Drug-Resistant Tuberculosis

What it is?

Drug-resistant tuberculosis, like normal tuberculosis, is caused by Koch bacilli (mycobacteria). However, there is a significant difference: Koch bacilli of drug-resistant tuberculosis are much more tenacious and evil. Most drugs that work well against ordinary tuberculosis are useless in this case. And the disease is much more severe. Every year, drug-resistant tuberculosis is becoming more common. If earlier it developed mainly due to improper treatment of normal tuberculosis, today it is detected in every second patient who seeks help from a TB specialist for the first time.

People most at risk of contracting drug-resistant tuberculosis are:

1. Patients who were previously treated, but did not fully recover;
2. Citizens held in pre-trial detention centers and prisoners in prisons (due to large crowds of people and improper treatment of tuberculosis);
3. Persons without a fixed place of residence (homeless people);
4. Alcoholics and drug addicts;
5. Persons with reduced immunity;
6. AIDS patients.

Causes

The first cause of drug-resistant tuberculosis is that a person became infected with this particular form of the disease from someone.

The second is that during the treatment of ordinary tuberculosis, the composition of bacteria changed. Among ordinary mycobacteria there is always a small number of defective ones that are insensitive to any drug. If we consider that in one tuberculosis focus there are about 100 million bacteria, then among them there will certainly be mutants to all existing anti-tuberculosis drugs. With proper treatment, these defective bacteria do not play a special role. But if treated incorrectly (doses too small, wrong types and combinations of drugs, treatment ended too quickly), the ratio between the number of mutants and regular mycobacteria changes. At the same time, mutants survive better and reproduce faster.

Signs

Patients complain of a cough with sputum, sometimes hemoptysis, weakness, sweating, and sudden weight loss. A TB doctor may suspect that a patient has drug-resistant tuberculosis even before determining the sensitivity of bacteria to drugs.

Main features:

1. Chronic course of the disease with frequent exacerbations;
2. On the X-ray, instead of small tuberculosis lesions, there are huge cavities;
3. Tuberculosis is often associated with a bacterial or fungal infection;
4. There are catastrophically many mycobacteria in sputum.

Treatment

It is useless to treat drug-resistant tuberculosis with a standard set of anti-tuberculosis drugs; they still have no effect on mutant bacteria. Which backup medications the doctor will use depends on the individual sensitivity of the patient’s mycobacteria to the drugs.

Treatment with reserve drugs lasts from one and a half to two years, and its success ranges from 50% to 80%. Many reserve drugs are toxic and cause distressing side effects.

When treating drug-resistant tuberculosis, it is often necessary to resort to surgical treatment - removing part of the lung. The basic principles of treatment remain the same as for ordinary tuberculosis: duration, continuity, a combination of several drugs, supervision by medical staff.