Search
As noted previously (UMEM Pearl of 1/7/2015), tuberculosis (TB) is a major infectious disease that occurs worldwide. Strains of tuberculosis can be resistant to one or more anti-tuberculosis medications. TB strains resistant to at least one medication have been found in all surveyed countries.
What is multidrug-resistant tuberculosis (MDR TB)?
- A TB organism resistant to at least isoniazid and rifampin
- Two of the most common, potent and standard TB medications
- Primary cause of MDR TB is inappropriate or incorrect usage of TB medications
- In 2013, there were approximately 480,000 cases of MDR TB globally
- Most cases were in India, China and the Russian Federation
- A concerning form of resistant TB is extensively drug resistant TB (XDR TB), which is resistant to multiple anti-tuberculosis medications (see UMEM Pearl from 8/14/2013).
Treatment of MDR TB
- MDR TB can usually be treated and cured with second-line treatments
- Use of second-line treatments tend to be more:
- Difficult to access the medications
- Expensive
- Likely to produce severe adverse reactions
Bottom line:
As noted previously, in your emergency department have a high index of suspicion for TB and MDR TB in patients with an appropriate risk profile.
- Recent travel from appropriate countries
- Most TB cases/deaths are in developing countries
- Individuals infected with HIV.
- Individuals using tobacco
- Increases the risk of infection and death from TB.
- Any age group, including children
- Mostly affects young adults in their productive years
References
http://www.who.int/mediacentre/factsheets/fs104/en/
http://www.cdc.gov/tb/topic/drtb/default.htm
http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm