title: Emergence and treatment of multidrug resistant (MDR) and extensively drug-resistant (XDR) tuberculosis in South Africa.
abstract: Drug resistant tuberculosis (TB) has reached alarming proportions in South Africa, draining valuable resources that are needed to fight drug susceptible TB. It is currently estimated that 9.6% of all TB cases have multi-drug resistant (MDR)-TB, thereby ranking South Africa as one of the highest MDR-TB burden countries in the world. Molecular epidemiological studies have demonstrated the complexity of the epidemic and have clearly shown that the epidemic is driven by transmission as a consequence of low cases detection and diagnostic delay. The latter has in turn fueled the amplification of drug resistance, ultimately leading to the emergence of extensively drug resistant (XDR)-TB. Despite the introduction of new drugs to combat this scourge, culture conversion rates for XDR-TB remain below 20%. Failure to achieve cure may be explained from DNA sequencing results which have demonstrated mutations in 7 genes encoding resistance to at least 8 anti-TB drugs. This review shows how molecular epidemiology has provided novel insights into the MDR-TB epidemic in South Africa and thereby has highlighted the challenges that need to be addressed regarding the diagnosis and treatment of MDR-TB. An important step towards for curbing this epidemic will be collaboration between clinicians, laboratories and researchers to establish scientific knowledge and medical expertise to more efficiently guide public health policy.
authors.affiliation: DST/NRF Centre of Excellence for Biomedical TB Research/MRC Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, Stellenbosch University, South Africa. lizma@sun.ac.za
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Streicher
authors.forename: Borna
authors.initials: B
authors.lastname: Müller
authors.forename: Violet
authors.initials: V
authors.lastname: Chihota
authors.forename: Charmaine
authors.initials: C
authors.lastname: Mlambo
authors.forename: Marisa
authors.initials: M
authors.lastname: Tait
authors.forename: Manormoney
authors.initials: M
authors.lastname: Pillay
authors.forename: Andre
authors.initials: A
authors.lastname: Trollip
authors.forename: Kim G P
authors.initials: KG
authors.lastname: Hoek
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Sirgel
authors.forename: Nicolaas C
authors.initials: NC
authors.lastname: Gey van Pittius
authors.forename: Paul D
authors.initials: PD
authors.lastname: van Helden
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Victor
authors.forename: Robin M
authors.initials: RM
authors.lastname: Warren
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D057210:Delayed Diagnosis; D024901:Drug Resistance, Multiple, Bacterial; D054908:Extensively Drug-Resistant Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D005838:Genotype; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000187:drug effects / Q000235:genetics; D058974:Phylogeography; D017410:Practice Guidelines as Topic; D013019:South Africa / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents