorrect, by this definition, to classify a patient has having multidrug resistant disease if they have an infection with a bacterium. Only when the bacteria become active do people become ill with tb. Xdr tb is defined as tb which is resistant to isoniazid and rifampin, plus resistant to any fluoroquinolone and at least one of three injectable second line drugs i. Multidrugresistant and extensively drugresistant tuberculosis. Epidemiology indicates that, in the absence of any intervention e. Good practices in the management of mdrtb are described. Background the emergence of pre extensively and extensively drug resistant tuberculosis prexdrxdrtb is the major hurdle for tb prevention and care programs especially in developing countries like ethiopia. Extensively drugresistant tb page 2 of 7 september 2016 capreomycin, or kanamycin. What is extensively drug resistant tuberculosis xdr tbextensively drug resistant tb. Extensively drugresistant tuberculosis xdrtb is a form of tuberculosis caused by bacteria that are resistant to some of the most effective antitb drugs. Multidrug and extensively drugresistant tuberculosis although the incidence of tb is steadily declining in germany, numbers of cases with mdr tb strains are increasing.
The treatment of tb with drug resistant organisms is more complicated and difficult and should be done by or in consultation with experts. We surveyed the network of supranational reference laboratories for m. Extensively drugresistant xdr tuberculosis is defined as disease caused by mycobacterium tuberculosis with resistance to at least isoniazid and rifampicin, any fluoroquinolone, and at least one of three injectable secondline drugs amikacin, capreomycin, or kanamycin. Treatment of drugresistant tuberculosis resistance to tuberculosis tb drugs is a formidable obstacle to effective tb care and prevention globally. Here we describe the first documented case of extensively drug resistant tuberculosis evolved from a susceptible ancestor within a single patient. A free powerpoint ppt presentation displayed as a flash slide show on id.
Background the continued advance of antibiotic resistance threatens the treatment and control of many infectious diseases. The less emphasis on universal access to laboratory techniques for the rapid diagnosis of tb and drug susceptibility testing dst makes the management of mdrtb a challenge. Tuberculosis remains a leading cause of morbidity and mortality. Thus, we read with interest the article by the collaborative group for the metaanalysis of individual patient data in mdrtb treatment2017,1 the results of which support our proposal,2 from 2015, to classify anti tuberculosis drugs on the basis of their.
Extensively drugresistant tb xdrtb is a form of tb caused by. Xdrtb strains have arisen after the mismanagement of individuals with multidrug resistant tb mdrtb. They are organized into the following broad objectives that. Worldwide emergence of extensively drugresistant tuberculosis. Treatment success rate in mdrtb patients increased from almost 49% in 2011 to over 51% in 2015, but remains far below the 75% target set out in the tuberculosis action plan for the who european region 20162020. What is extensively drugresistant tuberculosis xdr tb extensively. Apr 14, 2012 what is extensively drug resistant tuberculosis xdr tb. Multidrug and extensively drug resistant tuberculosis.
The epidemiology, pathogenesis, transmission, diagnosis, and. Background the emergence of preextensively and extensively drugresistant tuberculosis prexdrxdrtb is the major hurdle for tb prevention and care programs especially in developing countries like ethiopia. Prevalence, associated factors, outcomes and transmission of. Extensively drug resistant tuberculosis xdrtb in addition to inh and rif is also resistant to the best secondline drugs, the fluoroquinolones and an injectable such as kanamycin or capreomycin. Multidrug resistant tb mdrtb is multifactorial and fuelled by improper treatment of patients, poor management of supply and quality of drugs, and airborne transmission of bacteria in public places. Thus, we read with interest the article by the collaborative group for the metaanalysis of individual patient data in mdrtb treatment2017,1 the results of which support our proposal,2 from 2015, to classify antituberculosis drugs on the basis of. The burden of preextensively and extensively drugresistant. The latest antitb drug resistance surveillance data show that. Globally there is a burgeoning epidemic of drug monoresistant tuberculosis tb, multidrug resistant tb mdrtb and extensively drug resistant tb xdrtb.
Sep 14, 2006 this is cause enough for concern as multidrug resistant tuberculosis has a worse outcome and its management is very difficult even in high resource settings. Drug resistant tb multidrug resistant tb mdr tbresistant to at least rifampin rif and isoniazid inh 3. Extensively drug resistant tb united states pdf ppt. Extensively drug resistant xdr tb refers to mdrtb strains that are resistant to fluoroquinolones and secondline injectable drugs.
Cases of multidrugresistant tuberculosis resistance to isoniazid and rifampicin and extensively drugresistant tuberculosis are increasing in the united states, 10,521 cases of tuberculosis 3. It is therefore incorrect, by this definition, to classify a patient has having multi drug resistant disease if they have an infection with a bacterium. Extensively drugresistant 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. Definition of multidrug resistant tuberculosis multidrug resistant tuberculosis is defined as resistance to isoniazid and rifampicin whether there is resistance to other drugs or not.
Methods drug susceptibility testing to first and secondline drugs was performed by bactec mgit 960 and molecular typing, by is 6110 restriction fragment. Jul 27, 2019 the ideal number of drugs needed and treatment duration are crucial issues in the management of multidrugresistant tuberculosis mdrtb. Extensively drug resistant tb xdr tb is a rare type of multidrug resistant tuberculosis mdr tb that is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable secondline drugs i. Clinical management of adults and children with multidrug. Extensively drugresistant tb xdrtb is on the rise, but is considerably underreported. Favorable outcomes for multidrug and extensively drug.
Guidelines for treatment of drugsusceptible tuberculosis and. 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. We defined extensively drugresistant tb xdrtb as mdrtb with further resistance to. Drug resistant tuberculosisemerging human concern dr. Greece is a country with low tuberculosis tb prevalence tuberculosis. Extensively drug resistant xdr tb is defined as tb that is resistant to. Extensively drugresistant tuberculosis an overview. Pretomanid and bpal regimen for treatment of highly. It summarizes the latest data and provides latest estimates of the global epidemic of multidrug and extensively drugresistant tuberculosis mxdrtb. In several parts of the world there is an increasing incidence of mdrtb, and alarmingly, almost a third of mdrtb cases globally are. Global tuberculosis incidence has declined marginally over the past decade, and tuberculosis remains out of control in several parts of the world including africa and asia. It has affected mankind since its appearance, despite many efforts to control and eliminate it.
Extensively drug resistant tuberculosis xdr tb is a relatively rare type of multidrug resistant tuberculosis mdr tb. Extensively drug resistant tuberculosis xdrtb has been reported in 58 countries around the world and has emerged as a major public health challenge. Guidelines for treatment of drugsusceptible tuberculosis. Pdf extensively drugresistant tuberculosis in india. Multidrugresistant tuberculosis and extensively drugresistant. Multidrug and extensively drugresistant tuberculosis management. Thus, we read with interest the article by the collaborative group for the metaanalysis of individual patient data in mdrtb treatment2017,1 the results of which support our proposal,2 from 2015, to classify antituberculosis drugs on the basis of their. Our objective was to determine the impact of pulmonary resection on xdrtb treatment outcomes in a resourceconstrained setting. Ppt extensively drugresistant tb xdr tb summary report. Nov 22, 2017 to describe the prevalence, associated factors, treatment outcomes and transmission of extensively drugresistant xdr tuberculosis tb in the state of sao paulo, brazil, for 2011 to 20.
Extensively drug resistant tuberculosis xdrtb is a rare type of mdrtb, not only resistant to isoniazid and rifampin, but also to any fluoroquinolone and at least one of three injectable secondline drugs i. What is extensively drugresistant tuberculosis xdr tb. Extensively drug resistant tb xdrtb is also resistant to three or more of the six classes of secondline drugs. Extensively drugresistant xdr tb refers to mdrtb strains that are resistant to. Mycobacterium tuberculosis is characterized by a low mutation rate and a lack of genetic recombination. Antimicrobial resistance develops when treatment regimens are not properly administered or adhered to. Extensively drugresistant tuberculosis as a cause of death in patients coinfected with tuberculosis and hiv in a rural area of south africa. Pulmonary resection for extensively drug resistant. The ideal number of drugs needed and treatment duration are crucial issues in the management of multidrugresistant tuberculosis mdrtb. This new report on antituberculosis tb drug resistance by the world health organization who updates antituberculosis drug resistance in the world.
Clinicians should screen patients for abnormal behavior and symptoms of. Whoeurope multidrug and extensively drugresistant tb. Ppt pulmonary tuberculosis powerpoint presentation free. In regard to the term extreme drug resistance, it was first used in the field of oncologyhematology to designate tumorcell colonies that exhibit significantly decreased responsiveness in vitro to a studied chemotherapeutic agent. Multidrugresistant mdr tuberculosis tb entails resistance to at least two of the most effective tb drugs, isoniazid and rifampicin. Extensively drugresistant xdr tb refers to mdrtb strains that are resistant to fluoroquinolones and secondline injectable drugs. Treatment of drugresistant pulmonary tuberculosis in adults. The main causes of the spread of resistant tb are weak medical systems, amplification of resistance patterns through incorrect treatment, and transmission in communities and facilities. Extensively drug resistant xdr tb is a form of tb caused by bacteria resistant to all the most effective drugs i.
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