Video:Extensively drug-resistant tuberculosis

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Definition

Extensively drug-resistant tuberculosis is a form of tuberculosis caused by bacteria that are resistant to some of the most effective anti-TB drugs. XDR-TB strains have arisen after the mismanagement of individuals with multidrug-resistant TB.[1]The true scale of XDR-TB is unknown as many countries lack the necessary equipment and capacity to accurately diagnose it. By June 2008, 49 countries had confirmed cases of XDR-TB.[2] By the end of 2017, 127 WHO Member States reported a total of almost eleven thousand cases of XDR-TB, and 8 (point) 5 percent of cases of MDR-TB in 2017 were estimated to have been XDR-TB.[3]

Signs and symptoms

Symptoms of XDR-TB are no different from ordinary or drug-susceptible TB. A cough with thick, cloudy mucus, sometimes with blood, for more than two weeks, with fever, chills, night sweats, fatigue, muscle weakness, weight loss, and sometimes shortness of breath and chest pain.[4]

Complications

TB is one of the most common infections in people living with HIV/AIDS.[5] In places where XDR-TB is most common, people living with HIV are at greater risk of becoming infected with XDR-TB, compared with people without HIV, because of their weakened immunity.[6]

Cause

XDR-TB is caused by Mycobacterium tuberculosis strains that fulfill the definition of MDR/RR-TB and which are also resistant to any fluoroquinolone and at least one additional Group A drug.The Group A drugs are currently levofloxacin or moxifloxacin, bedaquiline and linezolid, therefore XDR-TB is MDR/RR-TB that is resistant to a fluoroquinolone and at least one of either bedaquiline or linezolid .[7]

Transmission

Like other forms of TB, XDR-TB is spread through the air. When a person with infectious TB coughs, sneezes, talks or spits, they propel TB germs, known as bacilli, into the air. The bacterium has the ability to stay in the air for several hours.[8]

Diagnosis

If TB bacteria are found in the sputum, the diagnosis of TB can be made in a day or two, however this finding will not be able to distinguish between drug-susceptible and drug-resistant TB. To evaluate drug susceptibility, the bacteria need to be cultivated and tested in a suitable laboratory. Final diagnosis in this way for TB, and especially for XDR-TB, may take from 6 to 16 weeks.[9]

Prevention

Countries aim to prevent XDR-TB by ensuring that the work of their national TB control programmes, is carried out according to the International Standards for TB Care.[10]The BCG vaccine prevents severe forms of TB in children, such as TB meningitis. It would be expected that BCG would have the same effect in preventing severe forms of TB in children, even if they were exposed to XDR-TB.[11]

Treatment

The principles of treatment for MDR-TB and for XDR-TB are the same. Second-line drugs are more toxic than the standard anti-TB regimen and can cause a range of serious side-effects including hepatitis, depression, hallucinations, and deafness.[12]

References

  1. "Tuberculosis: Extensively drug-resistant tuberculosis (XDR-TB)". www.who.int. Retrieved 7 September 2022.
  2. World Health Organization (2008). "Countries with XDR-TB confirmed cases as of June 2008" [1]
  3. "Global Tuberculosis Report s". www.who.int. Retrieved 7 September 2022.
  4. "WHO | Frequently asked questions - XDR-TB". web.archive.org. 6 October 2008. Retrieved 8 September 2022.
  5. Alexander, Paul E; De, Prithwish (2017-01-30). "The emergence of extensively drug-resistant tuberculosis (TB): TB/HIV coinfection, multidrug-resistant TB and the resulting public health threat from extensively drug-resistant TB, globally and in Canada". The Canadian Journal of Infectious Diseases & Medical Microbiology. 18 (5): 289–291. doi:10.1155/2007/986794. ISSN 1712-9532. PMC 2533560. PMID 18923728.
  6. Drug-resistant TB and HIV. World Health Organization. 2014. Archived from the original on 2 March 2022. Retrieved 9 September 2022.
  7. Viney, Kerri; Linh, Nguyen Nhat; Gegia, Medea; Zignol, Matteo; Glaziou, Philippe; Ismail, Nazir; Kasaeva, Tereza; Mirzayev, Fuad (2021). "New definitions of pre-extensively and extensively drug-resistant tuberculosis: update from the World Health Organization". The European Respiratory Journal. 57 (4): 2100361. doi:10.1183/13993003.00361-2021. ISSN 1399-3003. PMID 33833074. Archived from the original on 11 December 2021. Retrieved 15 March 2022.
  8. "Fact Sheets | Drug-Resistant TB | Extensively Drug-Resistant Tuberculosis (XDR TB) | TB | CDC". www.cdc.gov. 17 August 2022. Retrieved 10 September 2022.
  9. World Health Organization (2006). "Frequently asked questions – XDR-TB" [2] Archived 2008-10-06 at the Wayback Machine
  10. "WHO | International standards for tuberculosis care". www.who.int. Archived from the original on December 19, 2015. Retrieved 2017-01-30.
  11. "Extensively Drug-Resistant Tuberculosis (XDR TB)". Centers for Disease Control and Prevention (CDC). 4 May 2016. Archived from the original on 2019-04-12. Retrieved 2017-01-30.
  12. Jason Beaubien (June 4, 2013). "Moldova Grapples With Whether To Isolate TB Patients". Special Series: Tuberculosis Returns With A Deadly Twist. NPR. Archived from the original on November 26, 2018. Retrieved January 29, 2015.