XDR TB: Key facts signs, symptoms and prevention

XDR TB has hit Mumbai hard.

Mumbai continues to paint a gory picture of extremely resistant tuberculosis (XDR-TB) TB with Bai Jerbai (BJ) Wadia hospital alone having identified at least 11 children infected with XDR-TB after testing 500 children infected with TB in the last three years.

The death of a 31-year-old tuberculosis patient from Dharavi a couple of weeks ago rang alarm bells at P D Hinduja Hospital in Mahim, where she was referred to following a surgery to remove an infected lung. Doctors found that the woman was killed by an extreme form of tuberculosis, resistant to all medicines.

This form of tuberculosis is known as Totally Drug Resistant (TDR) TB, far dangerous that Multi Drug Resistant (MDR) and Extreme Drug Resistant (XDR) forms that doctors were aware of all these years.

12 cases identified

Since the highly-contagious infection spreads through air, doctors are worried about Mumbai’s vulnerability against TDR TB. They have already identified 12 patients suffering from TDR TB. A lung surgery may help,the doctors say, but the situation could turn dangerous if not brought under control soon enough.

James Natchway's TED wish: XDRTB org is an extraordinary effort to tell the story of extremely drug-resistant tuberculosis (XDR-TB) and TB through powerful photographs taken by James Nachtwey. XDR-TB, or extremely drug-resistant tuberculosis, is a new and deadly mutation of tuberculosis. Similar in creation to multidrug-resistant tuberculosis (MDR-TB) but more extreme in its manifestation, it arises when common tuberculosis goes untreated or standard TB drugs are misused. James photographs represent these varying strains. Learn more about TB, MDR-TB and XDR-TB, and learn how you can take action to stop this deadly disease.

What is XDR TB?

Extensively drug-resistant tuberculosis (XDR TB) is a relatively rare type of multidrug-resistant tuberculosis (MDR TB). It is resistant to almost all drugs used to treat TB, including the two best first-line drugs: isoniazid and rifampin. XDR TB is also resistant to the best second-line medications: fluoroquinolones and at least one of three injectable drugs (i.e., amikacin, kanamycin, or capreomycin).

How is XDR TB spread?

Drug-susceptible (regular) TB and XDR TB are spread the same way. TB germs are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. These germs can float in the air for several hours, depending on the environment. Persons who breathe in the air containing these TB germs can become infected.

TB is not spread by

shaking someone's hand

sharing food or drink touching bed linens or toilet seats

sharing toothbrushes

kissing smoking or sharing cigarettes

Why is XDR TB so serious?

Because XDR TB is resistant to the most powerful first-line and second-line drugs, patients are left with treatment options that are much less effective and often have worse treatment outcomes. XDR TB is of special concern for persons with HIV infection or other conditions that can weaken the immune system. These persons are more likely to develop TB disease once they are infected, and also have a higher risk of death once they develop TB disease.

Who is at risk for getting XDR TB?

Drug-resistant TB (MDR or XDR) is more common in people who:

Do not take their TB medicine regularly

Do not take all of their TB medicines as told by their doctor or nurse

Develop active TB disease again, after having taken TB medicine in the past

Come from areas of the world where drug-resistant TB is common

Have spent time with someone known to have drug-resistant TB disease

How can I prevent myself from getting TB?

Avoid close contact or prolonged time with known TB patients in crowded, enclosed environments like clinics, hospitals, prisons, or homeless shelters.

Can the TB vaccine (BCG) help prevent XDR TB?

There is a vaccine for TB disease called Bacille Calmette-Guerin (BCG). It is used in some countries to prevent severe forms of TB in children. However, BCG is not generally recommended in the United States because it has limited effectiveness for preventing TB in adults. The effect of BCG against XDR TB would likely be similar to the effect on drug-susceptible TB.

If I have regular (drug-susceptible) TB, how can I prevent getting drug-resistant TB?

The most important thing is for you to continue taking all your TB medicines exactly as prescribed. No doses should be missed and treatment should not be stopped early. You should tell your health care provider if you are having trouble taking the medications. If you plan to travel, make sure you have enough medicine to last while away.

Can XDR TB be treated and cured?

Yes, in some cases. Some TB control programs have shown that cure is possible for an estimated 30% of affected people. Successful outcomes depend greatly on the extent of the drug resistance, the severity of the disease, and whether the patient's immune system is weakened.

What are the symptoms of XDR TB?

The general symptoms of TB disease include feelings of sickness or weakness, weight loss, fever, and night sweats. The symptoms of TB disease of the lungs may also include coughing, chest pain, and coughing up blood. Symptoms of TB disease in other parts of the body depend on the area affected. If you have these symptoms, you should contact your doctor or local health department.