What critical issue does the development of multi-drug resistant tuberculosis (MDR-TB) highlight in global health efforts? Increased focus on non-communicable diseases Inconsistent antibiotic treatments and incomplete medication regimens Improvements in tuberculosis screening methods Over-vaccination in high-risk populations
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Step 1: Understand that MDR-TB arises when TB bacteria become resistant to at least isoniazid and rifampicin, the two most potent TB drugs, often due to incomplete or inconsistent treatment. Show more…
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INFECTIOUS DISEASE CASE STUDY 6: Tuberculosis (TB) is a potentially fatal bacterial infection. Though often associated with respiratory infections, TB may infect numerous regions of the body, including the nervous system, kidneys, and even skin. Found throughout the world, TB accounted for nearly 9 million new cases and 1.5 million deaths in the year 2013. The disease is especially prevalent in developing and low income regions, where proper prevention and treatments are difficult to implement. The risk of acquiring and dying from TB increases for those with compromised immune systems, such as individuals with HIV. Prisons in Russia and the former Soviet Union are of specific importance, as their crowded conditions and reduced quality of medical care are believed to aid the spread of TB and propagate new outbreaks of the illness, even in surrounding civilian populations. Proper identification and treatment of infected inmates could help slow the spread of the disease throughout these communities, as well as reduce the risk of TB transmission in the prisons. Thus, measures have been taken by the WHO to implement systems of diagnosing TB-positive inmates, such as medical screenings and self-referral inmate questionnaires. However, new quick and effective tests for diagnosing TB present higher costs and may be more difficult to acquire than slower, traditional methods. Improved medical technologies are currently being studied to discern the best techniques by which to identify people infected with TB.
Jorge V.
Background briefing: The arms race between humans and bacteria encourages disease-causing bacteria to evolve to evade our defenses: mainly, our drugs. The discovery of antibiotics in the 20th century helped humans to fight deadly diseases like syphilis and gangrene, but the more we use them, the greater the pressure becomes for bacteria to evolve. Any genetic mutation that helps a bacterium beat a drug very quickly gets 'selected' and spreads throughout the bacterial population as the cells without the mutation die off. Doctors are then left with fewer treatment options, meaning that patients take longer to recover or are less likely to survive. Inappropriate use of antibiotics - including doctors prescribing the drugs unnecessarily and patients failing to completely eliminate infections by not finishing antibiotic courses - is making the problem worse by giving bacteria a chance to develop resistance. To keep up with bacteria, drug companies need to develop entirely new classes of antibiotics. But the drug discovery and approval process is lengthy, and there are few incentives to develop antibiotics because they start becoming ineffective within a couple of years. Worldwide: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria. It is curable with a combination of antibiotics over a six-month course, though there are complications. Among curable infectious diseases, it is the top killer. In 2012 about 450,000 people developed multidrug-resistant TB, and 170,000 people died from it. The World Health Organization has outlined a target of treating 80 per cent of all multidrug-resistant (MDR) cases by 2015, but right now less than 3 per cent receive proper treatment. Treatment usually lasts for at least 2 years and involves daily injections. Five per cent of all cases of MDR-TB are considered extensively drug-resistant (XDR), meaning patients do not respond to first-line and some second-line drugs. Many labs are unable to even detect and diagnose this form of the disease. Eastern Europe: This region has the highest rate of MDR-TB, where it accounts for 20 per cent of all new TB cases. In Russia, it accounts for 28 per cent. India and China: These countries account for over half of all MDR-TB cases. United Kingdom: Around 9,000 cases of TB are reported each year, with most occurring in London and Birmingham. Of the cases reported in 2012, 1.6 per cent were of MDR-TB, and there were two cases of XDR-TB. There have been efforts to improve TB treatment and control, but the incidence of the disease in the UK is high compared to other western European countries. Children in high-risk areas receive the BCG vaccination to protect against severe forms of TB. Sources: TB Alliance, Public Health England, NHS Choices You're a doctor in a country where TB infections have reached crisis levels. Although it was once treatable, now no patients respond to the first-line medications available. 1. How should these patients be treated? 2. How could you - and your patients - help to slow the development of resistant bacteria? 3. How can drug companies be encouraged to develop new treatments? 4. What role could better diagnostic tests play in reducing resistance? 5. Should antibiotic use be restricted?
Madhur L.
Tuberculosis causes nearly 2 million deaths worldwide each year. Between 1985 and 1992, cases of TB in the United States increased by 20 percent, as shown in Figure 3. Write a paragraph suggesting a few reasons why this resurgence of TB might have occurred in the United States. The resurgence lasted until approximately 1992, then, in the United States, it began to abate. In 2005 the TB case rate in the U.S. was 4.8 per 100,000, as the U.S. medical community brought the epidemic under control (Centers for Disease Control & Prevention, National Prevention Information Network, n.d.). However, in U.S. prisons and all over the world TB remains a serious health problem. In the U.S., zero tolerance drug laws have resulted in a burgeoning incarcerated population, which constitutes a significant reservoir of disease, with a far higher incidence rate than the general population. In New York prisons, the incidence rate of TB is 156.0/100,000 compared to the rate of 10.4/100,000 in the general population (U.S. Agency for International Development, 2009). Considering all you have learned in Parts I and II, discuss why these rates may be so much higher in prison. We know a lot about how to prevent and treat tuberculosis. There is much more to be learned. In 2010, 8.8 million people in the world fell ill with TB and 1.4 million died (World Health Organization, 2012).
Shaiju T.
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