The Rise of Drug-Resistant Tuberculosis

Tuberculosis, once one of our grimmest public health problems, is back. Extensively drug-resistant tuberculosis (XDR-TB) is an opportunistic predator, and failure to defeat it could transform our pharmacological magic bullets for TB into blanks.

BALTIMORE -- Tuberculosis, one of the most deadly infectious diseases, is back with a vengeance, especially in Africa. Extensively drug-resistant tuberculosis (XDR-TB) is a difficult to treat strain of TB which, attacks where health systems are historically weak, especially in areas of high HIV prevalence. Failure to contain local outbreaks, develop tools and strategies for identifying and treating XDR-TB, and invest in longer-term improvements in TB control could transform our pharmacological magic bullets for TB into blanks.

The development of TB chemotherapy from the 1940’s through the 1970’s transformed the once deadly “white plague” into a curable disease. But TB treatment has been shadowed by the specter of drug resistance since the dawn of the antibiotic era.  Fifteen years ago, an epidemic of multidrug-resistant tuberculosis (MDR-TB) in New York City induced near panic, before a massive infusion of funds into the public health infrastructure turned the tide in the United States, and public interest waned. However, the problem of drug resistance has persisted, and efforts to contain it globally have not been sufficient.

Enter XDR-TB. The World Health Organization estimates that there were 425,000 new MDR-TB cases in 2004, with China, India, and Russia accounting for just over 60%. But it was an outbreak of XDR-TB in HIV-infected people in KwaZulu-Natal, South Africa, that turned the global spotlight on issues of extensively drug-resistant organisms.

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