Drug-resistant tuberculosis: an insurmountable epidemic?

Abstract

Drug-resistant tuberculosis has brought back the spectre of pre-antibiotic days. WHO surveillance data from 2007 showed multi-drug-resistant tuberculosis (MDR-TB)-tubercle bacillus resistant to both isoniazid and rifampicin accounting for 4.8% of all new and subsequent cases of tuberculosis. India and China-the two most populated countries of the world, house the maximum number of drug-resistant tuberculosis cases. In eastern European and central Asian countries, more than 6% of new TB cases are MDR-TB, whereas the number is <3% in the countries of the western world. Extensively drug-resistant tuberculosis (XDR-TB) has emerged with the prospect of tuberculosis becoming an incurable disease. A surveillance spreading over the six continents showed 10% of MDR-TB cases were also XDR-TB. The fact that tuberculosis is the most common opportunistic infection among HIV-infected patients in developing countries makes the challenge almost insurmountable. The mortality of HIV and MDR-TB co-infected patients is exceedingly high. The absence of guidelines for treatment of drug-resistant tuberculosis and of infrastructure for delivery of DOT program and rapid laboratory diagnostic facilities, including drug susceptibility testing for both first and second-line drugs, and lack of trained human resource in most of the developing world account for the emergence and perpetuation of this menacing problem. WHO along with partnership with Green Light Committee and individual national governments has started DOT plus program to control this global epidemic.

MmPPOX Inhibits Mycobacterium tuberculosis Lipolytic Enzymes Belonging to the Hormone-Sensitive Lipase Family and Alters Mycobacterial Growth

“…The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) Mycobacterium tuberculosis strains has made the current treatments less efficient. Therefore, the development of new pharmacological strategies to fight this disease are urgently needed [1]. It has been shown that M. tuberculosis is able to store triacylglycerols (TAG) as intracellular lipid inclusions (ILI), in vivo , during the infection process [2], [3], [4], [5] and in vitro , under stress conditions [6], [7].…”

Mycobacterial Etiology of Pulmonary Tuberculosis and Association with HIV Infection and Multidrug Resistance in Northern Nigeria

“…Isoniazid alone resistance produces poor outcomes following treatment with standard TB regimens [14], and isoniazid is frequently used alone or in combination with antiretroviral therapy (ART) for the prevention of TB in HIV-infected subjects, [15–17]. HIV coinfection increases the risk of death by 50 percent among TB cases, [18] with an even higher risk in the presence of MDR-TB [19, 20]. In a study of TB drug resistance and mortality in Peru involving 287 TB patients, 17 of 31 (55%) HIV-MDR-TB patients died before the confirmation of their MDR-TB status [21].…”

Multi-drug resistant tuberculosis and HIV-infection

“…в 2007 г.). Затем появился туберкулез с ШЛУ МБТ (ШЛУ туберкулез) [3][4][5][6][7], который до 2007 г. составлял около 10 % всех случаев туберкулеза с МЛУ МБТ [8]. ШЛУ туберкулез с МБТ распространен более чем в 45 странах, точные дан ные получить затруднительно, т. к. не во всех странах существуют специализированные бактериологичес кие лаборатории [9].…”