PHA-Exch> MDR Tuberculosis

[Claudio Schuftan]

From: Vern Weitzel <vern.weitzel at gmail.com>
crossposted from : "[health-vn discussion group]" <
health-vn at cairo.anu.edu.au>

From: Arlene Cohen <arlenegcohen at gmail.com>

Because MDR TB is in the news I thought you might be interested in the
following health information resources.  Feel free to share this
information with others who might be interested.
========================

>From the CDC Fact Sheet:  Multidrug-Resistant Tuberculosis (MDR TB) <
>
http://www.cdc.gov/tb/pubs/tbfactsheets/mdrtb.htm>

What is multidrug-resistant tuberculosis (MDR TB)?
      Multidrug-resistant TB (MDR TB) is TB that is resistant to at
least two of the best anti-TB drugs, isoniazid and rifampicin.  These
drugs are considered first-line drugs and are used to treat all persons
with TB disease.

How is TB spread?
      Drug-susceptible TB and MDR TB are spread the same way.  TB
germs are put into the air when a person with TB disease of the lungs or
throat coughs, sneezes, speaks, or sings.  These germs can float in the
air for several hours, depending on the environment.  Persons who
breathe in the air containing these TB germs can become infected.

TB is not spread by
      .  shaking someone's hand
      .  sharing food or drink
      .  touching bed linens or toilet seats
      .  sharing toothbrushes
      .  kissing

[Long term contact is needed, for example an eight hour airplane flight.
- Dr. A. on K-57]

What should I do if I think I have been exposed to someone with TB
disease?
      If you think you have been exposed to someone with TB disease,
you should contact your doctor or local health department about getting
a TB skin test or the QuantiFERONR-TB Gold test (QFT-G), a blood test.
And tell the doctor or nurse when you spent time with this person.

=======================

Clinical Practice Guidelines endorsed by the Infectious Diseases Society
of America
< http://www.idsociety.org/content.aspx?id=4432#ttb >

Basic FAQ on "Health Care Workers and Tuberculosis "
(American Academy of Family Physicians)
<
http://familydoctor.org/online/famdocen/home/healthy/safety/work/875.htm
l

>
>

Patient education information:
MEDLINEplus
< http://www.nlm.nih.gov/medlineplus/tuberculosis.html >


====articles of interest==============

1.  Management of multidrug-resistant tuberculosis: Update 2007.
Yew WW, Leung CC.
Respirology. 2008 Jan;13(1):21-46.  PMID: 18197909

Tuberculosis and Chest Unit, Grantham Hospital, Hong Kong, China.
<yewww at ha.org.hk>

Multidrug-resistant tuberculosis (MDR-TB) with bacillary resistance to
at
least isoniazid and rifampicin in vitro is a worldwide phenomenon. Hot
spots
of the disease are found scattered in different continents. Prevention
of
its development through good tuberculosis control programmes operating
under
the directly observed therapy, short-course (DOTS) strategy is of
paramount
importance. However, with established MDR-TB, treatment with alternative
and
specific chemotherapy is necessary to achieve a beneficial outcome. Such
an
approach on a programme basis is currently known as the 'DOTS-Plus'
strategy. Second-line (reserve) drugs utilized in the treatment of
MDR-TB
are generally less potent and more toxic, perhaps with the notable
exceptions of some fluoroquinolones and injectable agents. Surgery has a
distinct adjunctive role for the management of MDR-TB in selected
patients.
The emergence of extensively drug-resistant tuberculosis (XDR-TB), that
is,
MDR-TB with additional bacillary resistance to the fluoroquinolones and
injectables, has provided a very alarming challenge to global health, as
the
disease currently has a low cure rate and high mortality. In order to
combat
XDR-TB, strengthening of DOTS and DOTS-Plus programmes is mandatory,
especially in the face of surging HIV infection.  Furthermore, more
attention needs to be focused on developing new drugs with potent
bactericidal and sterilizing activities and low side-effects, and above
all,
drugs that are affordable for communities worldwide.


2.  MDR-TB--its characteristics and control in Asia-Pacific rim
symposium in
USJCMSP 10th international conference on emerging infectious diseases in
the
Pacific rim.
Mori T.
Tuberculosis (Edinb). 2007 Aug;87 Suppl 1:S5-9. Epub 2007 Jun 21.  PMID:
17588496

Leprosy Research Center, National Institute of Infectious Diseases,
4-2-1,
Aobacho, Higashimurayama-shi, Tokyo 189-0002, Japan.

The strategy of directly observed treatment, short course (DOTS) is
achieving substantial progress in coverage and quality improvements
worldwide. However, the problem of multi-drug-resistant tuberculosis
(MDR-TB) has emerged as a new challenge to TB control in both developing
and
industrialized countries. The effort of various countries of the Pacific
Rim
to fight this problem, one of the negative progenies from the 20th
century,
was a major theme of the conference.  Asia, WHO's Southwest Asia and
Western
Pacific Regions, combined, account globally for almost 60% of the newly
occurring MDR-TB cases. However, the problem has likely been overlooked,
as
it was masked by taking averages for countries or wider regions. In this
way, we may have lost sight of "hot zones" with extremely high
prevalence of
MDR-TB in smaller areas or in population segments. The problem was
basically
a result of the low-quality treatment program, but recently it may be
amplified in some areas by the HIV epidemic that is another new
challenge to
TB strategies. So far, developing countries have not been taking active
measures to manage this problem. However, some countries, such as the
Philippines and Peru, have undertaken aggressive efforts, supported
technically and financially by the new international mechanisms, such as
the
Stop TB Partnership and the Global Fund to fight AIDS, TB and Malaria.
These
efforts would be more effective if there were further technical
innovation
in diagnosis and treatment, supported  by a strong political commitment.


3.  The clinical management of drug-resistant tuberculosis.
Furin J.
Curr Opin Pulm Med. 2007 May;13(3):212-7.  PMID: 17414129

Brigham and Women's Hospital, Division of Social Medicine and Health
Inequalities, Harvard Medical School, Boston, Massachusetts 02120, USA.
<jfurin at partners.org>

PURPOSE OF REVIEW: Drug-resistant tuberculosis is a growing problem,
with
almost half a million cases worldwide. In spite of the difficulty in its
management, drug-resistant tuberculosis can be successfully treated,
even in
poor settings.

RECENT FINDINGS: This article will review key findings in the areas of
epidemiology, diagnosis and management of drug-resistant tuberculosis,
including new antituberculous drugs. The issue of extensively
drug-resistant
tuberculosis will also be reviewed and discussed. Finally, novel
approaches
to the management of drug-resistant tuberculosis in populations with
HIV, as
well as in pediatric populations, among pregnant women, and among
patients
requiring surgical therapy, will be reviewed.

SUMMARY: New advances in the diagnosis and management of drug-resistant
tuberculosis allow for excellent clinical outcomes to be achieved, even
in
difficult-to-treat populations. This is possible with timely diagnosis
of
disease and rapid initiation of appropriate therapy in supported
settings.


4.  Management of active tuberculosis.
Potter B, Rindfleisch K, Kraus CK.
Am Fam Physician. 2005 Dec 1;72(11):2225-32.  PMID: 16342845

University of Wisconsin Medical School, Madison, Wisconsin, USA.
<bepotter at wisc.edu>

Although the overall incidence of tuberculosis has been declining in the
United States, it remains an important public health concern,
particularly
among immigrants, homeless persons, and persons infected with human
immunodeficiency virus. Patients who present with symptoms of active
tuberculosis (e.g., cough, weight loss, or malaise with known exposure
to
the disease) should be evaluated.  Three induced sputum samples for
acid-fast bacillus smear and culture should be obtained from patients
with
findings of tuberculosis or suspicion for active disease. If the patient
has
manifestations of extrapulmonary tuberculosis, smears and cultures
should be
obtained from these sites. Most patients with active tuberculosis should
be
treated initially with isoniazid, rifampin, pyrazinamide, and ethambutol
for
eight weeks, followed by 18 weeks of treatment with isoniazid and
rifampin
if needed. Repeat cultures should be performed after the initial
eight-week
treatment.

It is available online at:
< http://www.aafp.org/afp/20051201/2225.html >

================

Teaching guides for community health workers from Partners in Health
Units 11 & 12 from their "Accompagnateurs Curriculum"  (a.k.a. community
health workers)

Unit 11: Tuberculosis
< http://model.pih.org/node/514 >
Unit 12: Tuberculosis Treatment and Side Effects
< http://model.pih.org/node/515 >

The entire curriculum is here
< http://model.pih.org/accompagnateurs_curriculum >
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