XDR Tuberculosis — Implications for Global Public Health

The global threat of XDR tuberculosis has great significance for the public health field. Drs. Mario Raviglione and Ian Smith write that its very existence is a reflection of weaknesses in tuberculosis management. Ian Smith discusses XDR tuberculosis, its relationship with HIV infection, and the global threat it poses. In early 2005, physicians at a rural hospital in KwaZulu-Natal, a province of South Africa, were concerned by a high rate of rapid death among patients infected with the human immunodeficiency virus (HIV) who also had tuberculosis. A study revealed the presence not only of multidrug-resistant (MDR) tuberculosis but also what came to be called extensively drug-resistant (XDR) tuberculosis. XDR tuberculosis is caused by a strain of Mycobacterium tuberculosis resistant to isoniazid and rifampin (which defines MDR tuberculosis) in addition to any fluoroquinolone and at least one of the three following injectable drugs: capreomycin, kanamycin, and amikacin. Of 53 patients . . .