As noted previously (UMEM Pearl of 1/7/2015), tuberculosis (TB) is a major infectious disease that occurs worldwide. Strains of tuberculosis can be resistant to one or more anti-tuberculosis medications. TB strains resistant to at least one medication have been found in all surveyed countries.

 

What is multidrug-resistant tuberculosis (MDR TB)?

• A TB organism resistant to at least isoniazid and rifampin
  • Two of the most common, potent and standard TB medications
• Primary cause of MDR TB is inappropriate or incorrect usage of TB medications
• In 2013, there were approximately 480,000 cases of MDR TB globally
  • Most cases were in India, China and the Russian Federation
• A concerning form of resistant TB is extensively drug resistant TB (XDR TB), which is resistant to multiple anti-tuberculosis medications (see UMEM Pearl from 8/14/2013).

 

Treatment of MDR TB

• MDR TB can usually be treated and cured with second-line treatments
• Use of second-line treatments tend to be more:
  • Difficult to access the medications
  • Expensive
  • Likely to produce severe adverse reactions

 

Bottom line:

As noted previously, in your emergency department have a high index of suspicion for TB and MDR TB in patients with an appropriate risk profile.

• Recent travel from appropriate countries
  • Most TB cases/deaths are in developing countries
• Individuals infected with HIV.
• Individuals using tobacco
  • Increases the risk of infection and death from TB.
• Any age group, including children
  • Mostly affects young adults in their productive years

References

http://www.who.int/mediacentre/factsheets/fs104/en/

http://www.cdc.gov/tb/topic/drtb/default.htm

http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm