title: Extensively drug-resistant tuberculosis: epidemiology and management challenges.
abstract: Widespread global use of rifampin for 2 decades preceded the emergence of clinically significant multidrug-resistant tuberculosis (MDR-TB) in the early 1990s. The prevalence of MDR-TB has gradually increased such that it accounts for approximately 5% of the global case burden of disease (approximately half a million cases in 2007). Eclipsing this worrying trend is the widespread emergence of extensively drug-resistant TB (XDR-TB). This article reviews the insights provided by clinical and molecular epidemiology regarding global trends and transmission dynamics of XDR-TB, and the challenges clinicians have to face in diagnosing and managing cases of XDR-TB. The ethical and management dilemmas posed by recurrent defaulters, XDR-TB treatment failures, and isolation of incurable patients are also discussed. Given the past global trends in MDR-TB, if aggressive preventive and management strategies are not implemented, XDR-TB has the potential to severely cripple global control efforts of TB.
authors.affiliation: Lung Infection and Immunity Unit, Division of Pulmonology and Clinical Immunology & UCT Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa. keertan.dheda@uct.ac.za
authors.forename: Keertan
authors.initials: K
authors.lastname: Dheda
authors.forename: Robin M
authors.initials: RM
authors.lastname: Warren
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D015373:Bacterial Typing Techniques; D016172:DNA Fingerprinting; D004196:Disease Outbreaks; D054908:Extensively Drug-Resistant Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D005838:Genotype; D015658:HIV Infections / Q000150:complications; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification*; D016896:Treatment Outcome
chemical_list: D000995:Antitubercular Agents