Translating basic science insight into public health action for multidrug- and extensively drug-resistant tuberculosis

Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, Colorado, USA.
Respirology (Impact Factor: 3.35). 03/2012; 17(5):772-91. DOI: 10.1111/j.1440-1843.2012.02176.x
Source: PubMed


Multidrug (MDR)- and extensively drug-resistant (XDR) tuberculosis (TB) impose a heavy toll of human suffering and social costs. Controlling drug-resistant TB is a complex global public health challenge. Basic science advances including elucidation of the genetic basis of resistance have enabled development of new assays that are transforming the diagnosis of MDR-TB. Molecular epidemiological approaches have provided new insights into the natural history of TB with important implications for drug resistance. In the future, progress in understanding Mycobacterium tuberculosis strain-specific human immune responses, integration of systems biology approaches with traditional epidemiology and insight into the biology of mycobacterial persistence have potential to be translated into new tools for diagnosis and treatment of MDR- and XDR-TB. We review recent basic sciences developments that have contributed or may contribute to improved public health response.

    • "About 9 % of M. tuberculosis MDR strains are XDR and 84 countries have now reported at least one XDR-TB case (WHO 2012). 'Completely' or 'totally' drug-resistant M. tuberculosis strains for which there is no effective treatment are increasingly reported, although criteria for 'totally' drug-resistant TB have not been formally defined yet (Walter et al. 2012). Moreover, the presence of dormant bacilli represents a major hurdle to the successful completion of chemotherapy, due to their distinctive recalcitrance to drugs. "
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