Totally drug-resistant tuberculosis

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Totally drug-resistant tuberculosis (TDR-TB) is a generic term for tuberculosis strains that are resistant to a wider range of drugs than strains classified as extensively drug-resistant tuberculosis. TDR-TB has been identified in three countries; India, Iran, and Italy. The emergence of TDR-TB has been documented in four major publications.[1][2][3][4] However, it is not yet recognised by the World Health Organization.

TDR-TB has resulted from further mutations within the bacterial genome to confer resistance, beyond those seen in XDR- and MDR-TB. Development of resistance is associated with poor management of cases. Drug resistance testing occurs in only 9% of TB cases worldwide. Without testing to determine drug resistance profiles, MDR- or XDR-TB patients may develop resistance to additional drugs.[2] TDR-TB is relatively poorly documented, as many countries do not test patient samples against a broad enough range of drugs to diagnose such a comprehensive array of resistance. The United Nations' Special Programme for Research and Training in Tropical Diseases has set up a TDR Tuberculosis Specimen Bank to archive specimens of TDR-TB.[5]

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  1. ^ Migliori GB, De Iaco G, Besozzi G, Centis R, Cirillo DM. First tuberculosis cases in Italy resistant to all tested drugs. Euro Surveill. 2007;12(20):pii=3194. Available online:
  2. ^ a b Katherine Rowland (13 January 2012). "Totally drug-resistant TB emerges in India". Nature. 
  3. ^ Velayati, A. A.; Masjedi, M. R.; Farnia, P.; Tabarsi, P.; Ghanavi, J.; Ziazarifi, A. H.; Hoffner, S. E. (2009). "Emergence of New Forms of Totally Drug-Resistant Tuberculosis Bacilli: Super Extensively Drug-Resistant Tuberculosis or Totally Drug-Resistant Strains in Iran". Chest. 136 (2): 420–425. doi:10.1378/chest.08-2427. PMID 19349380. 
  4. ^ Udwadia, Z. F.; Amale, R. A.; Ajbani, K. K.; Rodrigues, C. (2011). "Totally Drug-Resistant Tuberculosis in India". Clinical Infectious Diseases. 54 (4): 579. doi:10.1093/cid/cir889. PMID 22190562. 
  5. ^ Nathanson, C. M.; Cuevas, L. E.; Cunningham, J.; Perkins, M. D.; Peeling, R. W.; Guillerm, M.; Moussy, F.; Ramsay, A. (2010). "The TDR Tuberculosis Specimen Bank: A resource for diagnostic test developers". The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 14 (11): 1461–1467. PMID 20937188. 

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