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extensively drug-resistant tuberculosis (XDR-TB)

Etiology: - strains of Mycobacterium tuberculosisthat resistant to isoniazid, rifampicin, any fluoroquinolone, & either bedaquiline or linezolid (or both) [5] - formerly strains of Mycobacterium tuberculosis resistant to isoniazid, rifampin, & quinolones...plus amikacin, kanamycin, or capreomycin - risk factors: a) previous treatment of tuberculosis (RR = 11) b) HIV infection (RR = 3) c) homelessness (RR = 3) d) alcohol abuse (RR = 2) Epidemiology: - case of a woman who flew from India to Chicago in April 2015, then traveled within the U.S. [3] Management: - harder to treat & more lethal than drug-sensitive tuberculosis - lung surgery to remove source of infection - second line agents for treating multidrug-resistant tuberculosis - streptomycin - capreomycin - ethionamide - kanamycin or amikacin - levofloxacin or moxifloxacin - para-aminosalicylic acid - bedaquiline [4]

General

multi-drug resistant tuberculosis

References

  1. Prescriber's Letter 14(7): 2007 Extensively Drug-Resistant Tuberculosis (XDR TB) Detail-Document#: 230704 (subscription needed) http://www.prescribersletter.com
  2. Kliiman K and Altraja A. Predictors of extensively drug-resistant pulmonary tuberculosis. Ann Intern Med 2009 Jun 2; 150:766. PMID: 19487711
  3. Orciari Herman A, Fairchild DG Extensively Drug-Resistant TB Diagnosed in Traveler, Officials Seek Contacts. Physician's First Watch, June 10, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  4. Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018
  5. World Health Organization (WHO) WHO announces updated definitions of extensively drug-resistant tuberculosis. WHO News Release. Jan 27, 2021 https://www.who.int/news/item/27-01-2021-who-announces-updated-definitions-of-extensively-drug-resistant-tuberculosis