Drug Resistant Tuberculosis: Practical Guide for Clinical Management


by

Rafael Laniado-Laborín

DOI: 10.2174/97816810806661150101
eISBN: 978-1-68108-066-6, 2015
ISBN: 978-1-68108-067-3



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This book is a concise, straightforward practical guide to the clinical management of patients having drug resistant tuberculosis infe...[view complete introduction]

Table of Contents

Foreword

- Pp. i-ii (2)

Jose A. Caminero

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Preface

- Pp. iv

Rafael Laniado-Laborín

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Epidemiology of Drug Resistant Tuberculosis

- Pp. 3-4 (2)

Rafael Laniado-Laborín

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Mycobacterium Tuberculosis: Etiological Agent of Tuberculosis

- Pp. 5-13 (9)

Rafael Laniado-Laborín

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Biological Basis for Drug Resistant Tuberculosis

- Pp. 14-17 (4)

Rafael Laniado-Laborín

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Clinical Diagnosis of Drug Resistant Tuberculosis

- Pp. 18-21 (4)

Rafael Laniado-Laborín

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Drug Resistant Tuberculosis: Laboratory Diagnosis

- Pp. 22-28 (7)

Rafael Laniado-Laborín

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Antituberculosis Drugs

- Pp. 29-49 (21)

Rafael Laniado-Laborín

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Treatment of Drug Resistant Tuberculosis

- Pp. 50-64 (15)

Rafael Laniado-Laborín

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Adverse Effects and Toxicity of Antituberculosis Drugs

- Pp. 65-73 (9)

Rafael Laniado-Laborín

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Follow Up of Drug Resistant Cases During Treatment

- Pp. 74-75 (2)

Rafael Laniado-Laborín

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Drug Resistant Tuberculosis in Special Situations

- Pp. 76-83 (8)

Rafael Laniado-Laborín

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Hypothetical Illustrative Cases

- Pp. 84-96 (13)

Rafael Laniado-Laborín

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Subject Index

- Pp. 97-99 (3)

Rafael Laniado-Laborín

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Foreword

Drug resistant tuberculosis (DR-TB) has become one of the main obstacles for global control of the disease. This problem, generated by inadequate treatment is particularly worrisome when resistance includes isoniazid (H) and rifampin (R) simultaneously, the most potent and active drugs against Mycobacterium tuberculosis. Treatment for this form of TB known as multidrug resistant tuberculosis (MDR-TB) requires a minimum of 18-24 months of treatment with drugs that are less effective, more toxic and more expesive than those needed for drug susceptible TB; unfortunately the rate of success of treatment for this form of TB hardly reach 70%.

As it is well known, prognosis of drug resistant TB worsens even more when drug resistance extends to include fluoroquinolones and second line injectables, the two most useful group of second line drugs. This form of TB is known as extensive drug resistant TB or XDR-TB has even worst prognosis with a cure rate of only 50%.

Unfortunately, the extensive and inadequate use of rifampin in the past 30 years has generated an ever increasing number of MDR-TB cases that has reached epidemic levels in some regions of the world. It is estimated that by the year 2013 there were more than 480,000 cases of MDR-TB and that more than half of them were new cases never treated before, and thus the result of transmission of drug resistant strains in the community and confirms its epidemic nature.

This growing scenario of MDR and XDR-TB has many experts considering that we are going to face soon forms of TB that will be virtually incurable. This however, is not true since all forms of TB, even those with the most extensive degree of resistance have a possibility of being cured. This will depend decisively on the adequacy of the medical treatment available and this in turn will depend on the standards of quality for programmatic management of TB by national TB programs.

For this reason, sound clinical management of patients with suspected or confirms DR-TB is fundamental for successful management. And here lies the problem, since DR-TB is a relatively recent phenomenon for which, the best clinical approach has not been fully standardized. Standardization of this complex clinical problem is therefore urgently needed. That is why, that books like this one, written in a rational and simple style by Dr. Laniado, are very helpful for clinicians caring for these unfortunate patients.

I was fortunate to meet Dr. Laniado in his native Tijuana, Mexico. And from the beginning I knew that I had the luck to become acquainted with a clinician that not only had exquisite knowledge of TB and MDR-TB, but also had the passion and dedication to his patients and the will to explore to the maximum their possibilities of being cured. During all these years many patients have benefited from the quality and warmth that Dr. Laniado offers them every day. He has published extensively from his TB Clinic in Tijuana. And now we are in luck that he has dedicated innumerable hours to this book in which in a very straightforward way presents the fundamental principles of the best clinical management that can be offered to these patients. There will be many clinicians, pulmonologists and non pulmonologists that will benefit from this nice treatise.

Jose A. Caminero
Coordinator, MDR-TB Unit
International Unit against Tuberculosis and Lung Diseases (The Union)
Paris, France
Servicio de Neumología
Hospital General de Gran Canaria “Dr. Negrin”
Las Palmas de Gran Canaria
España


Preface

The emergence of highly drug-resistant strains of Mycobacterium tuberculosis (MTB) threatens to undermine global advances in tuberculosis (TB) control, and challenges the goal of elimination of TB in the 21st century; unfortunately, despite rampant drug resistance in many regions of the world, TB is still extremely unpopular as a field of interest for clinicians, policy makers and the media.

We have unfortunately witnessed an accelerated progression in resistance in many of the high TB-burden countries: multidrug-resistant TB being followed by extensively drug-resistant which in turn has been followed by what has been called totally drug-resistant TB which represents the most extreme form of amplified drug resistance.

The main objective of this practical guide is to help those physicians who are not experts in drug resistant tuberculosis, but have to diagnose and treat such cases in everyday practice. It includes a description of the latest diagnostic tests and treatment regimens for the different types of drug resistant tuberculosis. In the last chapter we have included a series of hypothetical cases to illustrate some of the most frequent problems encountered while treating patients “in the real world”. I sincerely hope that this work meets its goal.

Rafael Laniado-Laborín
Clínica y Laboratorio de Tuberculosis
Hospital General Tijuana, México

List of Contributors

Editor(s):
Rafael Laniado-Laborín
Clínica y Laboratorio de Tuberculosis
Hospital General Tijuana, México




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