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9 Addressing Diagnosis and Treatment Across the Spectrum of Drug Resistance
9 Addressing Diagnosis and Treatment Across the Spectrum of Drug Resistance
Pages 91-108
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From page 91... ...
• Properly applied adjunct therapies can help shorten treatment time, control damage in the lungs, and help establish productive and non damaging immune responses. • "Untreatable TB" is a function of both the resistance that exists in the organism and the drugs available to clinicians for the infected patient.
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From page 92... ...
In laboratories studied in South Africa, for example, the availability of Hain genotyping reduced the period from sputum collection to availability of drug susceptibility results in half, but 26 days still separated the two (Hanrahan et al., 2012)
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From page 93... ...
Group 5: Drugs of Unclear Efficacy Clofazimine (Clo) Clarithromycin (Cla)
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From page 94... ...
Enhancing the immune response at the wrong time and in the wrong place can harm a patient. But properly applied adjunct therapies can help shorten treatment time, control damage in the lungs, and help establish productive and nondamaging immune responses.
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From page 95... ...
Patients regained immune responses, as indicated by gamma-interferon production directed against TB antigens. In patients who responded, the treatment reduced unproductive inflammation, rebuilt lung tissue, and refocused the anti-TB immune response.
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From page 96... ...
For example, when should a sample be collected for second-line DST? Should universal screening be conducted 3 Thissection is based on the presentation by Martie van der Walt, Interim Director, Tuberculosis Epidemiology and Intervention Research Unit, South African Medical Research Council; and Professor, Department of Internal Medicines, Faculty of Health Sciences, University of Pretoria, South Africa.
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From page 97... ...
Migratory workers from many countries in Africa work in South Africa's mines, and rates of TB among these mineworkers are some of the highest measured in the world -- an estimated 3,000 to 7,000 per 100,000. Risk factors include the silica dust generated in the mines, reinfection caused by poor infection control and ongoing transmission, and high levels of HIV infection.
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From page 98... ...
Finally, the idea of untreatable TB raises ethical issues involving health care and human rights. MDR, XDR, and Untreatable TB from a Laboratory Perspective4 Failure to treat MDR and XDR TB patients correctly will create problems in the future, including the possibility of untreatable TB, said Sven Hoffner, Director, WHO Supranational Tuberculosis Reference Laboratory; and Department for Preparedness, Swedish Institute for Communicable Disease Control.
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From page 99... ...
These patients all had different genotypic profiles, although primary MDR TB patients were not included in this group, which may have suggested transmission. Hoffner emphasized the importance of rapid detection of resistance to rifampicin and isoniazid for timely modification of drug regimens so that MDR TB patients can quickly become noninfectious and then cured.
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From page 100... ...
• A human resources development plan should be established both to replace people leaving and to guarantee relevant knowledge in new techniques. • Infection control in TB laboratories needs to be improved, in part through a risk assessment of all diagnostic units and of the tests carried out.
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From page 101... ...
a This box is based on the presentation by Xiaoyou Chen, Director and Chief Physician, Tuberculosis Department, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute.
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From page 102... ...
Ten to 20 percent of patients may have a normal chest radiograph. The goals of therapy, said Xiao Ning, Thoracic Department, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Insti tute, are to eradicate M.tb.
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From page 103... ...
In the next few weeks, Udwadia saw three more cases from different parts of Mumbai with the same drug-resistance pattern, all in the free weekly clinic he has been running at Hinduja Hospital for the past two decades (where, he said, "I have witnessed firsthand the horrendous amplification of resistance over the decades")
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From page 104... ...
The meeting also called attention to concerns about the reliability, reproducibility, accuracy, and in vivo correlation of susceptibility testing for SLDs. In May 2012, the supranational reference laboratory to which the samples had been sent verified that the strains "are indeed resistant to all 12 drugs as reported" by the article.
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From page 105... ...
Thirty percent go to the public system, which offers little choice of treatment and can have the effect of amplifying resistance. The other 70 percent go to the private health care system, but many see nonspecialists, including providers who offer low-quality alternatives to conventional care.
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From page 106... ...
. TDR TB reinforces my claim that TB management should be deemed the largest violation of human rights the global health community has ever seen" -- a sentiment with which Udwadia heartily agreed.
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From page 107... ...
, XXDR (for extremely drug resistant) , or CXDR (for completely drug resistant)
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From page 108... ...
An alternative delivery system, such as the airway, may be needed for these drugs, but their existence and potential to treat DR TB demonstrates further that the disease is not untreatable. Chaisson questioned whether intensifying the rhetoric surrounding DR TB will be effective.
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