Multiple Drug-Resistant Tuberculosis (MDR-TB)

Bacterial pathogen Mycobacterium tuberculosis causes tuberculosis a complex granulomatous disease which is a global health concern. It is a very slow growing bacteria, thus is extremely time consuming to culture in laboratory. It can survive the attack of the immune arsenal of our body; can successfully hide inside the macrophage. This makes long periods of uninterrupted antibiotic treatment necessary for the patients with tuberculosis and contributes to drug resistance very quickly [WHO 2014]. All this poses an extreme challenge to the scientists and the medical community to develop effective drug, monitor and treat this disease across globe. Before the discovery of anti-tubercular drugs, this disease was one of the most dreaded diseases. In absence of any drugs the only form of treatment recommended was healthy diet, rest and fresh air. Patients were sent to Tuberculosis sanatorium hoping that they might survive. The origin of this pathogen is traced back to Africa around 70,000 years ago and they successfully coevolved with humans as they migrated out of Africa and settled across the globe. Nearly 10,000 years ago there was a sudden change in human demography and the human population density increased suddenly, this is termed as Neolithic Demographic Transition. Genomic data of Mycobacterium across

TB is still proven to be a top killer around the world, and with more cases of drug resistant TB being reported daily, the cost of treating and preventing this disease will continue to be on the rise.

Tuberculosis has been part of human history for a long time but how long is a long time? Recent research using genetic data has allowed us to know that the tuberculosis progenitor has been on this planet for about 3 million years affecting even our earlier ancestors (Gutierrez et al, 2005). Additionally this research showed that the bacilli from tuberculosis are capable of mixing sections of their genome with other strains and giving the pathogen a composite assembly, which resulted from ancient horizontal exchanges before its clonal expansion. This quality provided tuberculosis a big advantage that even now a days allows the organism to evade, adapt and create resistance to treatments that were once successful. In order to fix current and

Tuberculosis is a disease of an infectious nature caused by a bacterium known as mycobacterium tuberculosis. The disease spreads through the air. People with the disease can spread it to susceptible people through coughing, sneezing, talking or spitting. It mainly affects the lungs and other parts such as the lymph nodes and kidneys can also be affected. The symptoms for TB are fatigue, coughing, night sweats, weight loss and fever. One third of the population of the world is affected with mycobacterium tuberculosis. The rate of infection is estimated to be one person per second. About 14 million people in the world are infected with active tuberculosis. Drug resistant TB has been recorded to be a serious public health hazard in many countries. Resistant strains have developed making it difficult to treat the disease. TB has caused millions of death mainly in people living with HIV/AIDS ADDIN EN.CITE Ginsberg19981447(Ginsberg, 1998)1447144717Ginsberg, Ann M.The Tuberculosis Epidemic: Scientific Challenges and OpportunitiesPublic Health Reports (1974-)Public Health Reports (1974-)128-13611321998Association of Schools of Public Health00333549http://www.jstor.org/stable/4598234( HYPERLINK l "_ENREF_3" o "Ginsberg, 1998 #1447" Ginsberg, 1998). The World Health Organization came up with the DOTS (Directly Observed, Therapy, Short course) strategy. The approach involves diagnosing cases and treating patients with drugs for about 6-8

Once believed to be easily treated and prevented, Tuberculosis (TB) has recently been making a steady comeback. Previous to modern medicine, TB claimed millions of victims, spreading from person to person like wildfire. Around the 17th-18th centuries, the “White Plague” took the lives of 1 in 5 adults (20%) in Europe and North America (Iseman, 1994). However, as technological advances progressed, this seemingly ferocious viral disease became a primal, insignificant thing of the past. But, in the nature of all bacteria, TB has, in the recent years, mutated to become progressively drug resistant. Why is Tuberculosis coming back with a vengeance? Well, the answer’s quite simple. TB has done an amazing job of standing in the corner and

Tuberculosis, the white plague as used to be called once upon a time is still one of the deadliest bacterial killers affecting almost all parts, all corners of the globe. Though successful anti-tubercular antibiotic regimens and effective vaccine are available for decades and being used in the battle against Koch’s bacillus, Mycobacterium tuberculosis, the causative agent of this chronic multi organ granulomatous disease, our strand in the battle continuously seems to be in the losing side. Moreover the increasing prevalence of HIV-AIDS and diabetes mellitus is being proved to be providing predisposition to tuberculosis. As witnessed by the WHO, which has estimated that, in the year 2012, 8.6 million people have developed tuberculosis and 1.3 million have died of the disease including 320000 deaths of HIV-TB co-infected people (Global tuberculosis report 2013. World Health Organization; 2013). Long term antibiotic therapy and that too associated with several side effects and discomforts have diminished patient compliance with the anti-tubercular chemotherapy. This fact in turn has raised the new deadlier MDR-TB and XDR-TB strains. The whole scenario is a matter of panic and questioning the effectiveness of anti-tubercular antibiotics, immunologic efficacy of century old BCG vaccine and all other medical advents.

For many centuries, tuberculosis was considered a death sentence. However, the development of antibiotics and methods of controlling the disease substantially reduced its prevalence. TB is caused by a bacteria and is highly contagious as it is spread through the air. While usually a respiratory disorder that affects the lungs TB “can also affect other parts of the body, such as the brain, the kidneys, or the spine” (CDC 2012). Multidrug-resistant TB, however, is resistant to two of the most potent drugs used to contain the illness, isoniazid and rifampin (CDC 2012). Both drug-resistant and standard TB are spread in the same fashion; misuse of antibiotics such as discontinuing them

Tuberculosis (TB) is a chronic bacterial infection that affects millions of people globally. It is a contagious disease that is spread through the air, and it usually affects the lungs. It is transmitted from person to person through droplets from the respiratory tract of those who are already infected with the disease. Some who are infected with the bacteria that causes TB often exhibit no symptoms, because their immune systems stop the bacteria from growing and multiplying. Those with compromised immune systems are more susceptible to developing the full blown disease which can cause symptoms that include coughing, spitting blood, chest pains, weakness, weight loss, and fever. Tuberculosis can be treated with a six to nine month course of a combination of antibiotics. If left untreated, TB will spread and can be fatal.

Although, the overall incidence and mortality rate of Tuberculosis has fallen considerably between the year 2010 and 2013 to an average rate of 1.5% per year. Globally by WHO estimates, there were about 450,000 new incident Multi Drug Resistant TB cases in the world in 2012. Of these more than, half of the cases occurred in India, China and the Russian Federation and around more than 150,000 deaths occurred due to MDR-TB in 2012 alone. Around 3.6% people newly infected with Tuberculosis had Multi Drug resistant strains. Levels of MDR-TB strains are even higher among those

Drug resistance has been increasing among patients infected with Mycobacterium tuberculosis. Previous miracle drugs that were used in the 1950s have now been proven useless in many cases simply because the bacteria are not susceptible to antibiotics such as isoniazid, rifampin, pyrazinamide, etc. when they are taken. This pathogen is easily transmitted through air and has the capability of attacking the respiratory system and creating fatal consequences if not treated properly. A lot of people who contribute to the antibiotic resistant statistics are those that do not take medication accordingly. Even though the bacterium may not be resistant at first, it can

For years now drug resistance is increasing and not just in one or two strands of bacteria, it is in all of them. This resistance makes treating a patient with the infection more difficult to the point where some strands require surgery. Tuberculosis is not a bacterium that you can easily remove from the body though. It takes time and medication for the tuberculosis to be eradicated from the body. The problem is with the advancements of medicine bacterium, like tuberculosis, are starting to produce resistance to not just one or two drugs here or there, but the bacteria is producing resistance for multiple drugs at one time.

Multidrug resistant tuberculosis is defined in two different ways depending on whether or not the patients had previously received treatment for TB. In patients who had never received treatment or who had received treatment for less than a month, their multidrug resistance is defined by the presence of a resistant strain of mycobacterium tuberculosis and in patients that have been previously treated, it is characterised by the failure and relapse (Dhole et al., 2017). Research has also found that there are different strains of multidrug resistant TB, that some strains of MDR-TB may present a resistance to one drug while others with MDR-TB do not present a resistance to that specific drug. This further complicates

Georgia achieved significant progress in the management of tuberculosis and multidrug-resistant TB (MDR- TB) related to irregular intake of anti-TB drugs and drug withdrawals. Nevertheless, Georgia still remains among the world's 27 countries where the scale of MDR-TB is considered a public health issue (WHO,INT, 2012).

Tuberculosis is among the fatal diseases that are spread through the air. It’s contagious, meaning that it spreads from one infected individual to another, and at times it spreads very fast. In addition to being contagious, the disease is an opportunist infection as it takes advantage of those with weak defense mechanism, and especially the ones with terminal diseases like HIV and AIDS. Tuberculosis is therefore among the major concerns for the World Health Organization due to its contagious nature (World Health Organization 1).

In 2011, WHO estimated 12 million prevalent cases of tuberculosis worldwide, of which about 630 000 (roughly 5%) were MDR tuberculosis. The highest caseloads of MDR tuberculosis were reported in India, China, Russia, and South Africa, which accounted for more than 60% of cases worldwide. India and China have the highest number of MDR tuberculosis cases worldwide. Tuberculosis has now been made a notifiable disease in India. Drug resistance surveys in several states have indicated that the prevalence of MDR TB in India is 2–3 percent among new cases and 12-17 percent among reinfection cases. According to drug