Totally drug-resistant tuberculosis (TDR-TB) is a generic term for

tuberculosis Tuberculosis (TB), also known colloquially as the "white death", or historically as consumption, is a contagious disease usually caused by ''Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can al ...

strains that are resistant to a wider range of drugs than strains classified as

extensively drug-resistant tuberculosis Extensively drug-resistant tuberculosis (XDR-TB) is a form of tuberculosis caused by bacteria that are resistant to some of the most effective anti-TB drugs. XDR-TB strains have arisen after the mismanagement of individuals with multidrug-resi ...

. Extensively drug resistant tuberculosis is tuberculosis that is resistant to

isoniazid Isoniazid, also known as isonicotinic acid hydrazide (INH), is an antibiotic used for the treatment of tuberculosis. For active tuberculosis, it is often used together with rifampicin, pyrazinamide, and either streptomycin or ethambutol. F ...

and

rifampicin Rifampicin, also known as rifampin, is an ansamycin antibiotic used to treat several types of bacterial infections, including tuberculosis (TB), ''Mycobacterium avium'' complex, leprosy, and Legionnaires' disease. It is almost always used tog ...

, any

fluoroquinolone Quinolone antibiotics constitute a large group of broad-spectrum bacteriocidals that share a bicyclic core structure related to the substance 4-quinolone. They are used in human and veterinary medicine to treat bacterial infections, as well ...

, and any of the three second line injectable TB drugs (

amikacin Amikacin is an antibiotic medication used for a number of bacterial infections. This includes joint infections, intra-abdominal infections, meningitis, pneumonia, sepsis, and urinary tract infections. It is also used for the treatment of ...

capreomycin Capreomycin is an antibiotic which is given in combination with other antibiotics for the treatment of tuberculosis. Specifically it is a second line treatment used for active drug resistant tuberculosis. It is given by injection into a vein or ...

, and

kanamycin Kanamycin A, often referred to simply as kanamycin, is an antibiotic used to treat severe bacterial infections and tuberculosis. It is not a first line treatment. It is used by mouth, injection into a vein, or injection into a muscle. Kanamy ...

). TDR-TB has been identified in three countries;

India India, officially the Republic of India, is a country in South Asia. It is the List of countries and dependencies by area, seventh-largest country by area; the List of countries by population (United Nations), most populous country since ...

Iran Iran, officially the Islamic Republic of Iran (IRI) and also known as Persia, is a country in West Asia. It borders Iraq to the west, Turkey, Azerbaijan, and Armenia to the northwest, the Caspian Sea to the north, Turkmenistan to the nort ...

, and

Italy Italy, officially the Italian Republic, is a country in Southern Europe, Southern and Western Europe, Western Europe. It consists of Italian Peninsula, a peninsula that extends into the Mediterranean Sea, with the Alps on its northern land b ...

. The term was first presented in 2006, in which it showed that TB was resistant to many second line drugs and possibly all the medicines used to treat the disease. Lack of testing made it unclear which drugs the TDR-TB were resistant to. The emergence of TDR-TB has been documented in four major publications. However, it is not recognized by the World Health Organization. This is because the term defined as "totally drug resistant", has not been applied to the disease of tuberculosis. Certain strains of TB have not been properly tested to be deemed resistant due to lack of ''

in vitro ''In vitro'' (meaning ''in glass'', or ''in the glass'') Research, studies are performed with Cell (biology), cells or biological molecules outside their normal biological context. Colloquially called "test-tube experiments", these studies in ...

'' testing. TDR-TB has resulted from further mutations within the bacterial genome to confer resistance, beyond those seen in XDR- and MDR-TB. Development of resistance is associated with poor management of cases. As of 2011, drug susceptibility testing is done in less than 5% of TB cases globally Without testing to determine drug resistance profiles, MDR- or XDR-TB patients may develop resistance to additional drugs and can continue to spread the disease to others. TDR-TB is relatively poorly documented, as many countries do not test patient samples against a broad enough range of drugs to diagnose such a comprehensive array of resistance. The

United Nations The United Nations (UN) is the Earth, global intergovernmental organization established by the signing of the Charter of the United Nations, UN Charter on 26 June 1945 with the stated purpose of maintaining international peace and internationa ...

' Special Programme for Research and Training in Tropical Diseases has set up the TDR Tuberculosis Specimen Bank to archive specimens of TDR-TB. There have been a few examples of cases in several countries, including India, Iran, and Italy. Cases of TDR-TB have also been reported in the

United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...

. The first case was found in a young man from

Peru Peru, officially the Republic of Peru, is a country in western South America. It is bordered in the north by Ecuador and Colombia, in the east by Brazil, in the southeast by Bolivia, in the south by Chile, and in the south and west by the Pac ...

named Oswaldo Juarez. Juarez was in the United States for school and to study the English language. About a year later he was voluntarily sent to A.G. Holley State Hospital. They treated him with unconventional drugs that are not usually used for TB in extremely high doses. He stayed in that hospital for over nineteen months, but left cured of TB.

References

External links

MDRIpred
* {{cite journal , vauthors = Singla D, Tewari R, Kumar A, Raghava GP, ((Open Source Drug Discovery Consortium)) , title = Designing of inhibitors against drug tolerant Mycobacterium tuberculosis (H37Rv) , journal = Chemistry Central Journal , volume = 7 , issue = 1 , pages = 49 , date = March 2013 , pmid = 23497593 , pmc = 3639817 , doi = 10.1186/1752-153X-7-49 , doi-access = free Tuberculosis Antibiotic-resistant bacteria

See also

References

External links