TUBERCULOSIS -MDR & XDR TB

Tuberculosis (TB) is an airborne bacterial infection caused by Mycobacterium tuberculosis. Although the disease mostly affects lungs, it can also affect other body parts such as spine, gastro-intestinal tract, eyes, genitals etc.

Symptoms of TB vary depending on the organs involved. Unintentional and rapid weight loss, fever and night sweats are common symptoms associated with TB. Chronic cough with blood-containing sputum is a defining symptom of tuberculosis of lungs.

TB is spread by breathing through the air when people with active TB in their lungs cough, spit or sneeze. People with latent TB do not spread the disease.

Diagnosis of TB involves sputum test, chest X-rays and blood tests.

The treatment of TB is a long-drawn process. The first-line of treatment of TB involves taking a combination drugs daily over 6 months. This kind of a treatment regime is difficult to adhere to, especially when the symptoms disappear within the first 1 month of the treatment. As a result only 30 % of the patients in India complete the treatment. When treatment is not completed, there are high chances of reinfection with severe forms such as multi-drug resistant TB (MDR-TB), extremely-drug resistant TB (XDR-TB) and the deadliest totally-drug resistant TB (TDR-TB). TB has emerged as one of the deadliest communicable disease because it can quickly develop drug resistance.

Multi-drug-resistant tuberculosis (MDR-TB) is caused by bacteria that have become resistant to treatment at least two of the most powerful first-line anti-TB medications (drugs), isoniazid and rifampin. Mismanagement of TB treatment and person-to-person transmission are from people suffering from MDR TB are main causes.  Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of and not completing the treatment course can cause drug resistance. This drug resistant strain of bacteria can also spread onto other people.

MDR TB can be controlled by:

·         Ensuring that TB is cured by first time around with strict adherence to the drug-regime

·         Providing access to diagnosis

·         Ensuring adequate infection control in facilities where patients are treated

·         Ensuring the appropriate use of recommended second-line drugs.

Extremely-drug-resistant tuberculosis (XDR-TB) is caused by bacteria that have become resistant to treatment at least four of the core anti-TB drugs. This involves resistance to two most powerful anti-TB drugs, isoniazid and rifampicin, in addition to resistance to any of the fluoroquinolones and to at least one of the three injectable second-line drugs (amikacin, capreomycin or kanamycin). Mismanagement of TB treatment and person-to-person transmission are from people suffering from XDR TB are main causes.  Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of and not completing the treatment course can cause drug resistance. This drug resistant strain of bacteria can also spread onto other people.

Treatment depends on the extent of the drug resistance, the severity of the disease and whether the patient’s immune system is compromised.