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'''For the WikiDoc page for this topic, click [[Tuberculosis|here]]'''
'''For the WikiDoc page for this topic, click [[Tuberculosis|here]]'''
{{Tuberculosis (patient information)}}
{{CMG}}; {{AE}} {{Mashal Awais}}; Ethan Leeman; {{JS}}
==Overview==
[[Tuberculosis]] ([[TB]]) is a [[bacterial infection]] that resulted 1.8 million deaths worldwide. About 10.4 million individuals in the world are infected with TB. If Ieft untreated, active [[tuberculosis]] kills 60% of patients; however, with treatment, 90% of patients get cured. In 2015, the total number of  reported TB cases in the USA was about 9,421. Most individuals who get [[infected]] with [[TB]] have latent [[TB]]. This means that the [[bacteria]] is controlled by the [[immune system]]. Additionally, most of these TB cases are men; however, the impact of the disease is more severe on women and the mortality is more in women{{Cite web|Tuberculosis=https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-asia-pacific-2020_f494a701-en}}. Individuals who develop latent [[TB]] do not have [[symptoms]] and do not transmit [[TB]] to other people.
==What are the Symptoms of Tuberculosis?==
Latent [[TB]] is dormant in the [[alveoli]] of the [[lungs]]. As active [[TB]] develops, the [[bacteria]] spread out from the [[alveoli]] to the [[lungs]] and then to other [[organ systems]]. Consequently, depending on which [[organ system]] is affected, the [[symptoms]] may be variable. The primary stage of [[TB]] often doesn't cause [[symptoms]]. If [[symptoms]] of [[pulmonary]] [[TB]] occur, they include:<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref>
*[[Cough]]
*[[Night sweats]]
*[[Coughing]] up blood
*Excessive [[sweating]], particularly at night
*[[Fatigue]]
*[[Fever]]
*Unintentional [[weight loss]]
*[[Shortness of breath]]
*[[Chest pain]]
*[[Wheezing]]
[[Symptoms]] of [[TB]] disease in other parts of the body will vary according to the affected area.
==What Causes Tuberculosis?==
[[Pulmonary tuberculosis]] ([[TB]]) is caused by the [[bacterium]] [[Mycobacterium tuberculosis]]. The [[bacteria]] often affect the [[lungs]] but [[TB]] bacteria can damage any part of the body such as the [[kidney]], [[brain]], and [[Spinal cord|spine]]. If not well-managed, TB disease can be fatal.<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/topic/basics/default.htm }}</ref>
===Multidrug-Resistant Tuberculosis===
[[Multi-drug-resistant tuberculosis]] is due to the [[bacterium]] [[Mycobacterium tuberculosis]] resistant to anti-[[TB]] drugs. This [[drug resistance|resistance]] can occur due to misuse or mismanagement of the drugs:<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref>
*Patients do not complete their full regimen of treatment
*Health-care providers prescribe the wrong treatment, the wrong [[dose]], or duration for taking the [[drugs]]
*[[drugs]] are not always available
*[[drugs]] are of poor quality
==Who is at Highest Risk?==
[[Tuberculosis]] is transmitted from person to person through the air (cough, sneeze, or speaking) and physical contact.
The following individuals are at higher risk for developing active [[TB]]:
*Elderly
*Infants
*Patients with weakened [[immune system]]s ([[AIDS]], [[chemotherapy]], [[diabetes]], or certain medications)
Your risk of getting [[TB]] increases if you:
*Have prolonged frequent contact with TB patients
*Have poor [[nutrition]]
*Live in a [[crowded]] place or with poor hygiene
The following factors may increase the risk of [[TB]] [[infection]] in a population:
*Increase in rate of [[HIV]] infections
*Increase in number of homeless people
*The appearance of [[drug-resistant]] strains of [[TB]]
===Multidrug-Resistant Tuberculosis===
[[Drug resistance]] is more common in people who:<ref name="WHO">{{cite web | title = Multidrug-resistant tuberculosis | url = http://www.who.int/tb/challenges/mdr/en/ }}</ref>
*Do not take their [[TB]] medicine regularly and are [[non-compliant.]]
*Do not take all of their [[TB]] medication as prescribed by their doctors or nurses.
*Develop [[TB]] disease again, after having taken [[TB]] medication previously.
*Immigrate from regions of the world where [[drug-resistant]] [[TB]] is prevalent.
*Have been in frequent contact with someone who has [[drug-resistant]] [[TB]] disease
==When to Seek Urgent Medical Care?==
Call your health care provider if:
*You have been exposed to [[Tuberculosis|TB]] or traveled to areas with [[endemic]] TB disease
*You develop [[signs]] and [[Symptom|symptoms]] of TB
*Your symptoms continue in spite of treatment
*New symptoms develop
==Diagnosis==
The diagnosis of active TB is based on with a combination of symptoms, patient history (any known exposure to TB), TB tests, and x-rays.
Latent [[tuberculosis]] can be identified approximately 6-8 weeks after exposure. There are two tests that are used to detect [[TB]] [[infection]]:<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref>
*[[TB skin test]]
:*The [[TB skin test|skin test]] is more commonly used
:*A small needle is used to put some testing material, called [[tuberculin]], under the [[skin]]
:*In 2-3 days, the patient must return to the health care provider to check if there is a reaction to the test
*[[TB]] [[blood test]]
:*In some cases, a [[TB]] [[blood test]] is used to detect [[Tuberculosis|TB infection]]
:*This [[blood test]] measures how an individual’s [[immune system]] reacts to the organisms that cause [[TB]]
The [[drug resistance]] will be revealed by a [[drug]] susceptibility test. To inform if someone has [[TB]] disease, other tests may be required:<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref>
*[[Chest x-ray]] - [[X-ray]] of the [[lungs]] may show [[Cavity|cavities]] or lesions that are typical of [[TB]]
*[[sputum]] sample (the phlegm that is coughed up from deep inside the [[lungs]])
It is essential to inform your health care provider if you have ever had a “positive” reaction to a [[TB skin test]] or [[TB]] [[blood test]], or if you have previous treatment with [[TB|anti-TB]] drugs in the past.
==Treatment Options==
The typical [[Tuberculosis|TB]] treatment includes one or a few [[Antibiotic|antibiotics]] for months.  Following two weeks of treatment, patients are typically no longer [[contagious]]. Some of the drugs given for [[Tuberculosis|TB]] have some bad [[Adverse effect (medicine)|side effects]], particularly if combined with other drugs. Therefore, it is challenging for some patients to take their medication for the optimal duration. However, this makes the bacteria resistant to antibiotics and makes treatment even more difficult in the future. Treatment for [[multi-drug-resistant tuberculosis]] includes different treatment options with a far worse [[prognosis]].


[[Image:Tuberculosis-x-ray-1.jpg|thumb|Anatomy|100px|right|Chest X-ray with signs of active TB]]
===Multidrug-Resistant Tuberculosis===


{{SI}}
*[[TB]] is a treatable and curable disease. Treatment for [[multidrug-resistant tuberculosis]] should be confirmed by [[drug-susceptibility testing]]. However, as this testing takes weeks, treatment should be initiated with an [[empirical]] treatment regimen according to expert advice once [[drug-resistant]] [[TB]] disease is suspected. <ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref><ref name="WHO">{{cite web | title = Multidrug-resistant tuberculosis | url = http://www.who.int/tb/challenges/mdr/en/ }}</ref>


{{CMG}}; '''Assistant Editor(s)-in-Chief:''' Ethan Leeman
*When the [[Drug-susceptibility testing|drug-susceptibility]] testing results are available, the treatment regimen should be adjusted based on the results, to avoid suboptimal treatment. Patients should have close monitoring throughout treatment. <ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref>


==Overview==
*A common treatment regimen is at least 5 [[drugs]], to which the [[bacteria]] was reported to be susceptible.<ref>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>
'''Tuberculosis''', or '''TB''' is a bacterial infection that kills 3 million people worldwide, more people than any other infection in the world. Approximately one-third of the world is infected, and 15 million people in the US. Active tuberculosis kills 60% of the time if not treated, but treatment cures 90% of patients.
 
Most people are infected with TB have latent TB. This means that the bacteria is controlled by the body's immune system. People with latent TB do not have symptoms and cannot transmit TB to other people. However, later if the infected person has a weakened immune system (AIDS, young children, elderly, sick with other diseases, etc.), the bacteria can break out leading to active TB, or TB disease.
*Treatment regimens are usually divided into 2 phases: the initial phase and the continuation phase.
 
*A [[fluoroquinolone]] is indicated for the treatment of patients with [[MDR-TB]].
 
*Directly observed therapy (DOT) must be used for the treatment of [[drug-resistant]] [[TB]] to ensure adherence.<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref>
 
====Special Considerations====
=====HIV-Infected Persons=====
 
*Treatment of [[drug-resistant]] [[TB]] in persons with [[HIV infection]] is the same as for patients without [[HIV]].
*Management of [[HIV]]-related [[TB]] requires expertise in the management of both [[HIV]] and [[TB]].
*Providers must monitor the interactions among many of the [[antiretroviral drugs]].
*[[Rifampin]] should not be used with most [[antiretroviral drugs]]. [[Rifabutin]], which has fewer problematic drug interactions, may be used in place of [[Rifampin]].
*These recommendations are likely to be modified, as new [[antiretroviral]] agents and [[pharmacokinetic]] data become available.
 
=====Children=====
 
*Treatment of children with [[TB]] disease after exposure to a [[drug-resistant]] patient must be guided by the source-case susceptibility results.
*If the source is unknown and circumstances are suggestive of a high risk of [[drug resistance]], children must be treated with a standard four-drug initial-phase regimen until their susceptibility pattern is known.
*[[Ethambutol]] can be used safely (15-20 mg/kg per day), in case of the probability of [[Isoniazide]] resistance.
*[[Streptomycin]], [[kanamycin]], or [[amikacin]] can be selected as the fourth drug.
*Long-term use of [[fluoroquinolones]] in children has not been approved. However, most experts agree that [[fluoroquinolones]] should be considered for children with [[MDR-TB]].
*Consultation with a specialist in pediatric [[TB]] treatment is recommended.
 
=====Pregnant Women=====
 
*Case management for pregnant women who have [[drug-resistant]] [[TB]] requires consultation with an expert because most second-line [[drugs]] can have harmful effects on the [[fetus]].
*[[Pyrazinamide]] should not be used as part of the treatment regimen for pregnant women.
*Counseling concerning risks to the [[fetus]] should be provided.
 
=====Close Contacts of Drug-Resistant TB Patients=====
 
*Contacts of [[isoniazid]]-[[drug resistance|resistant]] [[TB]].
*Persons who have been exposed to [[Isoniazid]]-[[drug-resistant|resistant]], [[Rifampin]]-susceptible [[TB]] and are known or suspected to have latent [[TB]] [[infection]], a 4-month regimen of daily [[Rifampin]] is recommended.
*When [[Rifampin]] cannot be used, [[rifabutin]] is an alternative.
 
=====Contacts of MDR-TB=====
 
*For individuals with known or suspected latent [[tuberculosis]] [[infection]] [[drug resistance|resistant]] to both [[Isoniazid]] and [[Rifampin]], alternative regimens should be considered.
*Alternative regimens should include two [[drugs]] to which the [[TB]] strain is susceptible.
*A potential regimen should include a daily [[fluoroquinolone]].
*Contacts who are not [[immunosuppressed]] may be treated for 6 months or observed without treatment.
*All individuals with suspected [[Multi-drug-resistant tuberculosis|MDR]] latent TB should be monitored for 2 years regardless of the treatment regimen.
 
==Where to Find Medical Care for Tuberculosis?==
[https://www.google.com/maps/search/tuberculosis/@37.0625,-95.677068,2z/data=!3m1!4b1?hl=en Directions to Hospitals Treating Tuberculosis]
 
==What to Expect (Outlook/Prognosis)?==
Symptoms often improve in 2 - 3 weeks. A chest x-ray will not show this improvement until later. The outlook is excellent if pulmonary TB is diagnosed early and treatment is begun quickly.


==Symptoms==
===Multidrug-Resistant Tuberculosis===
Latent TB is held in the alveoli of the lungs. As active TB develops, the bacteria spreads out from the alveoli to the lungs and then to other organ systems, killing cells and making granulomas. As a result, depending on what organ system is affected, the symptoms can be very different. Some symptoms of early active TB include:
The [[prognosis]] of [[multidrug-resistant TB]] is worse than that of [[tuberculosis]] susceptible to the regular common treatment. So it is necessary to do a [[Drug susceptibility testing|drug susceptibility test]] and to monitor adherence to the treatment regimen to avoid new [[drug resistance]]s and ensure a better [[outcome|prognosis]].
*weight loss
*fever
*night sweats
*loss of appetite
*bad cough (>3 weeks)
*cough up blood


==What to do if you think you have Tuberculosis==
==Possible Complications==
Latent Tuberculosis can be detected about 6-8 weeks after exposure. A common test is a skin test, where substance called PPD, is injected underneath the forearm. If a red welt forms at the injection site, they may have Latent or Active TB. Latent TB is sometimes called PPD-positive.
[[Pulmonary TB]] can lead to permanent damage of the [[lung]] if not diagnosed and treated early. Medication used to treat TB may be associated with side effects, such as [[liver]] problems. Other side effects include:
Diagnosing active TB can be done with a combination of symptoms, patient history (any known exposure to TB), TB tests, and x-rays. X-rays of the lungs often show can show cavities or legions that are typical of TB.
People should contact their doctor and get test if they:
*Have spent time with a known or suspected person affected with TB
*Have HIV or another immuno-compromising condition
*Have symptoms of active TB
*Are from a country where TB is common (Most of Latin America, Caribbean, Africa, Asia, Eastern Europe, and Russia)
*Live somewhere where active TB is more common (homeless shelter, jail, nursing homes, etc.)
*Inject illegal drugs


==How is Tuberculosis spread?==
*Problems with vision
Tuberculosis is spread from person to person through the air as person with active tuberculosis coughs or sneezes. Tuberculosis is not often spread on surfaces or by objects of a person infected with active tuberculosis, or by:
*Orange- or brown-colored tears and urine
*shaking hands
*Skin rash
*sharing food
*kissing
*sharing toothbrushes


==Treatment==
A vision test may be performed before treatment so your doctor can monitor any changes in your eyes' health over time.
Typical treatment involves one or a few antibiotics for months. TB is notorious for having a lengthy treatment procedure. After two weeks of treatment, people are typically no longer contagious. Some of the medications given for TB have some negative side effects, especially in combination with other drugs. For these reasons, some patients find it very difficult to take their medicine for the necessary duration. However, doing so may make the bacteria resistant to the antibiotics and make treatment even more difficult in the future. Treatment for multi-drug-resistant tuberculosis or extensively drug-resistant TB have different treatments with far worse prognosis.


==Prevention==
==Prevention==
On an individual basis, covering coughs and sneezes does reduce transmission. On a larger scale, adequate ventilation and reduction of crowded areas can also reduce transmission. As with all infectious diseases, earlier identification of the disease is necessary to prevent spreading.
On an individual basis, covering sneezes and coughs can reduce the transmission of TB. On a wider scale, adequate ventilation and limiting the crowded areas can also reduce its transmission. As with all infectious diseases, early detection of the disease is essential to prevent its spreading. [[Isoniazid]] is a [[Prophylaxis|prophylactic]] [[antibiotic]] that can cure latent TB before it progresses to active TB and should be given to individuals who:  
A prophylactic antibiotic INH can cure latent TB before it progresses to active TB, and should be given to people who:  
*Have latent TB
*Are close contact with known infected patients
*Live in countries where TB is prevalent.
*Are at risk of TB infection
A vaccine called BCG prevents the spread of TB to other parts of the body but not infection. It is recommended just for infants in countries known to have high levels of TB. It is not recommended for overall use in the US. BCG is known to interfere with TB skin tests, giving false positives, and other tests are needed to test for TB in these cases.


==Where to find medical care for Tuberculosis==
*Have latent [[Tuberculosis|TB]]
[http://maps.google.com/maps?f=q&amp;hl=en&amp;geocode=&amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|Tuberculosis}}}}&amp;sll=37.0625,-95.677068&amp;sspn=65.008093,112.148438&amp;ie=UTF8&amp;ll=37.0625,-95.677068&amp;spn=91.690419,149.414063&amp;z=2&amp;source=embed Directions to Hospitals Treating Tuberculosis]
*Are close contact with known infected TB patients
*Live in countries where TB is [[Endemic (epidemiology)|endemic]].
*Are at risk of [[Tuberculosis|TB]] infection
 
A [[vaccine]] called [[BCG]] can prevent the spread of [[TB]] to other parts of the body but not the [[infection]]. It is recommended just for infants in countries known to have high prevalence of [[TB]]. [[BCG]] can interfere with [[TB skin test]]s, giving [[false positive]]s, and other tests are required to test for [[TB]] in these cases. It is not recommended for general use in the US because it has limited efficacy for preventing [[TB]].<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref>TB does not spread by: <ref name="CDC11">http://www.cdc.gov/tb/publications/factsheets/general/tbtravelinfo.htm Accessed on October 14, 2016</ref>
 
*Shaking someone’s hand
*Sharing food or drink
*Touching bed linens or toilet seats
*Sharing toothbrushes
*Kissing
 
===Travel warning and guidelines===
Travelers who expect possible prolonged exposure to patients with TB (for example, those who anticipate being in contact routinely with clinic, hospital, prison, or homeless shelter populations) must have a [[tuberculin skin test]] ([[Mantoux test|TST]]) or TB blood test before leaving the United States. If the reaction to the TST or TB blood test is negative, the test should be repeated 8 to 10 weeks after returning to the United States.
 
Moreover, annual testing is recommended for those who expect repeated or prolonged exposure or an prolonged stay over a period of years. Because individuals with [[Human Immunodeficiency Virus (HIV)|HIV]] infection are more likely to have an impaired response to both the [[Mantoux test|TST]] and TB blood test, travelers who are HIV positive should inform their physicians of their [[HIV AIDS|HIV infection]] status. According to [[World Health Organization|WHO]], the list of countries having a high prevalence of [[Tuberculosis|TB]] is:
 
*India
*Pakistan
*Bangladesh
*South Africa
*China
*Congo
*Columbia
*Cambodia
*Indonesia
*Korea
*Brazil
*Ethiopia
*Myanmar
*Mozambique
*Thailand
*Angola
*Vietnam
*Kenya
*Central Africa
*Russia
*Liberia
*Zimbabwe
*Namibia
*Philippine
*Nigeria
*Tanzania
*Sierra leone Zambia
*Papua New Guinea
*Lesotho
 
===Multidrug-Resistant Tuberculosis===
To prevent [[multi-drug-resistant tuberculosis]], the following recommendations should be followed:<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref>
 
*Take all medications exactly as prescribed by the physician
*The [[doses]] should not be missed and treatment should not be stopped early or without returning to the physician
*Patients should inform their health care provider if they are having problems understanding or taking the medications
*In case of planning to travel, they should talk to their physicians and make sure they have sufficient medication to last while away
*Avoid exposure to patients with known [[MDR TB|MDR-TB]]  and who are in crowded or closed places such as hospitals, prisons, or homeless shelters:
 
:*If health care workers are more likely to have contact with [[TB]] patients, [[infection]] control or occupational health experts must be consulted
:*Administrative and environmental procedures for preventing exposure to [[TB]] should be implemented. Once that is implemented, other measures may include using personal [[respiratory]] protective devices
 
Health care providers can help prevent [[MDR-TB]] by:<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref>
 
*Quickly [[diagnosis|diagnosing]] cases
*Following recommended treatment guidelines
*Monitoring patients’ response to treatment
*Making sure therapy is completed


==Sources==
==Sources==


*[http://www.nlm.nih.gov/medlineplus/tutorials/tuberculosis/htm/index.htm NLM]
*[http://www.nlm.nih.gov/medlineplus/tutorials/tuberculosis/htm/index.htm NLM]<br>
*[http://www.cdc.gov/tb/ CDC]
 
*[http://en.wikipedia.org/wiki/Tuberculosis Wikipedia]
[http://www.cdc.gov/ Center for Disease Control or Prevention]<br>
[http://www.who.int/en/ World Health Organization]


{{SIB}}
==References==
[[Category:Patient information]]
{{reflist|2}}
[[Category:Disease state]]
[[Category:Pulmonary Disease]]
[[Category:Infectious disease]]
[[Category:Tuberculosis]]
[[Category:Bacterial diseases]]


{{WH}}  
{{WH}}  
{{WS}}
{{WS}}
[[Category:Bacterial diseases]]
[[Category:Disease]]
[[Category:Patient information]]
[[Category: Pulmonology]]

Latest revision as of 06:29, 28 March 2021


For the WikiDoc page for this topic, click here

Tuberculosis

Overview

What are the symptoms?

What are the causes?

Who is at highest risk?

When to seek urgent medical care?

Diagnosis

Treatment options

Where to find medical care for Tuberculosis?

What to expect (Outlook/Prognosis)?

Possible complications

Prevention

Tuberculosis On the Web

Ongoing Trials at Clinical Trials.gov

Images of Tuberculosis

Videos on Tuberculosis

FDA on Tuberculosis

CDC on Tuberculosis

Tuberculosis in the news

Blogs on Tuberculosis

Directions to Hospitals Treating Tuberculosis

Risk calculators and risk factors for Tuberculosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mashal Awais, M.D.[2]; Ethan Leeman; João André Alves Silva, M.D. [3]

Overview

Tuberculosis (TB) is a bacterial infection that resulted 1.8 million deaths worldwide. About 10.4 million individuals in the world are infected with TB. If Ieft untreated, active tuberculosis kills 60% of patients; however, with treatment, 90% of patients get cured. In 2015, the total number of reported TB cases in the USA was about 9,421. Most individuals who get infected with TB have latent TB. This means that the bacteria is controlled by the immune system. Additionally, most of these TB cases are men; however, the impact of the disease is more severe on women and the mortality is more in womenEmpty citation (help). Individuals who develop latent TB do not have symptoms and do not transmit TB to other people.

What are the Symptoms of Tuberculosis?

Latent TB is dormant in the alveoli of the lungs. As active TB develops, the bacteria spread out from the alveoli to the lungs and then to other organ systems. Consequently, depending on which organ system is affected, the symptoms may be variable. The primary stage of TB often doesn't cause symptoms. If symptoms of pulmonary TB occur, they include:[1]

Symptoms of TB disease in other parts of the body will vary according to the affected area.

What Causes Tuberculosis?

Pulmonary tuberculosis (TB) is caused by the bacterium Mycobacterium tuberculosis. The bacteria often affect the lungs but TB bacteria can damage any part of the body such as the kidney, brain, and spine. If not well-managed, TB disease can be fatal.[1]

Multidrug-Resistant Tuberculosis

Multi-drug-resistant tuberculosis is due to the bacterium Mycobacterium tuberculosis resistant to anti-TB drugs. This resistance can occur due to misuse or mismanagement of the drugs:[1]

  • Patients do not complete their full regimen of treatment
  • Health-care providers prescribe the wrong treatment, the wrong dose, or duration for taking the drugs
  • drugs are not always available
  • drugs are of poor quality

Who is at Highest Risk?

Tuberculosis is transmitted from person to person through the air (cough, sneeze, or speaking) and physical contact.

The following individuals are at higher risk for developing active TB:

Your risk of getting TB increases if you:

  • Have prolonged frequent contact with TB patients
  • Have poor nutrition
  • Live in a crowded place or with poor hygiene

The following factors may increase the risk of TB infection in a population:

  • Increase in rate of HIV infections
  • Increase in number of homeless people
  • The appearance of drug-resistant strains of TB

Multidrug-Resistant Tuberculosis

Drug resistance is more common in people who:[2]

  • Do not take their TB medicine regularly and are non-compliant.
  • Do not take all of their TB medication as prescribed by their doctors or nurses.
  • Develop TB disease again, after having taken TB medication previously.
  • Immigrate from regions of the world where drug-resistant TB is prevalent.
  • Have been in frequent contact with someone who has drug-resistant TB disease

When to Seek Urgent Medical Care?

Call your health care provider if:

  • You have been exposed to TB or traveled to areas with endemic TB disease
  • You develop signs and symptoms of TB
  • Your symptoms continue in spite of treatment
  • New symptoms develop

Diagnosis

The diagnosis of active TB is based on with a combination of symptoms, patient history (any known exposure to TB), TB tests, and x-rays.

Latent tuberculosis can be identified approximately 6-8 weeks after exposure. There are two tests that are used to detect TB infection:[1]

  • The skin test is more commonly used
  • A small needle is used to put some testing material, called tuberculin, under the skin
  • In 2-3 days, the patient must return to the health care provider to check if there is a reaction to the test

The drug resistance will be revealed by a drug susceptibility test. To inform if someone has TB disease, other tests may be required:[1]

It is essential to inform your health care provider if you have ever had a “positive” reaction to a TB skin test or TB blood test, or if you have previous treatment with anti-TB drugs in the past.

Treatment Options

The typical TB treatment includes one or a few antibiotics for months. Following two weeks of treatment, patients are typically no longer contagious. Some of the drugs given for TB have some bad side effects, particularly if combined with other drugs. Therefore, it is challenging for some patients to take their medication for the optimal duration. However, this makes the bacteria resistant to antibiotics and makes treatment even more difficult in the future. Treatment for multi-drug-resistant tuberculosis includes different treatment options with a far worse prognosis.

Multidrug-Resistant Tuberculosis

  • When the drug-susceptibility testing results are available, the treatment regimen should be adjusted based on the results, to avoid suboptimal treatment. Patients should have close monitoring throughout treatment. [1]
  • A common treatment regimen is at least 5 drugs, to which the bacteria was reported to be susceptible.[3]
  • Treatment regimens are usually divided into 2 phases: the initial phase and the continuation phase.
  • Directly observed therapy (DOT) must be used for the treatment of drug-resistant TB to ensure adherence.[1]

Special Considerations

HIV-Infected Persons
Children
  • Treatment of children with TB disease after exposure to a drug-resistant patient must be guided by the source-case susceptibility results.
  • If the source is unknown and circumstances are suggestive of a high risk of drug resistance, children must be treated with a standard four-drug initial-phase regimen until their susceptibility pattern is known.
  • Ethambutol can be used safely (15-20 mg/kg per day), in case of the probability of Isoniazide resistance.
  • Streptomycin, kanamycin, or amikacin can be selected as the fourth drug.
  • Long-term use of fluoroquinolones in children has not been approved. However, most experts agree that fluoroquinolones should be considered for children with MDR-TB.
  • Consultation with a specialist in pediatric TB treatment is recommended.
Pregnant Women
  • Case management for pregnant women who have drug-resistant TB requires consultation with an expert because most second-line drugs can have harmful effects on the fetus.
  • Pyrazinamide should not be used as part of the treatment regimen for pregnant women.
  • Counseling concerning risks to the fetus should be provided.
Close Contacts of Drug-Resistant TB Patients
Contacts of MDR-TB
  • For individuals with known or suspected latent tuberculosis infection resistant to both Isoniazid and Rifampin, alternative regimens should be considered.
  • Alternative regimens should include two drugs to which the TB strain is susceptible.
  • A potential regimen should include a daily fluoroquinolone.
  • Contacts who are not immunosuppressed may be treated for 6 months or observed without treatment.
  • All individuals with suspected MDR latent TB should be monitored for 2 years regardless of the treatment regimen.

Where to Find Medical Care for Tuberculosis?

Directions to Hospitals Treating Tuberculosis

What to Expect (Outlook/Prognosis)?

Symptoms often improve in 2 - 3 weeks. A chest x-ray will not show this improvement until later. The outlook is excellent if pulmonary TB is diagnosed early and treatment is begun quickly.

Multidrug-Resistant Tuberculosis

The prognosis of multidrug-resistant TB is worse than that of tuberculosis susceptible to the regular common treatment. So it is necessary to do a drug susceptibility test and to monitor adherence to the treatment regimen to avoid new drug resistances and ensure a better prognosis.

Possible Complications

Pulmonary TB can lead to permanent damage of the lung if not diagnosed and treated early. Medication used to treat TB may be associated with side effects, such as liver problems. Other side effects include:

  • Problems with vision
  • Orange- or brown-colored tears and urine
  • Skin rash

A vision test may be performed before treatment so your doctor can monitor any changes in your eyes' health over time.

Prevention

On an individual basis, covering sneezes and coughs can reduce the transmission of TB. On a wider scale, adequate ventilation and limiting the crowded areas can also reduce its transmission. As with all infectious diseases, early detection of the disease is essential to prevent its spreading. Isoniazid is a prophylactic antibiotic that can cure latent TB before it progresses to active TB and should be given to individuals who:

  • Have latent TB
  • Are close contact with known infected TB patients
  • Live in countries where TB is endemic.
  • Are at risk of TB infection

A vaccine called BCG can prevent the spread of TB to other parts of the body but not the infection. It is recommended just for infants in countries known to have high prevalence of TB. BCG can interfere with TB skin tests, giving false positives, and other tests are required to test for TB in these cases. It is not recommended for general use in the US because it has limited efficacy for preventing TB.[1]TB does not spread by: [4]

  • Shaking someone’s hand
  • Sharing food or drink
  • Touching bed linens or toilet seats
  • Sharing toothbrushes
  • Kissing

Travel warning and guidelines

Travelers who expect possible prolonged exposure to patients with TB (for example, those who anticipate being in contact routinely with clinic, hospital, prison, or homeless shelter populations) must have a tuberculin skin test (TST) or TB blood test before leaving the United States. If the reaction to the TST or TB blood test is negative, the test should be repeated 8 to 10 weeks after returning to the United States.

Moreover, annual testing is recommended for those who expect repeated or prolonged exposure or an prolonged stay over a period of years. Because individuals with HIV infection are more likely to have an impaired response to both the TST and TB blood test, travelers who are HIV positive should inform their physicians of their HIV infection status. According to WHO, the list of countries having a high prevalence of TB is:

  • India
  • Pakistan
  • Bangladesh
  • South Africa
  • China
  • Congo
  • Columbia
  • Cambodia
  • Indonesia
  • Korea
  • Brazil
  • Ethiopia
  • Myanmar
  • Mozambique
  • Thailand
  • Angola
  • Vietnam
  • Kenya
  • Central Africa
  • Russia
  • Liberia
  • Zimbabwe
  • Namibia
  • Philippine
  • Nigeria
  • Tanzania
  • Sierra leone Zambia
  • Papua New Guinea
  • Lesotho

Multidrug-Resistant Tuberculosis

To prevent multi-drug-resistant tuberculosis, the following recommendations should be followed:[1]

  • Take all medications exactly as prescribed by the physician
  • The doses should not be missed and treatment should not be stopped early or without returning to the physician
  • Patients should inform their health care provider if they are having problems understanding or taking the medications
  • In case of planning to travel, they should talk to their physicians and make sure they have sufficient medication to last while away
  • Avoid exposure to patients with known MDR-TB and who are in crowded or closed places such as hospitals, prisons, or homeless shelters:
  • If health care workers are more likely to have contact with TB patients, infection control or occupational health experts must be consulted
  • Administrative and environmental procedures for preventing exposure to TB should be implemented. Once that is implemented, other measures may include using personal respiratory protective devices

Health care providers can help prevent MDR-TB by:[1]

  • Quickly diagnosing cases
  • Following recommended treatment guidelines
  • Monitoring patients’ response to treatment
  • Making sure therapy is completed

Sources

Center for Disease Control or Prevention
World Health Organization

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 "Tuberculosis Fact Sheet".
  2. ↑ 2.0 2.1 "Multidrug-resistant tuberculosis".
  3. ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
  4. ↑ http://www.cdc.gov/tb/publications/factsheets/general/tbtravelinfo.htm Accessed on October 14, 2016

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