Download Jeanette Henson Multidrug-Resistant Tuberculosis Concordia

Jeanette Henson
Multidrug-Resistant Tuberculosis
Concordia University
Tuberculosis is a disease that we as humans have battled with for a long
time. Tuberculosis (TB) can be dated back over 5000 years in Egypt, the deformities from
mummified remains show evidence of TB (Daniel, 2006). Tuberculosis has had many names
over the years, one such name was consumption because of the way it seemed to consume the
infected persons life and health. Many of the names for tuberculosis involved an aspect of the
person’s health rapidly declining, like wasting. Before the advances of medicine, TB patients
were sent to a sanatorium to get better or to live out their days there. The thinking behind
sanatorium was a place where patients received healthy food, high altitudes and fresh air would
aid their body in fighting the disease. The introduction of antibiotics turned around the fight
against this bacteria.
Tuberculosis is cause by Mycobacterium tuberculosis and mainly infects the lungs of the
host. The bacteria is spread by sneezing, coughing, singing, talking or anything that expels
droplets of the respiratory tract of an infected person. Once infected the symptoms that manifest
are a lingering cough that can be accompanied by blood in the sputum, fever, night sweats,
weakness, fatigue and weight loss (CDC, 2012). Tubercles or large masses form in the lungs and
break down the respiratory tissue and create cavities. They also erode blood vessels, this is what
causes the sick person to cough up blood (Britannica, 2014). The disease can spread outside the
lungs as well for instance in can get the vertebra tissue between disks. The surrounding tissue is
destroyed and a deformity in the spinal vertebra is created. This devastating diseases takes a toll
on the body of the infected. Antibiotics and other drugs shown to help fight TB have proven to
be a great asset. The treatment process can be long and patients do not always follow through
on the entire treatment plan. This is a contributing factor to the emergence of drug-resistant TB.
The two main drugs in the treatment of TB are isoniazid and rifampicin but there are ten
approved drugs for the treatment of Tuberculosis. The Center for Disease Control and
Prevention has a table for the treatment of TB and the length of time required for each
medication. The multidrug-resistant (MDR-TB) form of TB is resistant against two of the main
treatments for TB, isoniazid and rifampicin. According to Skrahina (2013), “At any given time,
about 630,000 people in the world are thought to carry strains of M. tuberculosis showing
resistance to the two drugs that are currently the most effective against tuberculosis”(pg. 36).
Extensively drug-resistant (XDR-TB) TB is resistant to isoniazid, rifampicin, fluoroquinolones
and at least one aminoglycoside, severely limiting the treatment options for this disease. XDR
was reported in 100 countries in 2013 and the number of cases are growing (WHO,
2014). Tuberculosis has become drug resistant and the drug resistant forms are a serious problem
in parts of Africa, Europe, India and Asia. 300,000 individuals, 5%, reported multidrug-resistant
TB in 2013 (WHO, 2014).
When a person with a healthy immunity system comes in contact with the
Mycobacterium tuberculosis, their immune system takes care of the bacteria and the person may
not even get sick. People at the greatest risk for TB are those with weak immune systems,
especially people with HIV, elderly people and young children. A study of TB in HIV infected
patients in Mumbai, India showed that HIV infected individuals are more likely to have a drugresistant strain of the disease (Isaakidis, 2014). Less developed countries have high rates of TB
and even more so MDR-TB and XDR-TB. A study in Belarus showed unemployed people were
more likely to have TB and there is a higher rate in people who smoke and abuse alcohol
(Skrahina, 2012). Belarus has established a control program for TB and are enforcing
international standards for TB treatment (Skrahina, 2012). According to Skrahina (2012) in the
Belarus study:
“One of the most striking findings of the present study was that the majority of
TB patients in Belarus who have had previous treatment for the disease have
MDR-TB. This finding, similar to an observation made in Minsk, indicate that
the common practice of re-treating TB cases with only first-line drugs will not
generally be ineffective in Belarus.” (pg.40)
Drug resistant strains of diseases are nothing new. This resistance occurs when a
infectious agent mutates or when a drug therapy is not followed out the more resistant harder to
kill microbes are still living and able to multiply. Only the strongest microbes survive and now
when they multiply they make more resistant microbes that will not be affected by the
medication treatment that was previously tried. The National Institute of Allergy and Infectious
Disease have an illustration to show this mutation process:
In order to stop the spread of drug-resistant TB strict protocol for testing and treatment must be
adhered to. Programs like DOT (directly observed therapy) have been put in place in to combat
the spread of these resistance strains. Patients go to clinics or have a medical professional stop
by their home or work to witness their compliance with the treatment program. This measure is
to try to ensure drug-resistances does not continue. DOT seems like an invasive measure but the
importance of compliance to drug therapies is worth the inconvenience and invasiveness. A very
critical step as we get closer to needed new medications with indications for TB, is to find and
develop new drugs for treatment. Waiting until the spread of extremely drug resistant
tuberculosis (XXDR-TB) to develop new cures will be disastrous.
Tuberculosis is a very serious disease that has claimed many lives over its very long
history. Drug-resistant strains are become more prevalent and are a serious problem in cities all
over the world.
Standards for screening and treatment need to be followed by every medical
facility treating TB. The elimination of deadly diseases happens when the world comes together
to agree on a treatment strategy. The world needs to ban together and end drug-resistant
tuberculosis.
References:
American Thoracic Society, CDC, and Infectious Diseases Society of America (2003).
Treatment of Tuberculosis. Morbidity and Mortality Weekly Report. Vol. 52, No. RR-11.
Retrieved from: http://www.cdc.gov/mmwr/PDF/rr/rr5211.pdf
Britannica online (2014). Tuberculosis. Encyclopedia of Britannica Retrieved from:
http://www.britannica.com/EBchecked/topic/608235/tuberculosis-TB
CDC (2012). Tuberculosis facts. Centers for disease control and prevention. Retrieved from:
http://www.cdc.gov/tb/
CDC (2012). Self-Study Modules on Tuberculosis. Centers for disease control and prevention.
Retrieved from: http://www.cdc.gov/tb/education/ssmodules/module9/ss9reading2.htm
Daniel, T., (2006). The History of Tuberculosis. Respiratory Medicine vol. 100 issue 11 pgs.
1862-1870. Retrieved from: http://www.resmedjournal.com/article/S09546111%2806%2900401-X/fulltext
Isaakidis, P., Das, M., Kumar, A., Peskett, C., Khetarpal, M., Bamne, A., Adsul, B., Manglani,
… Saranchuk, P. (2014). Alarming Levels of Drug-Resistant Tuberculosis in HIVInfected Patients in Metropolitan Mumbai, India. PLOS One vol. 9, issue 10
Migliori, G., Dheda, K., Centis, R., Mwaba, P., Bates, M., O’Grady J., Hoelscher, M., Zumla, A.,
(2010). Review of multidrug-resitant and extensively drug-resistant TB: globa
prespectives with a focus on sub-Saharan Africa. Tropical Medicine and International
Health vol. 15, no. 9 pgs. 1052-1066.
NIAID (2009). Antimicrobial (drug) resistance. National Institute of Allergy and Infectious
Disease. Retrieved from:
http://www.niaid.nih.gov/topics/antimicrobialResistance/Understanding/Pages/mutation.a
spx
Skrahina, A., Hurevish, H., Zalutskaya, A., Sahalchyk, E., Astrauko, A., Hoffner, S., Rusovich,
V., Dadu, A., Colombani, P., Dara, M., Gemert, W., Zignol, M. (2012). Multidrugresistant tuberculosis in Belarus: the size of the population and associated risk
factors. Bull World Health Organ pg. 36-45.
WHO (2014). Tuberculosis WHO global tuberculosis report 2014. World Health
Organization. Retrieved from:
http://www.who.int/tb/publications/factsheet_global.pdf?ua=1