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The third epidemic--multidrug-resistant tuberculosis
K Neville1, A Bromberg, R Bromberg
1Department of Medicine, Bellevue Hospital Center, New York University Medical Center, New York 10016.
Chest
|January 1, 1994
Summary
Multidrug-resistant tuberculosis (MDR-TB) has surged in New York, complicating the AIDS and TB epidemics. Urgent action is needed for faster diagnosis, new treatments, and improved patient care environments.
Area of Science:
- Public Health
- Infectious Diseases
- Epidemiology
Background:
- Tuberculosis (TB) remains a significant global health challenge.
- The rise of multidrug-resistant tuberculosis (MDR-TB) presents a critical threat to public health efforts.
- Co-epidemics of Acquired Immunodeficiency Syndrome (AIDS) and TB have been observed.
Purpose of the Study:
- To investigate the increasing prevalence of multidrug-resistant tuberculosis (MDR-TB) at Bellevue Hospital Center.
- To identify demographic and clinical characteristics of patients with drug-resistant TB.
- To highlight the complex interplay between TB, AIDS, and MDR-TB epidemics.
Main Methods:
- Retrospective review of laboratory susceptibility test results for 4,681 TB cases over 20 years (1971-1991).
- Analysis of combined resistance to isoniazid and rifampin.
- Review of medical records for 100 patients diagnosed with drug-resistant TB.
Main Results:
- A significant increase in MDR-TB was observed, with combined isoniazid and rifampin resistance rising from 2.5% in 1971 to 16% in 1991.
- Drug-resistant TB patients were predominantly young (under 40), minority, male, jobless, undomiciled, with high rates of drug abuse and HIV infection.
- Higher rates of resistance were noted for individual anti-TB drugs.
Conclusions:
- The epidemics of AIDS and TB are compounded by a third epidemic of MDR-TB.
- Urgent attention is required for rapid MDR-TB diagnosis and development of novel therapeutic regimens.
- Addressing the social and hospital care environments is crucial for managing MDR-TB patients.