Addressing the Threat of Drug-Resistant Tuberculosis: A by Institute of Medicine

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Additional info for Addressing the Threat of Drug-Resistant Tuberculosis: A Realistic Assessment of the Challenge: Workshop Summary

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Figure 2-2 R01436 TABLE 2-1 Estimated Number of TB Cases and Number of Deaths, by fully editable Type, 2006 Form of TB Estimated Number of Cases Estimated Number of Deaths All forms Multidrug-resistant (MDR TB) Extensively drug-resistant (XDR TB) HIV-associated 9,200,000 489,000 40,000 700,000 1,650,000 120,000 20,000 200,000 SOURCE: Nunn, 2008. ) Burden of MDR and XDR TB Fifty-seven percent of the MDR TB burden is found in just three countries: as of 2006 China had about 131,000 cases per year, India about 22 THREAT OF DRUG-RESISTANT TUBERCULOSIS 700,000 650,000 Number of MDR TB cases 600,000 550,000 500,000 450,000 400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000 0 Total China + India + Russian Federation China India Russian Federation FIGURE 2-3 Two-thirds of the MDR TB burden is located in just three countries.

Genotyping, however, demonstrated that these two new XDR TB isolates resulted from new infections due to primary transmission, not acquired resistance to second-line therapy. Gandhi suggested that three important lessons should be learned from these findings: • • • Efforts must focus on creating infection control programs to prevent the further transmission of drug-resistant strains. Currently, most health care and congregate settings worldwide utterly lack infection control facilities. Early diagnosis of MDR and XDR TB cases is critical to facilitate infection control measures.

All 17 patients had different genotypes in their relapse isolates compared with their initial isolates. Although there was diversity among the TB strains in the initial isolates, only a few TB strains were seen among the MDR and XDR TB relapses. , 2008. Copyright 2008 by the Infectious Diseases Society of America. All rights reserved. Figure 3-4 R01436 landscape only the labels on the right are editable the rest is bitmapped FIGURE 3-4 Four TB strains in a single patient. , 2008. Copyright 2008 by the Infectious Diseases Society of America.

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