Extensively drug resistant tuberculosis: a serious wake-up call for global health

Tuberculosis outbreaks in the developed world are newsworthy. [1] However, in the developing world, where deaths from tuberculosis are common, it takes something exceptional for an outbreak to attract much attention. In response to a recent report at the 16th international AIDS conference [2] and to increasing South African media reports, the World Health Organization last week expressed concern about extensively drug resistant tuberculosis (also referred to as XDR tuberculosis). [3]

Among 536 culture confirmed cases of tuberculosis at a rural hospital in South Africa, 41% were multidrug resistant, [2] defined as resistance to rifampicin and isoniazid (two key first line drugs). This is cause enough for concern as multidrug resistant tuberculosis has a worse outcome and its management is very difficult even in high resource settings. [4 ] Even more alarming was that 53 (24%) of the isolates from multidrug resistant tuberculosis fulfilled the definition of extensively drug resistant tuberculosis