Tuberculosis: Multidrug Resistant

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

Many people take breathing for granted, some never give it a second thought until a problem presents itself. Respiratory diseases affect millions of Americans as well as people from all over the world. Anyone can suffer from these disorders to include men, women, and children, with conditions ranging from mild, moderate, to chronic in nature. This paper will focus on one of the many respiratory disease called mycobacterium tuberculosis; more commonly referred to as TB.

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

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.

This multiplication continues until cell-mediated immune response developed. Once the adaptive cell-mediated immune response developed, migration of neutrophils, lymphocytes and other immune cells to the site of primary infection form a cellular infiltrate which is called granuloma [8]. The process takes approximately 2 years [9-11]. Granuloma is covered by fibrotic components, which becomes calcified where Mtb remains encapsulated inside and protected by the host immune response. The Mtb can survive for years, decades or for lifetime in this protective and non-metabolically active state (latent TB) [12]. During latent state, a dynamic equilibrium between Mtb and host immune response is established and any suitable conditions that weakens cell mediated immunity may lead to break down of granuloma, replication of bacteria and turn to active disease (active

Mycobacterium tuberculosis is a pathogen, which its physiology is directly linked to features of tuberculosis that it causes. The crucial feature for a mycobacteria’s survival is its unique cell wall structure. The insoluble cell wall core of MTB is formed by a large variety of lipid-containing molecules, such as mycolic acid, that are covalently attached (6). This hydrophobic cell wall provides a physical protection from the host immune response and serves as a barrier against many toxic insults (2). Further, the complex MTB cell wall is impermeable to both hydrophobic and hydrophilic molecules, resulting in inherent resistance of MTB to most common antibiotics (8). Lipoarabinomannan is an antigen on the outside of the organism. This antigen is another important component of the cell wall because it inhibit the fusion of Mycobacterium-containing phagosomes with lysosomal compartments (4). Lipoarabinomannan hinders the fusion of phagosome with lysosome by impairing Ca2+/calmodulin pathway and inactivates macrophages (8). Therefore, this cell-surface component of MTB is able to facilitate the survival of mycrobacteria within macrophages (8). Also, MTB is able to survive the harsh environment of the host tissues by utilizing any available

XDR-TB is Extensively drug resistant Tuberculosis. It is resistant to all fluoroquinolones and to second-line injectable drugs. Treatment for this variation of TB is complicated and in cases impossible to accomplish. 70% of all patients who are infected with TB will die within a month. Most places cannot detect or diagnose XDR-TB and 5% or MDR cases may likely be XDR-TB. But help is out there.

Since the 1940s, the rate of deaths and cases of Tuberculosis (TB) has been decreasing in developed countries. However, the disease remains to be a major health challenge among developing countries, mostly from Asia and Africa. The disease is persistent in these areas due to lack of inadequate health facilities (Salinas et al., 2016). TB has been worsened by its strong association with HIV. The combination of the two diseases has led to TB drug resistance breeds that have become a threat to the developing countries and now spreading to the developed countries (Sulis et al., 2014).

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.

Tuberculosis (TB) is an infectious disease caused by a bacterium known as Mycobacterium tuberculosis, which usually affects the lungs and the respiratory tract. People infected with the disease cough or sneeze to release the pathogen in the air surrounding them, which is then inhaled by other people close to them. Although it is a curable and preventable disease yet, it is categorised as the second greatest infectious killer worldwide (the first being AIDS).

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

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).

India, the second most populous country with over 1.31 billion people, has the highest burden of tuberculosis (TB) in the world, accounting for 20% of the global incidence of TB, and an even higher share of global incidence of multi–drug resistant (MDR) TB. With an estimated 2 million new cases of TB and 5, 00,000 TB-related deaths in India annually, those who got diagnosed with different forms of DR-TB were 35,385 cases but only 20,753 people started on multidrug-resistant TB (MDR-TB) treatment in 2013. The National Tuberculosis Program was launched in 1962, but suffered heavily continuing TB led mortality. Acknowledging this reality, a Revised National Tuberculosis Control Programme (RNTCP) was launched by the Government of India in 1997, however even today it does not comply with World Health Organization (WHO) recommendations.