The CDC, in 2023, says the following about tuberculosis:
Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection (LTBI) and TB disease. If not treated properly, TB disease can be fatal. {CDC}
Symptoms
TB Disease: Symptoms are usually a bad cough that lasts 3 weeks or longer, pain in the chest, coughing up blood or sputum. weakness or fatigue, weight loss, no appetite, chills, fever, sweating at night. Usually feel sick. May spread TB bacteria to others. Usually has a skin test or blood test result indicating TB infection. May have an abnormal chest x-ray, or positive sputum smear or culture. Need treatment for TB disease.
Spinal TB: Back pain, Muscle spasms, Stiffness. Spinal tuberculosis can put pressure on the spinal cord and nerves that exit the spine, causing neurological symptoms such as weakness in the legs, numbness, tingling, or even paralysis. As the disease progresses, symptoms can become more apparent, causing: Joint deformities/scoliosis (an abnormal curve in the spine), Swelling, Decreased range of motion, Ulcers, Swollen lymph nodes, Cold abscess (pockets of pus).
Latent TB: None. People who have latent TB infection do not feel sick, do not have any symptoms, and cannot spread TB to others, but they require treatment to prevent TB disease. They usually will have a skin test or blood test result indicating TB infection.
Drug Resistant TB Update
The status of multi-drug resistant tuberculosis (MDR TB) is a significant concern worldwide. MDR TB is a form of TB caused by bacteria that are resistant to at least two of the most effective anti-TB drugs, isoniazid and rifampicin. This resistance makes it more challenging to treat and control the disease. Additionally, extensively drug-resistant TB (XDR TB), which is resistant to additional second-line drugs, has also emerged as a major concern. XDR TB is associated with even higher mortality rates and limited treatment options.
“XDR TB is defined as strains that are not only resistant to the front-line drugs, but also three or more of the six classes of second-line drugs. This, according to Dr Paul Nunn, coordinator of the WHO team at the Stop TB department, makes it virtually untreatable.” {BBC}
The status of Multi-Drug Resistant (MDR) and Extensively Drug Resistant (XDR) Tuberculosis (TB) varies across different world regions. Here is an overview of the status of MDR and XDR TB by world regions:
1. Africa:
– MDR and XDR TB are major challenges in Africa.
– The prevalence of MDR TB is higher in countries with a high burden of TB and weak healthcare systems.
– Limited access to proper diagnosis, suitable treatment, and healthcare infrastructure contribute to the spread of MDR and XDR TB in some regions.
2. Americas:
– MDR and XDR TB are present, but the overall prevalence is lower compared to other regions.
– The United States, Canada, and most countries in South America have relatively low levels of MDR and XDR TB due to strong healthcare systems and effective control programs.
3. Asia:
– Asia accounts for the majority of MDR and XDR TB cases globally.
– Countries like India, China, and Russia have a significant burden of MDR and XDR TB due to large populations, high rates of TB, and inadequate healthcare infrastructure.
– Limited access to quality diagnosis, appropriate treatment, and poor infection control measures contribute to the spread of drug-resistant TB in this region.
4. Europe:
– MDR and XDR TB remain a concern in some parts of Eastern Europe and Central Asia.
– Countries like Ukraine, Belarus, and Moldova have high rates of drug-resistant TB due to inadequate healthcare resources, high HIV co-infection rates, and poor compliance with treatment regimens.
5. Middle East and North Africa (MENA):
– MDR and XDR TB rates vary across the MENA region.
– Conflict-affected areas like Yemen and Syria have reported increasing rates of drug-resistant TB due to disrupted healthcare systems, inadequate access to treatment, and limited resources for diagnosis and care.
6. Oceania:
– MDR and XDR TB rates are relatively low in Oceania.
– Australia and New Zealand have robust healthcare systems and effective TB control programs, leading to low rates of drug-resistant TB.
It is important to note that the status of MDR and XDR TB can change over time due to various factors including healthcare infrastructure, access to diagnosis and treatment, infection control measures, and overall management of TB programs in each region.
According to the World Health Organization (WHO), there were an estimated 465,000 cases of MDR TB globally in 2019. This accounted for about 3.3% of all new TB cases and 18% of previously treated TB cases.
The highest burden of MDR TB is found in countries with weaker health systems and limited resources for diagnosis and treatment. Eastern Europe and Central Asia have the highest rates of MDR TB, followed by Asia and Africa. In these regions, inadequate access to quality healthcare, poor adherence to treatment, and limited diagnostic capacities contribute to the spread of MDR TB.
The treatment of MDR TB is complex and requires longer durations (up to two years) and more expensive drugs with more side effects. New treatments are being sought:
The combination of bedaquiline, pretomanid, and linezolid led to a favorable outcome at 6 months after the end of therapy in a high percentage of patients with highly drug-resistant forms of tuberculosis; some associated toxic effects were observed. (Funded by the TB Alliance and others; ClinicalTrials.gov number, NCT02333799. opens in new tab.)
Efforts to control MDR TB involve a comprehensive approach, including early detection through rapid diagnostic tests, proper management using second-line drugs, infection control measures, and strong healthcare systems. However, challenges persist, including the high cost of drugs, limited access to quality diagnostics, and inadequate funding for TB control programs.
Overall, while progress has been made to address MDR TB, it remains a significant global health challenge that requires continued efforts to prevent its spread and improve treatment outcomes.