Drug resistant TB - latest developments in epidemiology, diagnostics and management

Simon Tiberi; Natasa Utjesanovic; Jessica Galvin; Rosella Centis; Lia D'Ambrosio; Martin van den Boom; Alimuddin Zumla; Giovanni Battista Migliori

doi:10.1016/j.ijid.2022.03.026

Drug resistant TB - latest developments in epidemiology, diagnostics and management

Int J Infect Dis. 2022 Nov:124 Suppl 1:S20-S25. doi: 10.1016/j.ijid.2022.03.026. Epub 2022 Mar 25.

Authors

Simon Tiberi¹, Natasa Utjesanovic², Jessica Galvin³, Rosella Centis⁴, Lia D'Ambrosio⁵, Martin van den Boom⁶, Alimuddin Zumla⁷, Giovanni Battista Migliori⁴

Affiliations

¹ Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London. Department of Infection, Royal London Hospital, Barts Health NHS Trust, London UK. Electronic address: s.tiberi@qmul.ac.uk.
² Department of Clinical Virology, University College London Hospital, UCL Hospitals NHS Foundation Trust, London UK.
³ Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London. Department of Infection, Royal London Hospital, Barts Health NHS Trust, London UK.
⁴ Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.
⁵ Public Health Consulting Group, Lugano, Switzerland.
⁶ WHO Regional Office for the Eastern Mediterranean Region, Cairo, Egypt.
⁷ Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, and National Institute for Health Research Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.

PMID: 35342000
DOI: 10.1016/j.ijid.2022.03.026

Abstract

Aim: The aim of this review is to inform the reader on the latest developments in epidemiology, diagnostics and management.

Epidemiology: Drug-resistant Tuberculosis (DR-TB) continues to be a current global health threat, and is defined by higher morbidity and mortality, sequelae, higher cost and complexity. The WHO classifies drug-resistant TB into 5 categories: isoniazid-resistant TB, rifampicin resistant (RR)-TB and MDR-TB, (TB resistant to isoniazid and rifampicin), pre-extensively drug-resistant TB (pre-XDR-TB) which is MDR-TB with resistance to a fluoroquinolone and finally XDR-TB that is TB resistant to rifampicin, plus any fluoroquinolone, plus at least one further priority A drug (bedaquiline or linezolid). Of 500,000 estimated new cases of RR-TB in 2020, only 157 903 cases are notified. Only about a third of cases are detected and treated annually.

Diagnostics: Recently newer rapid diagnostic methods like the GeneXpert, whole genome sequencing and Myc-TB offer solutions for rapid detection of resistance.

Treatment: The availability of new TB drugs and shorter treatment regimens have been recommended for the management of DR-TB.

Conclusion: Despite advances in diagnostics and treatments we still have to find and treat two thirds of the drug resistant cases that go undetected and therefore go untreated each year. Control of TB and elimination will only occur if cases are detected, diagnosed and treated promptly.

Keywords: Active TB drug safety monitoring (aDSM); Adherence; BPaL; Drug susceptibility testing (DST); Drug-resistant TB (DR-TB); Rehabilitation; Treatment Guidelines; Video Observed Therapy (VOT); WHO shorter oral regimen.

Publication types

Review

MeSH terms

Antitubercular Agents / pharmacology
Antitubercular Agents / therapeutic use
Extensively Drug-Resistant Tuberculosis* / diagnosis
Extensively Drug-Resistant Tuberculosis* / drug therapy
Extensively Drug-Resistant Tuberculosis* / epidemiology
Humans
Isoniazid / therapeutic use
Mycobacterium tuberculosis* / genetics
Rifampin / therapeutic use
Tuberculosis, Multidrug-Resistant* / diagnosis
Tuberculosis, Multidrug-Resistant* / drug therapy
Tuberculosis, Multidrug-Resistant* / epidemiology

Substances

Antitubercular Agents
Isoniazid
Rifampin

Grants and funding

001/WHO_/World Health Organization/International