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Tuberculosis (cont.)

What Is Drug-Resistant TB?

  • Most strains of the TB bacteria require at least two drugs for treatment to prevent resistance.
  • Resistance is caused by inconsistent or partial treatment. In some instances, patients are prescribed inadequate therapy or enough drug is not available. Usually this occurs because patients tend to stop taking their medication once they start to feel better. Observed therapy is often required and monitored by health departments in the U.S.
  • Multidrug-resistant TB (MDR-TB) is caused by a bacteria that is resistant to at least isoniazid and rifampicin. Prolonged alternative therapy is required to treat this form of TB, often for up to two years.
  • Extensively drug-resistant TB (XDR-TB) is rare but extremely problematic. This form of TB is very difficult to treat and often requires prolonged isolation of the individual to protect the community at large. If TB is treated properly and consistently, these resistant forms are much less likely to spread.

Tuberculosis Pictures

Tuberculous cavities in the right upper lobe are shown here.
Tuberculous cavities in the right upper lobe are shown here.

Tubercle bacilli in the lung tissue
Tubercle bacilli in the lung tissue.

Kinyoun stain shows presence of mycobacteria in sputum sample.
Kinyoun stain shows presence of mycobacteria in sputum sample.

A 48-year-old foreign-born woman developed cough, sputum production, and blood-tinged sputum. Sputum staining showed tubercle bacilli. Her chest X-ray showed a cavity-like lesion in right upper lobe of her lung.
A 48-year-old foreign-born woman developed cough, sputum production, and blood-tinged sputum. Sputum staining showed tubercle bacilli. Her chest X-ray showed a cavity-like lesion in right upper lobe of her lung.

Doctors treated the same woman with three medications for TB. One month later, she showed significant improvement, as seen by this repeat chest X-ray.
Doctors treated the same woman with three medications for TB. One month later, she showed significant improvement, as seen by this repeat chest X-ray.

Mantoux test is done to identify patients who are infected with the tuberculous infection; they may or may not have the disease. This test is also used as a public-health measure to detect infection in patient's family and friends.
Mantoux test is done to identify patients who are infected with the tuberculous infection; they may or may not have the disease. This test is also used as a public-health measure to detect infection in patient's family and friends.

Erythema nodosum is skin condition sometimes seen in tuberculosis when there are spots on the shins, which are painful and red and disappear within a few weeks.
Erythema nodosum is skin condition sometimes seen in tuberculosis when there are spots on the shins, which are painful and red and disappear within a few weeks.

Prior to the 1950s, medications were not available for treating tuberculosis. One of the treatments was placing paraffin wax sheets in the chest cavity to stop the infection. This patient had this treatment performed on her. This is of pure historical interest because this treatment is no longer performed.
Prior to the 1950s, medications were not available for treating tuberculosis. One of the treatments was placing paraffin wax sheets in the chest cavity to stop the infection. This patient had this treatment performed on her. This is of pure historical interest because this treatment is no longer performed.

REFERENCES:

U.S. Centers for Disease Control and Prevention. "Decrease in Reported Tuberculosis Cases -- United States, 2009." MMWR 59.10 (2010): 289-294.

U.S. Centers for Disease Control and Prevention. "Updated Guidelines for Using Interferon Gamma Release Assays to Detect Mycobacterium tuberculosis Infection -- United States, 2010." MMWR 59 (No. RR-5) June 25, 2010: 1-25.


Medically Reviewed by a Doctor on 6/24/2016

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