the multi-drug resistant tuberculosis

It is a bacterial infection caused by Mycobacterium tuberculosis. It is a respiratory disease spread by the air. Antimicrobial drug resistance can develop in the tuberculosis causative agent. They do not react to the most potent anti-tuberculosis medications, isoniazid, and rifampicin. Multi-drug resistant tuberculosis continues to grow and spread as a result of tuberculosis care mismanagement and dissemination from one person to another (Davies, 2004). Any tuberculosis patients are healed following a six-month treatment regimen with support and monitoring. Drug resistance by the bacteria is because of inappropriate use of antimicrobial drugs, use of ineffective formulations of drugs such as generic medicine, and premature treatment interruption (Okumura &Kudoh, 2011). This paper is going to discuss the agents that cause the disease and its discovery, its epidemiology, symptoms, diagnosis, and treatment. The socioeconomic relevance of the disease also discussed.

Agents That Cause The Disease And Its Discovery

Mycobacterium tuberculosis is the causative organism of tuberculosis. It belongs to the family of Mycobacteriaceae. The bacteria are obligate, pathogenic and rod-shaped. Mycobacterium tuberculosis is highly resistant to adverse conditions, and they can survive in the dust for several months (Frieden et al., 1996). Its resistance is because of a cell wall which is rich in lipids. It requires oxygen to grow, and it replicates every fifteen to twenty hours. It has a waxy coating on its cell wall due to the presence of Mycolic acid. Other forms of the bacteria are Mycobacterium Africanum and Mycobacterium Bovis. The latter is found in cattle while the former is in human beings.

Drug-resistant tuberculosis was first discovered in 1948 and published in the report on streptomycin therapy by the British Medical Research Council. Analysis revealed that the death rates of the patients treated by the Streptomycin for pulmonary tuberculosis were same for those people who had a similar disease but were not under treatment (Morris et al., 2013). It meant that the therapy was not providing any visible health functions. When the phenomenon got discovered, a surfaced multi-agent chemotherapy for the disease was adopted. The treatment proved to be efficient. Through the 1960s to 1980s, little attention got paid to the resistance of drugs by the bacteria. Issues that were sporadic were ignored until in the early 1990s when the multi-drug resistant tuberculosis got discovered in the United States of America (Okumura & Kudoh, 2011). The disease became an epidemic with cases seen to be immune to Isoniazid and Rifampin in New York, Jersey, and Florida. Tuberculosis got transmitted in public places such as jails, hospitals, and homeless shelters. It was observed that the death trend of patients was consistent in both HIV infected and uninfected people. Economic and financial interventions helped to curb the spread of the disease, but still, it claimed lives.

Epidemiology

The United States has reported a significant increase in the number of cases of Multi-drug resistant tuberculosis, though; the percentage is still small compared to other countries globally. Although many cases of the disease got reported in many parts of the country, the majority of the cases is in the urban areas. The multi-drug resistant tuberculosis is difficult and expensive to treat. In response to the spread of the disease, the government through the Center For Disease Control has developed a National plan to combat this type of tuberculosis (Morris et al., 2013). The elements of the program include a surveillance and epidemiological study of the resistant disease, and initiatives to make the laboratory diagnosis of Multi-drug resistance tuberculosis reliable, sensitive and rapid. The plan also aims at educating health officers on the disease, its prevention, control, and treatment. The measures that are to be taken to facilitate the development of new tuberculosis drugs are also considered (Davies, 2004). Furthermore, the Center for Disease Control has published guidelines for the prevention of the spread of tuberculosis. The guidelines have outlined that if medical practitioners have diagnosed a patient, they should prescribe the required medication to prevent the disease from spreading to other people (Frieden et al., 1996). The doctor should ensure that the patient takes all the medicine through directly observed therapy. More specific interventions such as the use of incentives to improve compliances in certain situations can be applied in groups where high rates of drug resistance have been found (Morris, 2013). Such groups include HIV-positive persons, homeless people and those that got exposed to multi-drug resistant tuberculosis patients. Quick and efficient government interventions through the public health service targeted towards these groups will reduce the spread of the drug-resistant tuberculosis disease.

Global Impact

Despite being one of the diseases with the most efficacious treatment available over decades, tuberculosis is still claiming lives (Davies, 2004). It is a major global health problem. In 1993, the disease was declared a global public health emergency by the World Health Organization (WHO). At that time, an estimated 7 to 8 million cases were reported while 1.2 million to 1.6 million deaths occurred annually. In 2010, the number of cases of tuberculosis increased to 8.5 million to 9 million. The number of people who died from the disease was estimated to be 1.2 to 1.5 million people.

Globally, an estimated 50,000 cases of Multi-drug resistant tuberculosis were reported to the World Health Organization (WHO) in 2010. Most of the cases were from the countries in Europe and South Africa. It represented about 18% of 290,000 cases of Multi-drug resistant tuberculosis that existed among pulmonary tuberculosis patients globally in 2010. The proportion of tuberculosis patients who had the Multi-drug resistant tuberculosis was estimated to be under 10% of the total of the patients from 27 countries with high numbers of Multi-drug resistant tuberculosis (Morris et al., 2013). Russian Federation is the third country in the world with many patients with drug-resistant tuberculosis. Estimated cases of the disease were 44% of Multi-drug resistant cases in the world.

The efforts to estimate the number of global cases of multi-drug resistant tuberculosis began in 1994 when the International Union Against Tuberculosis and Lung Diseases (IUATLD) met with World Health Organization (WHO). At this summit, the Global Project on tuberculosis drug-resistance surveillance was launched Frieden, 1996). The first results were reported in 1998 when 35 countries from five different continents had almost 9.9% of the patients diagnosed with tuberculosis had drug resistance. Some of the countries which had a high number of such patients were the Dominican Republic and Argentina.

In 2000, a report prepared by the World Health Organization (WHO) covering 72 countries showed a high level of Multi-drug resistant tuberculosis in fifteen nations globally. The disease was more prevalent in Sierra Leone, Zimbabwe, Romania, Brazil and Peru than any other country in the world. In Russia, ten percent of the one million prisoners had contracted drug-resistant tuberculosis (Davies, 2004). The high incidences of the disease in India and China are worrisome since they have a close to 40% of all the tuberculosis cases globally.

A report by the world health organization in 2008 concluded that the proportion of people with Multi-drug resistant tuberculosis was 2.9% and 15.3% for new and old cases. In the Soviet state, it was noted that half of all the cases were only resistant to at least one drug. Twenty percent were Multi-drug resistant while the other twenty percent had extensive drug resistance. In the United Kingdom, nearly 7.5% of the cases were resistant to antibiotics (Okumura & Kudoh, 2011). In countries such as Wales, England, and Northern Ireland, 7% of tuberculosis patients develop resistance to Isoniazid while 0.9% are multi-drugs. Since 2006, only two cases of anti-Isoniazid have been recorded in London and Northern Ireland. In the United States of America, resistant tuberculosis is not a problem because the risk of acquiring it is low (Davis, 2004). Reports from the National Tuberculosis Surveillance System (NTSS) says that only 63 cases of resistant tuberculosis have been recorded since the year 1993 to 2011.

Symptoms

Some of the symptoms of tuberculosis include a feeling of sickness or weakness, weight loss, fever and night sweats. The signs associated with tuberculosis of the lungs include coughing, coughing up blood, and chest pains (Morris et al., 2013). The disease affects different organs of the body; hence symptoms may not be the same for every part of the body that is infected.

Diagnosis Of Multi-Drug Resistant Tuberculosis

For over a century, the diagnosis of the disease has been finding acid bacilli in the clinical sample of patients. However, the detection of drug-resistant tuberculosis has been difficult because it requires a pure culture of Mycobacterium tuberculosis. Compared to other drug tests, Mycobacterium tuberculosis takes twenty-four hours to replicate and a maximum of one month to be visible in a solid medium (Frieden, 1996). The test for drug-resistant tuberculosis requires six to eight weeks and a well-equipped laboratory. This kind of facilities are not available in the areas where Multi-drug resistant tuberculosis persists, hence brings about a challenge when it comes to controlling the disease.

With the advancement in technology, new molecular methods used to detect the bacterial gene mutation of the drug-resistant tuberculosis are becoming increasingly available. The Mycobacterium

Reference

Unit in the United Kingdom uses a commercial assay to identify the gene mutations responsible for the resistance of the Rifampicin antibiotic drug (Morris et al., 2013). When compared to other tests, it had a sensitivity of 85.5% and specificity of 88.2% when used in the same samples and when a pure bacterial was used it yielded sensitivity of 98.7% and 100% sensitivity. Efforts are being made to develop assays and tests which are more accessible in low resource settings. For instance, microscopic observation drug assay based on the unique appearance of the bacteria in liquid medium observed under a microscope has been developed (Okumura & Kudoh, 2011). The resistance of the bacteria is quantified by seeing its growth in the presence of the drug. This test can detect about ninety-nine percent of multiple drug-resistant bacteria and give results within seven days as compared to other techniques.

The World Health Organization has endorsed a diagnostic test kit for the future called MTBDRsl. This test is based on DNA. It identifies genetic multi-drug resistant strains which makes them immune to tuberculosis drugs and Fluoroquinolones (Davies, 2004). It can also produce results within forty-eight hours as compared to the previous which took three months. The fast testing enables the management and treatment process of the disease to begin immediately hence patients can be placed in the second line appropriate drugs.

Treatment

To understand how multi-drug resistant tuberculosis is treated, an understanding of the first and second line tuberculosis drugs is required. The five essential medicines used include; Rifampicin, Isoniazid, Ethambutol, Streptomycin, and Pyrazinamide. These drugs are given to patients who have not gotten tuberculosis treatment before. The drugs that are used to treat resistant tuberculosis are divided into five groups. The first group is line one oral medication. Amikacin, Kanamycin, and Capreomycin are the second group of drugs. They are usually injected. The third group of drugs is known as Fluoroquinolones. Group four of tuberculosis drugs are called Oral Bacteriostatic second-line agents. The fifth categories of drugs are rarely used, and their effectiveness is not well understood (Frieden, 1996). They include Clofazimine, Linezolid, and Thibacetazone. The treatment of resistant tuberculosis is usually complicated because no established parameters exist. Medical experts are employed to provide attention to special treatment for specific patients. Drug-resistant tuberculosis can be treated within a year as opposed to two years; it used to take before the development of new methods of treatment (Frieden et al., 1996). Though incidences of resistant tuberculosis are low in the United States of America, the treatment is usually expensive and harmful at some point. The patients who undergo the therapy experience side-effects of the drugs such as depression, hearing loss, psychosis, and kidney impairment.

Socioeconomic relevance of the disease

Multi-drug resistant tuberculosis has social and economic effects on the patients and their families. The disease has also caused an impact on the lives of people in the country and globally as its prevalence continues to rise (Morris et al., 2013). Patients usually have social effects when diagnosed and while undergoing treatment for the disease. The way people view and interact with tuberculosis patients is of concern in their daily lives. In some societies, stigma usually arises due to social disapproval and misunderstanding of personal characteristics or beliefs which are different from cultural norms (Okumura & Kudoh, 2011). Patients report cases of friends and family members alienating and not communicating with them after realizing that they have been diagnosed with multi-drug tuberculosis. Such acts affect their social life, and most of the time they stay away from the community. In some cases, the family members of the tuberculosis patient always ignore them even after they are done with the medication. They view them as “unsafe” and distance themselves (Davies, 2004). Friends and family abandon the patients because they lack information about the disease. Awareness should be created about tuberculosis so that those affected are not affected socially.

When an individual is diagnosed with multi-drug resistant tuberculosis, he or she may lose a job because the employer may see that they are unproductive. It may cause them to experience economic problems because of the cost of medication that is required for the patient to heal. He or she may also not be capable of providing for the family because of lack of a job. The salaries of most patients with multi-drug resistant tuberculosis may be reduced. It causes them to have little money to spend hence ending up becoming poor.

Countries all over the world spend a lot of money annually to come up with facilities that will improve the treatment of drug-resistant tuberculosis. A lot of resources are also allocated for research institutions that conduct experiments to discover ways of curbing the spread of the disease. The government also spends money to purchase drugs for citizens.

In conclusion, Multi-drug resistant tuberculosis is a disease that has caused lives of many people globally, and immediate remedy needs to be put in place to reduce the number of casualties all over the world. It has become one of the dangerous infections in the world.

References

Davies, P. D. (2004). Multi-drug-resistant tuberculosis. In Tuberculosis (pp. 809-837). Springer Berlin Heidelberg.

Frieden, T. R., Sherman, L. F., Maw, K. L., Fujiwara, P. I., Crawford, J. T., Nivin, B., ... & Kreiswirth, B. N. (1996). A multi-institutional outbreak of highly drug-resistant tuberculosis: epidemiology and clinical outcomes. Jama, 276(15), 1229-1235.

Morris, M. D., Quezada, L., Bhat, P., Moser, K., Smith, J., Perez, H., ... & Rodwell, T. C. (2013). Social, economic, and psychological impacts of MDR-TB treatment in Tijuana, Mexico: a patient's perspective. The International Journal of Tuberculosis and Lung Disease, 17(7), 954-960.

Okumura, M., & Kudoh, S. (2011). Treatment of multi-drug resistant tuberculosis. Nihon rinsho. Japanese journal of clinical medicine, 69(8), 1394-1399.