UMEM Educational Pearls

Title: Multidrug Resistant Tuberculosis (MDR TB)

Category: International EM

Keywords: Tuberculosis, infectious disease, drug resistance, multidrug resistant tuberculosis (PubMed Search)

Posted: 1/21/2015 by Jon Mark Hirshon, PhD, MPH, MD
Click here to contact Jon Mark Hirshon, PhD, MPH, MD

As noted previously (UMEM Pearl of 1/7/2015), tuberculosis (TB) is a major infectious disease that occurs worldwide. Strains of tuberculosis can be resistant to one or more anti-tuberculosis medications. TB strains resistant to at least one medication have been found in all surveyed countries.

 

What is multidrug-resistant tuberculosis (MDR TB)?

  • A TB organism resistant to at least isoniazid and rifampin
    • Two of the most common, potent and standard TB medications
  • Primary cause of MDR TB is inappropriate or incorrect usage of TB medications
  • In 2013, there were approximately 480,000 cases of MDR TB globally
    • Most cases were in India, China and the Russian Federation
  • A concerning form of resistant TB is extensively drug resistant TB (XDR TB), which is resistant to multiple anti-tuberculosis medications (see UMEM Pearl from 8/14/2013).

 

Treatment of MDR TB

  • MDR TB can usually be treated and cured with second-line treatments
  • Use of second-line treatments tend to be more:
    • Difficult to access the medications
    • Expensive
    • Likely to produce severe adverse reactions

 

Bottom line:

As noted previously, in your emergency department have a high index of suspicion for TB and MDR TB in patients with an appropriate risk profile.

  • Recent travel from appropriate countries
    • Most TB cases/deaths are in developing countries
  • Individuals infected with HIV.
  • Individuals using tobacco
    • Increases the risk of infection and death from TB.
  • Any age group, including children
    • Mostly affects young adults in their productive years

References

http://www.who.int/mediacentre/factsheets/fs104/en/

http://www.cdc.gov/tb/topic/drtb/default.htm

http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm