Multi-drug Resistant (MDR) and Extensively Drug Resistant (XDR) Tuberculosis Case Study Book Project
By Richmond Darko
Background: Multidrug-resistant tuberculosis (MDR TB) is caused by infection with an M. tuberculosis isolate resistant to at least Isoniazid (INH) and Rifampin (RIF), the two most potent anti-TB medications. Extensively drug-resistant TB (XDR TB) is a form of TB caused by M. tuberculosis isolate resistant) to INH and RIF, and, in addition, a fluoroquinolone and one of three second-line anti-TB injectable drugs. The morbidity, mortality and cost associated with drug-resistant TB is significant and challenges TB control programs throughout the world. Several factors drive the amplification and transmission of drug-resistant TB, including the lack of expertise for complex issues in clinical care and management. This lack of expertise can be addressed through training and education.
Objectives: The objective of this thesis is to provide the scientific background for an MDR TB Case Study Book to be published by the Centers for Disease Control and Prevention (CDC). The objectives of the MDR TB Case Study Book (TCSB) are the following: 1) develop a summary of expert opinions in diagnosing, treating, and managing MDR TB cases in a case study format using actual cases from treatment centers in the United States, 2) present radiographic manifestations of TB for the training and educating of care providers, and 3) provide continuing education (CME) credits through a self-study format.
Methods: Cases were collected from the four TB Regional Training and Medical Consultation Centers (RTMCCs). Data were extracted from patients' medical records. Each case was written in a format detailing patient's background, disease and management timeline, discussion with expert opinions, and 3 or more self-study questions.
Results: Twenty cases were compiled, 10 are being reviewed by the stakeholders from the RTMCCs and the CDC. Prior to publication of the final product, the book will be piloted among physicians and other public health professionals who specialize in TB treatment and management.
Discussion: A survey of those who read the TCSB and take the CME question will help evaluate the impact of the book on provider knowledge.
Table of Contents
Abstract Cover Page
Global Burden of Multi-drug Resistant (MDR) and Extensively Drug Resistant (XDR) Tuberculosis (TB)
Part One: Introduction to MDR and XDR-TB...3
Part Two: TB and HIV...10
Part Three: Biologic Basis and Mechanism of Resistance in MDR and XDR TB...12
Part Four: Management Options...18
Conclusion and Recommendations...32
About this Master's Thesis
|Committee Chair / Thesis Advisor|
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