Practice Tip of the Week: Focus on Tuberculosis

World TB Day, held on March 24 each year, commemorates the date in 1882 when Dr. Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacillus that causes tuberculosis (TB). TB is curable with proper treatment, but resistant strains are spreading around the world.   In the US, the overall rate of TB is declining with 2.96 cases per 100,000 persons. Texas has higher rates of TB than the national average with 1,269 cases of tuberculosis (TB) as of 2014, for a rate of 4.7 per 100,000 population.

Multi-drug resistant TB (MDR-TB) is defined as TB disease that is resistant to the two main drug therapies:  isoniazid and rifampin.  In the last decade, a rare form of MDR-TB has emerged around the world:  extensively drug-resistant TB (XDR-TB).  This form of TB is resistant to isoniazid and rifampin and also resistant to fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin).

In the US there were 63 cases of XDR-TB reported between 1993 and 2011 but only 2 XDR-TB cases were reported in 2014.  In Texas, 7 people have been diagnosed with MDR-TB.  In 2013, the Wall Street Journal and other news outlets reported on the story of a Nepalese man with XDR-TB who was detained and quarantined in South Texas after traveling through 13 countries on public transportation.  It is estimated that between 30% and 50% of XDR-TB cases can be cured with proper treatment. 

Web Resources

The Texas Department of State Health Services Infectious Disease Control Unit TB Page

World Health Organization TB Page

Centers for Disease Control and Prevention TB Page

National Institutes of Health - National Institute of Allergy and Infectious Diseases

Videos

PBS Series – Rx for Survival on Deadly Diseases

Four short videos on MDR-TB in Peru, featuring Partners in Health cofounders Paul Farmer, MD and Jim Yong Kim, MD