Management of contacts of multidrugresistant tuberculosis. Sep 12, 2008 multi drug resistant tuberculosis mdr tb implications and diagnosis dr. Update ipd mdr protocol feb 2016 determinants of treatment. This study identifies factors associated with the occurrence of mdr tb in patients who underwent firstline tb treatment in addis ababa city. Management of contacts of mdr tb and xdr tb patients. Report from the 10 th zonal tuberculosis and chest disease centre, chiang mai, thailand, in 2011 which had been collected from the data of laboratoryconfirmed 254 mdrtb patients 72. Mdr tb rates are extremely high in eastern europe, where as many as 28 percent of new tb cases are mdr. Updated antitb medications for the treatment of rrtb and mdr tb. Established multidrugresistant mdrtb requires a longer duration of treatment generally 1824 months and necessitates the use of alternative chemotherapy regimens, which are more costly and. Multidrugresistant tuberculosis mdrtb has become a major public health problem and obstacle to global tb control 1, 2. Currently it takes two to three months to obtain a diagnosis of mdrtb. More than 60% of tb infected patients in south africa are coinfected with hiv, further complicating the diagnosis and management of these two diseases. Multidrug resistant tuberculosis mdr tb is resistant to at least two of the main firstline drugs used to treat tb. Some forms of tb are also resistant to secondline medications, and are called extensively drugresistant tb.
Mdrtb is associated with higher case fatality rates, especially among hivinfected patients 3, 4, and is much more difficult and costly to treat than drugsusceptible tb. Monitoring patient response to mdrtb treatment using culture. However, only 6,000 mdrtb cases 28% were detected and notified, and the situation for detecting xdrtb was even more unsatisfactory because of. Extensively drugresistant tb xdr tb is when there is resistance to inh and rifampicin, along with resistance to any fluoroquinolone and at least one injectable secondline anti tb drugs. People with mdrtb disease must consult a tb specialist to observe their treatment to check its effectiveness. Tb usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. These methods should also be evaluated and applied in highincidence areas. Multidrugresistant tuberculosis mdr tb what is tuberculosis tb. Hiv infected persons who developed mdrtb are at a high risk of death and the case is even worse for xdrtb. Guidelines for the management of multidrugresistant. Treatment of xdrtb is far more difficult even in developed countries.
The moleculargenetic methods rely on detection of mutations in the dna of m. On diagnosis of mdr especially if result is old dst may have changed all extrapulmonary tb specimens eg. The e tb manager is a webbased tool that integrates data across all aspects of tb control, including information on patients, medicines, laboratory testing, diagnosis, treatment, and outcomes. Pdf tuberculosis diagnosis an overview to the conventional. A policy framework on decentralised and deinstitutionalised management for south africa will guide provinces in the complex process of decentralisation of drugresistant tb care and treatment. Practitioners can ensure that the proper treatment is used on mdr tb patients, avoiding medications where the patient is immune nathanson, nunn, uplekar, floyd, jaramillo, lonnroth, raviglione, 2010. Pdf the burden of tuberculosis is high in developing countries, where diagnosing latent tb, drug resistant tb, hiv coinfected mycobacterium. Multi drug resistant tuberculosis mdr tb implications and diagnosis dr. The new action plan set the targets to be achieved by the end of 2015, are. Reported cases of mdrtb 2012 total cases tested for mdrtb 55 611 laboratoryconfirmed mdrtb cases 16 588 patients started on mdrtb treatment 14 143 9. In the united states, almost 80% of tuberculosis tb cases are diagnosed on the basis of positive culture results for mycobacterium tuberculosis, and 90% of initial isolates are tested for drug susceptibilities 1,2.
Mdr tb patients tend to have chronic disease and require prolonged therapy. Little is known about the longterm followup of patients treated for mdrtb, including rates of relapse and chronic disability among cured persons. One such method uses biochips developed in russia see the next section. Scribd is the worlds largest social reading and publishing site. We must reconsider our current strategy and combine social compo nents with. Pdf timely diagnosis of mdrtb under program conditions. The causes of multidrug resistant tuberculosis borgen. The mdr tb is a major threat to global public health as it is difficult to treat and often results in relapse or treatment failure. We will include studies that have at least 25 patients with mdrtb. A total of 111,000 people started secondline treatment for mdr tb globally, an increase of 14% from 20. Diagnosis of drugresistant tb the new profile of drug. Algorithm for laboratory diagnosis and treatmentmonitoring. Mdr tb is a form of tb that responds poorly to standard treatment because of resistance to the firstline drugs isoniazid and rifampicin.
Recommended treatment durations are 69 months for patients with isoniazid and rifampinsusceptible tb. A total of 111,000 people started secondline treatment for mdrtb globally, an increase of 14% from 20. Longterm followup for multidrugresistant tuberculosis. Two countries, india and china, carry the most incidences of mdr tb. As a result, the diagnosis of tb disease may be delayed or even overlooked, and the patient may remain ill and possibly infectious for a prolonged period. Fourth, diagnosing mdrtb cases among previously treated patients and providing effective treatment will greatly help in halting the spread of mdrtb. Multidrugresistant tuberculosis mdr tb challenges tb control efforts because of delays in diagnosis plus its longterm treatment which has toxic effects.
Tuberculosis is spread through the air when a person sneezes, coughs, or breathes. In addition to increased mdrtb prevention efforts, the. Rapid diagnosis of mdr and xdr tuberculosis with the. The diagnosis of mdrtb and xdrtb is hampered by the absence of effective and affordable rapid diagnostic techniques for drug sensitivity. Mdrtb patients tend to have chronic disease and require prolonged therapy. Multidrugresistant tuberculosis mdrtb challenges tb control efforts because of delays in diagnosis plus its longterm treatment which has toxic effects. Recent advances in the diagnosis and treatment of multidrug. The global response to mdr tb and xdr tb enrolment on mdr tb. 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.
Management and control of multidrugresistant tuberculosis. All household contacts of patients with mdr tb grade c. Management of contacts of mdr tb and xdr tb patients ecdc guidance 2 1 introduction 1. Diagnosis and treatment of drugresistant tuberculosis archivos. Who consolidated guidelines on drugresistant tuberculosis treatment. Established multidrugresistant mdr tb requires a longer duration of treatment generally 1824 months and necessitates the use of alternative chemotherapy regimens, which are more costly and. Global tuberculosis control has been riding a wave of progress over the past decade. Mdrtb is a form of tb that responds poorly to standard treatment because of resistance to the firstline drugs isoniazid and rifampicin. Health care providers can help prevent mdr tb by quickly diagnosing cases, following recommended treatment guidelines, monitoring patients response to treatment, and making sure therapy is completed.
Whilst south africa is the third country with the highest burden of tuberculosis tb in the world, following india and china, it is also overburdened with an hiv prevalence of 17. Determinants of multidrugresistant tuberculosis in patients. Using medical records and patient questionnaires, we conducted a casecontrol study among patients diagnosed with tb between january 2007 and march 2009. The worldwide burden of mdrtb has been growing, and in 2008, there were 440,000 estimated new. The treatment of mdrtb is complex, much more expensive than the. Characteristics of multidrugresistant tuberculosis in. In another series of ofxresistant mdr tb patients treated with lzd in combination with other anti tb drugs, the dose of lzd had to be reduced from 600 to 300 mgday in four out of seven patients. This study identifies factors associated with the occurrence of mdrtb in patients who underwent firstline tb treatment in addis ababa city. Of tb highincidence countries, india carries the highest burden of mdrtb cases. Ethiopia is 15th among the 27 mdrtb highburden countries.
This edition also addresses the prevention of acquired mdrtb, especially among new tb patients who already have isoniazidresistant mycobacterium tuberculosis when they start treatment. Rapid diagnostic methods 1 ctri of the russian academy of medical sciences uses both conventional and newer, rapid methods of mycobacteria identification see box 51 for an. Multidrug resistant tuberculosis is a manmade problem created by inadequate or. Funding available for mdr tb has increased from usd 0. Ensuring that the diagnosis of tuberculosis accelerates.
At present it is estimated that only 2% of mdr tb cases worldwide are being diagnosed and treated appropriately, mainly because of inadequate laboratory services. Ethiopia is 15th among the 27 mdr tb highburden countries. Pathways to multidrugresistant tuberculosis diagnosis and. Tuberculosis tb is an infectious disease caused by a germ called mycobacterium tuberculosis. In addition, inappropriate treatment before the diagnosis of mdr tb may increase the risk of transmission of drugresistant strains and allow new mdr tb patients to emerge in the community 12. Nov 27, 2007 the diagnosis of mdr tb and xdr tb is hampered by the absence of effective and affordable rapid diagnostic techniques for drug sensitivity. Treatment duration for patients with drugresistant.
Mortality and incidence are now falling in all six world health organization who regions and the tuberculosisrelated targets of the millennium development goals now seem more reachable 1, 2. Presentations on the diagnosis of drugresistant tb addressed rapid diagnostic methods, the use of biochip technology, and the need for improved laboratory capacity. Rao md slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. In many settings, scaleup of mdrtb diagnosis and treatment is not happening at an optimal pace given its mandate, the mdrtb working group can and should bring the stp partners together to help with scaleup of drug resistant tuberculosis treatment and optimization of care delivery. This study aimed to explore and compare mdrtb patients experiences of their diagnostic and treatment initiation pathway in. This document builds on the framework of the tb rep project to support member states in the eastern europe and central asia region to. Little is known about the longterm followup of patients treated for mdr tb, including rates of relapse and chronic disability among cured persons. Mdr tb multidrugresistant tuberculosis pdr polydrugresistant tuberculosis. Newer diagnostic methods in tuberculosis detection. Effects of introducing xpert mtbrif test on multidrug. Another way to prevent getting mdr tb is to avoid exposure to known mdr tb patients in closed or crowded places such as hospitals. Pdf new approaches in the diagnosis and treatment of. Tb patients had a threefold higher risk of having fqresistant tb when prescribed fqs before tb diagnosis, compared to non fqexposed patients or 2. New tools for diagnosis of tb and drugresistant tb have been introduced for.
Xpert also detected 95% of rifampicinresistant tb cases with specificity of 98%. Among patients treated for pansusceptible tb, chronic disability caused by. At present it is estimated that only 2% of mdrtb cases worldwide are being diagnosed and treated appropriately. Tuberculosis tb is a leading cause of morbidity and mortality worldwide. The e tb manager is a webbased tool that integrates data across all aspects of tb control, including information on patients, medicines, laboratory testing, diagnosis, treatment, and. Extensively drugresistant tb xdrtb is when there is resistance to inh and rifampicin, along with resistance to any fluoroquinolone and at least one injectable secondline antitb drugs. Of tb highincidence countries, india carries the highest burden of mdr tb cases. Must report at least one of the following outcomes.
In patients who may be infected with the human immunodeficiency virus hiv grade a sputum tb culture is recommended for all smear negative patients, whenever resources permit, with additional dst for patients at risk for drug resistance grade a. The project countries will receive the new diagnostic tests through the procurement services and support of the stop tb partnerships global drug facility gdf. Diagnosis of multidrugresistant tuberculosis and extensively. Aug 28, 20 worldwide, there were 650,000 multidrugresistant tuberculosis mdr tb cases in 2010, and in 2008 the world health organization estimated that 150,000 deaths occurred annually due to mdr tb. National center for hivaids, viral hepatitis, std, and tb prevention division of tuberculosis elimination tb elimination multidrugresistant tuberculosis mdr tb what is tuberculosis tb. However, the management of contacts of mdr tb and xdr tb patients is particularly challenging as the evidence base for best practises is very limited and there are few therapies available. A nurse case management intervention to improve mdrtbhiv co. European centre for disease prevention and control. Criteria for the control of drugresistant tuberculosis.
Guidelines for clinical and operational management of drug. Multidrugresistant tuberculosis mdr tb is a form of tuberculosis tb infection caused by bacteria that are resistant to treatment with at least two of the most powerful firstline anti tb medications drugs, isoniazid and rifampin. Determinants of multidrugresistant tuberculosis in. Worldwide, there were 650,000 multidrugresistant tuberculosis mdrtb cases in 2010, and in 2008 the world health organization estimated that 150,000 deaths occurred annually due to mdrtb. Epidemiology of drtb in children estimated mdrtb in children is 25,00032,000 new cases per year worldwide, but there is little surveillance data on mdrtb i. Listing a study does not mean it has been evaluated by the u.
In our cohort study, tb and 40% with mdr tb completed therapy within 24 months, suggesting no improvement since 1993 in the length of treatment duration for rifampinresistant tb strains. The new line probe assay method will dramatically cut this to less than two days. Bridging the growing gap between diagnosis and treatment in multidrugresistant tuberculosis mdrtb an unprecedented scaleup in test development and laboratory strengthening has been seen since 2009, when the world health assembly called for universal access to tuberculosis tb drug susceptibility testing dst and treatment of all patients with drugresistant disease. Mdrtb is at least 100 times more expensive to cure than nonresistant tb. An update sundari mase md, mph team lead for medical affairs division of tuberculosis elimination centers for disease control and prevention may 3, 2012 session objectives definitions epidemiology of mdrxdr tb building a treatment regimen managing contacts to mdr tb mdr tb treatment outcomes adjunctive. In one study conducted in the united states, 62% of hivinfected patients with mdrtb died during treatment compared to 26% of hiv infected patients with tb or without mdrtb 1. In addition, inappropriate treatment before the diagnosis of mdrtb may increase the risk of transmission of drugresistant strains and allow new mdrtb.
Diagnosis, treatment, and prevention of tb has become more complex because of resistance to commonly used antituberculous drugs. Only 50% of mdr tb patients who received treatment were successfully treated, demonstrating the need for improved quality. Only 50% of mdrtb patients who received treatment were successfully treated, demonstrating the need for improved quality. Efficacy and safety of levofloxacin for the treatment of mdrtb study. Several approaches, phenotypic and molecular, have been explored to develop rapid, reliable and accurate methods for the rapid detection of drug resistance in m tuberculosis. Dec 29, 2012 to describe the epidemiology and possible risk factors for the development of multidrugresistant tuberculosis mdr tb in namibia. This progress reflects important momentum on many fronts, from more systematic community. Multidrugresistant tuberculosis mdrtb continues to account for only a small proportion 3% of cases in germany 6. Pdf tuberculosis tb is killing nearly two million people worldwide every year. Who treatment guidelines for drug resistant tuberculosis. Dna, twostage polymerase chain reaction, hybridization with amplicons labeled with fluorescent marks on the biochip, and detection of results using an analyzer with.
Mdrtb diagnosis after 9 to 12 weeks mdrtb diagnosis after 3 to 5 weeks mdrtb diagnosis after 1 to 2 days rrtb diagnosis in 2 hrs time to dst results by method property of presenter not for reproduction. Tuberculosis tb is a disease caused by bacteria that are spread from person to person through the air. Clinical practice guidelines for the diagnosis, treatment. Practitioners can ensure that the proper treatment is used on mdrtb patients, avoiding medications where the patient is immune nathanson, nunn, uplekar, floyd, jaramillo, lonnroth, raviglione, 2010. A nurse case management intervention to improve mdr tb hiv coinfection outcomes the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. In the last 2 decades, drugresistant tuberculosis has become a threat and a.
5 130 780 1464 1209 618 777 345 999 885 1144 857 1522 1458 842 406 1140 520 389 867 985 146 190 1520 310 471 253 119 1483 1503 757 1381 809 11 855 926 1274 1210 209 861 1432