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5.5 XDR TB PDF
5.5 XDR TB PDF
A second way of developing MDR- or XDR-TB is It is vital that clinicians caring for TB patients are treatment, using a surgical mask, especially in
when a patients own TB develops resistance. aware of the possibility of drug resistance and have closed environments with poor ventilation.
access to laboratories that can provide early and
This can occur when anti-TB drugs are misused accurate diagnosis so that effective treatment is The risk of becoming infected with TB is very low in
or mismanaged. This happens when TB control provided as soon as possible. Effective treatment the open air. Overall, the chances of being infected
programmes are poorly managed, for example when requires that all six classes of second-line drugs are with XDR-TB are even lower than with ordinary TB
patients are not properly supported to complete available to clinicians who have special expertise in because cases of XDR-TB are still very rare.
their full course of treatment; when health-care treating such cases.
providers prescribe the wrong treatment, or the How can a person who already has
wrong dose, or for too short a period of time; when How common is XDR-TB? ordinary TB i.e drug-sensitive TB, avoid
the supply of drugs to the clinics dispensing drugs We do not know at the moment, but XDR-TB is rare. getting XDR-TB?
is erratic; or when the drugs are of poor quality. However, WHO estimates that there were almost The most important thing is for a patient to continue
half a million cases of MDR-TB worldwide in 2004, taking all their treatment exactly as prescribed.
How easily is XDR-TB spread? and MDR-TB usually has to occur before XDR-TB No doses should be missed, but this is especially
There is probably no difference between the speed arises. important if the course of treatment is meant to
of transmission of XDR-TB and any other forms of be taken every other day: so-called intermittent
TB. The spread of TB bacteria depends on factors We also know that findings from the only global treatment.
such as the number and concentration of infectious study carried out so far showed that in some places
people in any one place together with the presence perhaps as many as 19% of MDR-TB cases were Above all, the treatment should be taken right
of people with a higher risk of being infected (such in fact XDR-TB, but this is likely to be uncommon. through to the end. If a patient finds that side-
as those with HIV/AIDS). Wherever second-line drugs to treat MDR-TB are effects are a problem, for example, the tablets make
being misused, the possibility of XDR-TB exists. them feel sick, they should inform their clinician or
The risk of becoming infected increases the longer Research is being carried out urgently to find out nurse, because often there is a very simple solution.
the time that a previously uninfected person spends more.
in the same room as an infectious case. If they need to go away for any reason, patients
How can a person become infected with should make sure they have enough tablets with
The risk of spread increases where there is a XDR-TB? them for the duration of the trip.
high concentration of TB bacteria, such as can The majority of healthy people with normal immunity
occur in closed environments like overcrowded may never become ill with TB, unless they are Why have we never heard of XDR-TB
houses, hospitals or prisons. The risk will be heavily exposed to infectious cases who are not before?
further increased if ventilation is poor. The risk of treated or who have been on treatment for less than For some years we have seen isolated cases of very
spread will be reduced and eventually eliminated if about one week. highly resistant TB around the world that we would
infectious patients receive proper treatment. today call XDR-TB. All the drugs used against TB
Even then, 90% of people infected with TB have been around for a long time. If they are not
Can XDR-TB be cured or treated? bacteria never develop TB disease. This applies to used carefully, then resistance can develop.
Yes, in some cases. Several countries with good XDR-TB as well as to ordinary TB. People with
TB control programmes have shown that cure is HIV infection, however, in close contact with a TB It is only recently, as we carry out regular surveys
possible for up to 5060% of affected people. But patient, are more likely to catch TB and fall ill. of drug resistance in more and more countries, and
successful outcomes also depend greatly on the with improvements in laboratory capacity, that these
extent of the drug resistance, the severity of the The TB patients whom they meet should be cases are being reported in greater numbers. This
disease and whether the patients immune system encouraged to follow good cough hygiene, for has led to the problem being more closely examined
is compromised. example, covering their mouths with a handkerchief and given a name.
when they cough, or even, in the early stages of
What risks do health-care workers face What is WHO doing to combat XDR-TB?
with XDR-TB, particularly those who may First, WHO is ensuring that the health authorities
be HIV-positive themselves? responsible for TB control receive accurate
To protect health-care workers who may come into information about XDR-TB.
contact with infectious TB patients, appropriate WHO emphasizes that
and strict infection control measures must be Second, WHO is emphasizing that good TB control
implemented in health-care facilities at all times. prevents the emergence of drug resistance in the good TB control prevents
first place, and that the proper treatment of MDR-
Health care workers are also encouraged to make TB prevents the emergence of XDR-TB. the emergence of drug
sure they are aware of their HIV status so that they
can avoid putting themselves at risk of exposure. This is completely in line with the new Stop TB
resistance in the first
How quickly can XDR-TB be diagnosed?
Strategy launched in March 2006. Third, WHO
is disseminating MDR-TB guidelines for national
place, and that the proper
This depends on the patients access to health-care TB control programme managers published in treatment of MDR-TB
services. If TB bacteria are found in the sputum, the May 2006 to help countries establish effective
diagnosis of TB can be made in a day or two, but programmes to combat drug-resistant TB. prevents the emergence of
this finding will not be able to distinguish between
drug-susceptible and drug-resistant TB. Fourth, the WHO Stop TB and HIV departments are XDR-TB.
coordinating an international response through a
To evaluate drug susceptibility, the bacteria need WHO Global Task Force on XDR-TB which met for
to be cultivated and tested in a suitable laboratory. the first time in October 2006.
Final diagnosis in this way for TB, and especially for
XDR-TB, may take from 6 to 16 weeks. To reduce
the time needed for diagnosis, new tools for rapid
TB diagnosis are urgently needed.