UMEM Educational Pearls

Title: Multidrug Resistant Tuberculosis (MDR TB)

Keywords: Tuberculosis, infectious disease, drug resistance, multidrug resistant tuberculosis (PubMed Search)

Posted: 1/21/2015 by Jon Mark Hirshon, MD, MPH, PhD
Click here to contact Jon Mark Hirshon, MD, MPH, PhD

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