title: Extensively drug-resistant tuberculosis: are we learning from history or repeating it?
abstract: Tuberculosis (TB) is an enormous global public health problem. Cases of extensively drug-resistant TB (XDR-TB) are being reported in increasing numbers across the globe. A large outbreak of XDR-TB associated with rapid and nearly universal mortality has been reported among patients with human immunodeficiency virus infection or acquired immunodeficiency disease in South Africa who have been receiving standard TB therapy and antiretrovirals. Epidemiologic features of this outbreak make it highly suspicious for health care-associated transmission. We urge the Infectious Diseases Society of America and its members to increase involvement in ongoing international TB prevention and treatment efforts and to develop a registry of experts in infection control and laboratory and disease management. We urge advocacy for increased funding for domestic and global TB control programs, including expanded access to sputum culture and drug susceptibility testing, as well as funding for TB clinical trials and research capacity. We believe that substandard TB diagnostic tests are not acceptable for TB control in resource-poor countries. We urge the development of shorter, less toxic TB treatment and prevention regimens. Funding of TB control and research should be reassessed to prevent budget cuts at a time when the disease is killing as many as 2 million people a year.
authors.affiliation: Duke University School of Medicine, Durham, NC 27710, USA. dukes002@mc.duke.edu
authors.forename: Carol
authors.initials: C
authors.lastname: Dukes Hamilton
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Sterling
authors.forename: Henry M
authors.initials: HM
authors.lastname: Blumberg
authors.forename: Michael
authors.initials: M
authors.lastname: Leonard
authors.forename: James
authors.initials: J
authors.lastname: McAuley
authors.forename: David
authors.initials: D
authors.lastname: Schlossberg
authors.forename: Jason
authors.initials: J
authors.lastname: Stout
authors.forename: Gwen
authors.initials: G
authors.lastname: Huitt
mesh_terms: D003906:Developing Countries; D024881:Drug Resistance, Bacterial; D006801:Humans; D011634:Public Health; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology