Worrisome first case of highly drug-resistant TB in US

Jenny Decker RN's picture
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As part of a six month investigation of global drug resistance, Associated Press came across the first case of highly drug-resistant TB in the US. This case is one of only a few cases of the proposed designation for tuberculosis that is resistant to all first line and second line drugs that are active against TB. Most cases of drug resistant TB occur when the drugs are not used correctly. The worrisome first case of highly drug-resistant TB in the US is a concern because the patient did not have any previously reported treatment of TB.

According to Dean Schraufnagel, MD, tuberculosis expert at the University of Illinois in Chicago and president-elect of the American Thoracic Society, in an interview with MedPage Today, there are some places that do sell these drugs over the counter. This makes the drugs available to anyone. Without knowing how to use them correctly, people will take one or the other drug for only a few weeks. Schraufnagel states that this creates perfect breeding for drug-resistant TB.

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There is a range of drug-resistant tuberculosis. First, there is the ordinary TB that is easily treated with first line drugs according to CDC guidelines. These are isoniazid, rifampin (Rifadin, Sanofi-Aventis), ethambutol (Myambutol, X-Gen), and pyrazinamide for 2 months which is followed by isoniazid and rifampin for another 4 months.

The multidrug-resistant TB, or MDR-TB, is the next on the continuum. This is where the TB is resistant to isoniazid and rifampin. It is more difficult to treat than the more common ordinary TB. Higher up on the continuum of drug-resistant TB is the extremely drug-resistant TB, also known as XDR-TB. This is where the TB is resistant to first line therapy and one of three injectable second line drugs. Examples of these are amikacin (Amikin), kanamycin (Kantrex), and capreomycin (Capastat).

The case found by Associated Press was in a 19 year old Peruvian by the name of Oswaldo Juarez. He was treated for two years and finally released from the A.G. Holley State Hospital in Lantana, Florida. He was released with inactive TB. However, others who have had this XXDR-TB have not survived. So far there have only been a few cases of XXDR-TB worldwide.

This strain of TB is described by ABC News as contagious, aggressive, and especially drug-resistant. WebMD reports that TB is a bacterial infection that is transmitted through the air and very contagious. However, one must be exposed to TB intensely by one who has active disease. Many people do not show signs and symptoms of active disease, indeed, their cases of TB are often inactive and only 10% of those infected will ever develop the disease. TB will spread to the lymph nodes, to the bloodstream, and to any organ in the body, most commonly in the lungs. Signs and symptoms of active TB include not feeling well, cough that begins with yellow or green mucus, but progresses to bloody mucus, fatigue, shortness of breath, weight loss, low grade fever, night sweats, and pain that occurs in the chest, back, or kidneys, although pain could be in all three areas. If you live in crowded conditions, you could be at risk for contracting TB, or if you have HIV, your chances of active TB are higher. Only a doctor can diagnose you, so if you think you may have TB, please call immediately to be seen.

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