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Definition and Deployment of Extensively drug-
Resistant Tuberculosis (XDR-TB)
Definition
Tuberculosis is a disease caused by infection with Mycobacterium tuberculosis complex.
Extensively drug-resistant TB (XDR-TB) is defined as TB germs that are resistant to isoniazid, rifampicin,
all of which include fluoroquinolone class and at least one of three second-line drugs for TB injection
(amykacin, kanamycin or capreomycin). XDR-TB resistant to all drugs that are bactericidal against
Mycobacterium tuberculosis germs, this led to his treatment and his little difficult to cure rate.
Previously XDR-TB is defined as TB resistant to INH, rifampicin and at less resistant to 3 of 6 second-line
drug class, this definition has been revised.
The spread of XDR-TB
TB germs mutations in a population of microorganisms can occur spontaneously and can also occur as a
result of improper treatment, both of dose and composition. Resistance can occur during the treatment,
where his initial TB germs that are sensitive to anti-TB drugs (OAT) to become resistant, and can occur
amplification when TB germs have become resistant to OAT also resistant to additional drugs in the
event of re-treatment. Eventually there will be a primary resistance which a person infected with TB
germs that have been resistant.
Things above often occurs in patients who received treatment with regimens and dosages that are not
appropriate, malabsorption (especially in patients with HIV coinfection), or in circumstances where
there is penetration of antibiotic resistance, such as the granuloma, and the empyema cavity.
Often also occur in a health care system that is not good, unavailability of equipment and materials for
resistance tests, and lack of specialists. This will result in a person often too late to get treatment and
diagnosed with MDR-TB, so the case will continue to be XDR-TB.
According to the Lung Association Physician Indonesia there are several factors that influence the
emergence of resistant germs M. Tuberculosis, namely:
1. Microbiologic factors: the natural resistance, acquired resistance, amplifier effects, the virulence of
the bacteria, infected with resistant strains of bacteria.
2. Clinical factors: health care providers, medications, patient.
http://mypulmonologist.com/definition-and-deployment-of-extensively-drug-resistant-tuberculosis-xdr-tb/
3. Factor program: there are no facilities for culture and sensitivity test, amplifier effect, no DOTS
programs, DOTS programs are not going well, at great cost.
4. Factors HIV / AIDS: the possibility of greater resistance, impaired absorption, the possibility of side
effects is greater
5. Germ factor: M. Tuberculosis super strains are very virulent, higher survival.
Several recent studies in Africa found an MDR-TB germ that evolved into the XDR-TB. Research
conducted by Pillay et al in Kwazulu-Natal (South Africa) in 1994 to 2005, found that an increase in cases
of XDR-TB in these ten years. They revealed that the main cause of his was the addition of streptomycin
injections is not appropriate in patients with tuberculosis and also as a result of treatment of MDR-TB
that is not true.
Nosocomial spread of XDR-TB is also thought to occur in KwaZulu-Natal, as a result many people with
HIV and hospitals with no good ventilation and isolation of TB germs that way below standard. In
Norway reported one case of XDR-TB patients who escaped from the follow-up and spread to 14 people.
In California also reported the spread of XDR-TB to two people who live with the patient.