Multidrug-resistant tuberculosis: past, present and future Ivan Bastian and Franyoise Portaels Mycobacteriology Unit. Institute of Tropical Medicine. Antwerp. Belgium The Lord hath created medicines out of the earth and he that is wise will not abhor them. Ecclesiasticus 38:4, quoted by Selman Waksman when accepting the 1952 Nobel Prize for Medicine that was awarded for the discovery of the first effective antituberculosis drug. streptomycin. which was derived from the soil bacterium, Streptomyces grisells. 1. HISTORICAL PERSPECTIVE This book has been published at the close of the twentieth century when the medical profession and the general community are increasingly concerned about the threat of multidrug-resistant tuberculosis (MDRTB)[1. 2]. However, at this epoch, it is enlightening to move back from our immediate concerns about MDRTB 'hot spots' in Asia, South America, and the former Soviet Union [3], and to place our current predicament in an historical context. If the results of the global survey of antituberculosis drug resistance conducted by the World Health Organisation (WHO) and the International Union against Tuberculosis and Lung Disease (IUATLD) can be extrapolated, only 2. 2% of TB cases worldwide are due to multi drug resistant strains [3]. At the beginning of the 20th century, all TB cases were refractory to all available therapies. Great advances had been made during the 19th century in the understanding of the epidemiology and pathogenesis of TB, and in the diagnosis of the disease (reviewed in references 4-7). Front Matter....Pages i-xv Introduction....Pages 1-15 The epidemiology of multidrug-resistant tuberculosis in the United States and other established market economies....Pages 17-28 Epidemiology of multidrug-resistant tuberculosis in low- and middle-income countries....Pages 29-44 The interaction of human immunodeficiency virus and multidrug-resistant Mycobacterium tuberculosis ....Pages 45-57 Clinical mismanagement and other factors producing antituberculosis drug resistance....Pages 59-76 The molecular mechanisms of drug resistance in Mycobacterium tuberculosis ....Pages 77-114 DOTS and multidrug-resistant tuberculosis....Pages 115-131 Conventional methods for antimicrobial susceptibility testing of Mycobacterium tuberculosis ....Pages 133-143 Novel rapid antimicrobial susceptibility tests for Mycobacterium tuberculosis ....Pages 145-162 Pharmacology of the second-line antituberculosis drugs....Pages 163-174 Treatment of multidrug-resistant tuberculosis....Pages 175-190 Treatment of multidrug-resistant tuberculosis in developing countries....Pages 191-203 Treatment outcome of multidrug-resistant tuberculosis....Pages 205-212 Chemoprophylaxis and BCG in contacts of multidrugresistant tuberculosis....Pages 213-224 Multidrug-resistant tuberculosis and the health care worker....Pages 225-239 The development of new chemotherapeutics for multidrug-resistant tuberculosis....Pages 241-252 Population dynamics and control of multidrug-resistant tuberculosis....Pages 253-267 Administrative, engineering, and personal protective measures for controlling Mycobacterium tuberculosis ....Pages 269-284 Making DOTS-Plus work....Pages 285-306 Back Matter....Pages 307-312 The emergence of multidrug-resistant tuberculosis (MDRTB) threatens TB control programs worldwide. Outbreaks of MDRTB in the United States grabbed the attention of the medical community and the general public, and subsequent surveys have found 'hot spots' of MDRTB in low- and middle-income countries on four continents. Unlike other textbooks that contain only a single chapter on MDRTB, this book is devoted to the subject. Contributions from experts from multi disciplines provide detailed descriptions, causation, molecular biology, laboratory diagnosis, treatment, prevention, and public health, aspect of this disease. This book provides an authoritative overview of MDRTB and will be a useful reference book for clinicians, scientists and other health personnel involved in the care of TB and MDRTB patients in industrialized and developing countries The emergence of multidrug-resistant tuberculosis (MDRTB) threatens TB control programs worldwide. This work provides detailed descriptions, causes, molecular biology, laboratory diagnosis, treatment, prevention, and public health aspects of this disease.
