Extensively drug-resistant tuberculosis: a case report and literature review

Abstract

Extensively drug-resistant tuberculosis (XDR-TB) is an emerging health problem that threatens tuberculosis (TB) control worldwide, since suitable treatment for this disease has not yet been found. We report a case of secondary pulmonary XDR-TB in a 54-year-old, HIV-negative male from Goiânia, Brazil. The patient had long-standing pulmonary tuberculosis (nine years) with extensive bilateral lung damage and had been treated with multiple antituberculosis drugs (self-administered) before XDR-TB diagnosis. The strain of Mycobacterium tuberculosis was resistant to R-rifampicin, H-isoniazid, E-ethambutol, Eto-ethionamide, Ofx-ofloxacin, and Am-amikacin. This patient died with multiple organ failure due to sepsis secondary to bacterial pneumonia.

Successes and failures in the control of infectious diseases in Brazil: social and environmental context, policies, interventions, and research needs

“…117 Extensive data for the prevalence of extensively drug-resistant tuberculosis are not available, but cases have been reported. 119 The proportion of health services that off er directly supervised treatment increased from 7% in 2000 to 81% in 2006, 120 although these seem to be reaching no more than a quarter of patients in treatment. 121 Brazil has a very successful Family Health Programme, and there are plans to include tuberculosis monitoring in its activities, therefore extending the coverage of supervised treatment.…”

Population structure and circulating genotypes of drug-sensitive and drug-resistant Mycobacterium tuberculosis clinical isolates in São Paulo state, Brazil

“…Although the incidence of TB in São Paulo state is close to the average for Brazil (Bombarda and Galesi, 2006; WHO, 2011), it nonetheless requires special attention because of the high number of patients; the increased number of multidrug-resistant (MDR) tubercle bacilli cases, which are defined by simultaneous drug resistance to isoniazid (I) and rifampin (R) (i.e., n = 1056 cases in 2007); and the relatively high prevalence of HIV (12%) in patients with TB in Brazil (http://www.stoptb.org/assets/images/about/tbl_burden.gif). As of October 2008, extensively drug-resistant TB (XDR-TB, which is defined as MDR-TB, i.e., resistance to I and R and simultaneous resistance to any of the fluoroquinolones and at least one of the three injectable second-line drugs) had also been found in Brazil (Araújo-Filho et al, 2008). …”

An Investigation of Extensively Drug - resistant Tuberculosis: Revealing Potential Improvements for Tuberculosis Control Program

“…This issue was also mentioned in a previous case investigation. 29 DST can provide a definitive diagnosis and proper treatment of DR-TB, which can improve the treatment success rate. 30 In addition, the index case received the adequate dosage and duration of TB drugs, but his disease was resistant to two drugs during the MDR-TB treatment period.…”

“…Inadequate drug treatment for MDR-TB could amplify XDR strains (secondary XDR-TB), which could eventually be transmitted to contacts, who then develop primary XDR-TB. 22,23,29,33 From the health system perspective, drug quality is another risk factor explored in this study. In the TB clinic the room containing the DOT stockpile during the day-time had inadequate temperature and humidity levels, which could affect the quality of drugs leading to treatment failure.…”