The burden of drugresistant tuberculosis in papua new guinea. Laboratory diagnosis of tuberculosis gs linkedin slideshare. Figure 11 shows drug resistant tb cases since 2003 illustrating that south dakota most often has single drug resistant cases. Table iii number of mdr and xdrtb patients started on treatment. Therefore, mdrtb patients diagnosed in 2015 and 2016 included in our study may have experienced difficulties to start treatment especially for patients from townships outside mandalay. Drugresistant tuberculosis drtb poses a major threat to control of tuberculosis worldwide. Other articles where multidrugresistant tuberculosis is discussed. South dakota reported the first multidrug resistant tb case in 2015. Mdrtb treatment facilitates the development of extensively drug resistant tb mdrtb plus resistance against one fluoroquinolone and one. The world health organization recommends this assay as a firstline diagnostic test for persons with suspected pulmonary tb who are considered to be at risk for harboring mdr tb bacilli. Of these, a total of 156 000 were enrolled and started on treatment with a secondline regimen.
Use of verbal autopsy to determine underlying cause of death. Another way to prevent getting mdr tb is to avoid exposure to known mdr tb patients in closed or crowded places such as hospitals. Instead of taking daily medication on their own, patients are directly observed by a clinician or responsible family. Legal issues around the management of drugresistant tuberculosis drtb are complex and have been addressed in separate documents, guided by evolving health legislation and the constitution of south africa. Tuberculosis tb is an infectious disease usually caused by mycobacterium tuberculosis mtb bacteria. Data missing in the registry were completed with data from the patients medical files. Who who treatment guidelines for rifampicin and multidrug. Prisons are highrisk environments for tuberculosis tb and multidrugresistant tb mdr tb. Adds sensitivity to diagnosis of tb in sputum specimens with lower bacillary load e. The moleculargenetic methods rely on detection of mutations in the dna of m.
The document presents comprehensive algorithms for diagnosis and treatmentmonitoring of pulmonary tb and mdrtb using rapid molecular techniques recommended by. Data were collected from the mdrrrtb registry for all 206 patients who started mdrtb treatment in the kidh, between september 2009, when the mdrtb treatment programme started, and december 20. The mdrtb is a major threat to global public health as it is difficult to treat and often results in relapse or treatment failure. Recent developments in the rapid diagnosis of mdrtb. The burden of drugresistant tuberculosis in papua new. Effect of reliance on xpert mtbrif on time to treatment. Future research should focus on the potential efficacy of quantification of specifically activated lymphocytes in body fluid and blood using ifny release assay in the diagnosis of tb. Most treatment failures for patients with mdr tb are due to death during tb treatment.
Globally it is estimated that 480 000 people developed multidrugresistant tuberculosis mdr tb in 2014 and 190 000 people died from the disease. Diagnosis of multidrugresistant tuberculosis and extensively. 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. Mdr tb was more prevalent among the afghan patients. The current global status of multidrugresistant tb mdrtb tb resistant to at least isoniazid h and rifampicin r is worrying, and the overall response to this.
Therefore, mdr tb patients diagnosed in 2015 and 2016 included in our study may have experienced difficulties to start treatment especially for patients from townships outside mandalay. It is widely held that delay in time to initiation of treatment for mdr tb is an important predictor of. Most infections show no symptoms, in which case it is known as latent tuberculosis. Current tools available for the diagnosis of drugresistant tuberculosis.
Communitybased mdrtb care project improves treatment. Mainstay of ntp id transmitters of tb, posing a infection risk essential for diagnosis andor management of drug susceptible and resistant strains of tb 2. 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. Multidrugresistant tuberculosis mdrtb world health organization. About 600,000 new cases of rifampicinresistant or multidrugresistant tuberculosis mdrrrtb are estimated to emerge each year, requiring treatment with secondline tb treatment regimens. The course contains seven modules and covers etiology and pathogenesis of tb, diagnosis and treatment, special situations. Outbreak of tuberculosis and multidrugresistant tuberculosis.
The diagnosis of tuberculosis tb frequently requires a high index of suspicion, especially. Tuberculosis tb is a leading cause of morbidity and mortality worldwide. Successful treatment outcomes are achieved in only 50 % of patients with mdrtb, compared to 86 % for drug susceptible disease. Future surveys should further explore this finding. Verbal autopsy data may improve surveillance and program monitoring and evaluation and could stimulate change in public health policy 11. The effect of early versus late treatment initiation after. Who treatment guidelines for drug resistant tuberculosis. Ethiopia is among the 30 high tb, hiv and mdr tb burden countries, with annual estimated tb incidence of 177100,000 populations and death rate of 25 per 100,000 populations for 2016. Treatment success rate at 56%, remains low globally. Management of dr tb is an evolving strategy, and needs to be adapted through evidencebased information. Currently, only 10% of the estimated mdr tb cases are detected. It is accredited by the south african medical association and the norwegian medical association. The public health importance of drugresistant tuberculosis pdf version of the powerpoint presentation by sarita shah, p.
Tb usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. Currently, only 10% of the estimated mdrtb cases are detected. View multidrugresistanttuberculosis12212306946875219. According to ntp mdr tb management guidelines 2016, all diagnosed mdr tb patients should be put on treatment within 14 days after diagnosis. Tuberculosis generally affects the lungs, but can also affect other parts of the body. About 10% of latent infections progress to active disease which, if left untreated, kills about half of those affected. Management of drugresistant tuberculosis tb online. In subsaharan africa, the spread of tb in prisons has been fueled by the hivaids epidemic. Diagnosis of drugresistant tb the new profile of drug. Globally, the prevalence of tb in prisons is much higher than in the general population, both in high and lowincome countries. The number of drugresistant tb drtb cases is increasing worldwide. Resistance to at least one substance inh, emb, rmp, pza, streptomycin was recorded for 12% to 14% of patients with tb in germany between 20 and 2017.
European tuberculosis laboratory initiative regional tb and. Multidrugresistant tuberculosis mdrtb oxford academic journals. 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. The document replaces other who recommendations relating to the treatment of multidrug and rifampicinresistant tuberculosis mdrrrtb issued since 2011. The 2015 mdrtb case was resistant to inh, rif, pza, emb, sm, rifabutin and ethionamide. We sought to determine the proportion of deaths during mdr tb treatment attributable to tb itself. Treatment in developed countries is expensive and involves an individualized regimen based on drug susceptibility data and use of reserve drugs. Globally it is estimated that 480 000 people developed multidrugresistant tuberculosis mdrtb in 2014 and 190 000 people died from the disease.
Multi drug resistant tuberculosis mdr tb implications and diagnosis d r. Management of contacts of multidrugresistant tuberculosis. We used a structured verbal autopsy tool to interview family members of patients who died during mdr tb treatment in india. Management of contacts of mdr tb and xdr tb patients. 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. Legal issues around the management of drugresistant tuberculosis dr tb are complex and have been addressed in separate documents, guided by evolving health legislation and the constitution of south africa. 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. The 2015 mdr tb case was resistant to inh, rif, pza, emb, sm, rifabutin and ethionamide. Diagnosis, treatment, and prevention of tb has become more complex because of resistance to commonly used antituberculous drugs. This report is aimed at healthcare professionals involved in the diagnosis andor treatment of people with tb, commissioners involved in planning and financing tb. Recent advances in the diagnosis and treatment of multidrug. Drug resistance is a major challenge for tuberculosis tb treatment and eradication. European tuberculosis laboratory initiative regional tb.
Pdf pdf icon 37k multidrugresistant tuberculosis mdr tb what is tuberculosis tb. Multidrugresistant tuberculosis mdrtb in hiv endemic settings is a major threat to public health. Management of drtb is an evolving strategy, and needs to. Ethiopia is among the 30 high tb, hiv and mdrtb burden countries, with annual estimated tb incidence of 177100,000 populations and death rate of 25 per 100,000 populations for 2016. 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 mdr tb patients 72. Treatment of multidrugresistant tuberculosis mdr tb it is accredited by the south african medical association and the norwegian medical association. Treatment outcomes and antiretroviral uptake in multidrug. Algorithm for laboratory diagnosis and treatmentmonitoring. In png the proportion of mdrtb in new cases is slightly lower than the regional average of 4. Highest death rates among mdr tb patients seen in african region 19% extensively drug resistant tb xdr tbmdr tb plus resistance to at least 1 fluoroquinolone and 1 secondline. This mdr tb online course exists as a free selflearning online tool in allowing physicians worldwide to learn and test their knowledge of mdr tb. Some forms of tb are also resistant to secondline medications, and are called extensively drugresistant tb. Patients with drugsusceptible tb must take treatment drugs for 68 months, while mdr tb treatment can take 2 years.
Pdf drugresistant tuberculosis diagnosis, treatment. Residence in or travel to a region with a high prevalence of drugresistant tb see. The course contains seven modules and covers etiology and pathogenesis of tb, diagnosis and treatment, special situations, patientphysician communication, treatment adherence, and tb infection. European centre for disease prevention and control. Who treatment guidelines for rifampicin and multidrugresistant tuberculosis, 2018 update guideline development group gdg meeting 16 to 20 july 2018. Extensively drug resistant tb xdr tb is a rare type of mdr tb that is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable secondline drugs i. Pdf multidrugresistant tb is definded as tb bacilli revealing resistance to at. Background reliable estimates of the burden of multidrugresistant tuberculosis mdrtb are crucial for effective control and prevention of tuberculosis tb. Drugresistant tuberculosis curry international tuberculosis center. Mdrtb was more prevalent among the afghan patients. Multidrug resistant tuberculosis mdrtb is tb that does not respond to at least isoniazid and rifampicin, the two most powerful antitb drugs.
Financing for infrastructure improvements will additionally be made available both new construction and renovations to support infection control for mdrtb and tb in public. Use of verbal autopsy to determine underlying cause of. 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. The number of drugresistant tb dr tb cases is increasing worldwide.
These updated guidelines have introduced novel approaches for detecting and treating patients with mdrtb. The present article provides a narrative overview of the various diagnostic options available for xdrtb, including conventional tools and newer rapid. Computerized mdrtb test diagnosis web site other useful business software replace disconnected documentation, tutorials or training with contextual inplace guidance and support with our. The medical device reporting mdr regulation 21 cfr part 803 contains mandatory requirements for manufacturers, importers, and device user facilities to report certain devicerelated adverse. 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. Methods a crosssectional study was conducted in four png provinces. Mdrtb is a substantial and underreported problem in subsaharan africa ssa, with recognised cases projected to increase with advancement in diagnostic technology. Percentage of estimated mdrtb cases enrolled on treatment in 2011. These updated guidelines have introduced novel approaches for detecting and treating patients with mdr tb. Mdr tb 20% among previously treated tb cases 50% of all mdr cases are estimated to occur in india and china globally, outcome data for mdr tb is limited. Papua new guinea png is a high tb burden country with limited information on the magnitude of the mdrtb problem.
Dna, twostage polymerase chain reaction, hybridization with amplicons labeled with fluorescent marks on the biochip, and detection of results using an analyzer with. The accurate diagnosis of mdrtb requires a positive. In our study, we used the verbal autopsy method to determine the underlying causes of death for persons who died during mdr tb treatment technical appendix. Tuberculosis tb is a disease caused by bacteria that are spread from person to person through the air. The diagnosis of mdrtb and xdrtb is hampered by the absence of effective and affordable rapid diagnostic techniques for drug sensitivity. Available to download in english and to order as a pdf or printed resource in 20 additional languages. Diagnosis and treatment of drugresistant tuberculosis archivos. The introduction of the xpert mtbrif assay cepheid, sunnyvale, ca, usa is an important breakthrough in the fight against tb and mdr tb 1214.
It is widely held that delay in time to initiation of treatment for mdrtb is an important predictor of. According to ntp mdrtb management guidelines 2016, all diagnosed mdr tb patients should be put on treatment within 14 days after diagnosis. Who consolidated guidelines on drugresistant tuberculosis treatment. Tb and multidrugresistant tb mdrtb through scalingup the appropriate use of whorecommended rapid molecular diagnostic techniques. Also, in 2016 about 19% of previously treated tb cases were estimated to have either rifampicin or multi drug resistant 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. Because xdr tb is resistant to the most potent tb drugs, patients are left with treatment options that are much.
Tb and its diagnosis an overview of tb and common tb tests for patients about to be tested for tb. A large proportion of mdrtb cases were identified from a single hospital in western province, suggesting that the prevalence of mdrtb across the country is heterogeneous. Firstline tuberculosis drug resistance patterns and associated risk. Aug 16, 2016 both tests based on detection of ifny in blood have been found to be more accurate than the tuberculin skin test in the diagnosis of latent tb infection. Both tests based on detection of ifny in blood have been found to be more accurate than the tuberculin skin test in the diagnosis of latent tb infection. Rapid laboratory diagnosis of pulmonary tuberculosis article pdf available in international journal of mycobacteriology 63. 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. Treatment of multidrugresistant tuberculosis mdrtb. 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. One such method uses biochips developed in russia see the next section. Pdf rapid laboratory diagnosis of pulmonary tuberculosis. Multidrugresistant tuberculosis pathology britannica.