A contagious cancer (MDR-T) – multidrug-resistant tuberculosis

Tuberculosis, once known as the white plague, is the disease with the highest mortality rate caused by infection with a single pathogen. In my country, tuberculosis was first recorded as "pulmonary tuberculosis" in the Yellow Emperor's Classic of Internal Medicine, and in Europe, tuberculosis caused a quarter of the deaths [1]. In recent years, a new virus with multidrug resistance is spreading rapidly, posing a great threat to human health. It is multidrug-resistant tuberculosis (MDR-T), which is more contagious and pathogenic and is known as "contagious cancer"!

What is MDR-T?

The lungs are the most common site of infection for Mycobacterium tuberculosis. The conventional first-line treatment for pulmonary tuberculosis is rifampicin, isoniazid, ethambutol and pyrazinamide [2]. However, due to poor patient compliance and irregular drug use, the incidence of multidrug-resistant Mycobacterium tuberculosis is increasing [3]. Like common pulmonary tuberculosis, MDR-T is also caused by the simultaneous infection of Mycobacterium tuberculosis resistant to two first-line drugs, rifampicin and isoniazid, through the respiratory tract [4].

Clinical symptoms of MDR-T

The clinical symptoms of MDR-T are similar to those of ordinary pulmonary tuberculosis patients, including cough and sputum, blood in sputum for ≥ 2 weeks, fever, fatigue, night sweats and weight loss. In addition, drug sensitivity tests or X-pert tests are required to confirm that it is drug-resistant Mycobacterium tuberculosis.

How serious is MDR-T[5-7]?

1. Long course of disease and difficult treatment: Compared with the 6-8 months treatment period for common pulmonary tuberculosis, the treatment period for MDR-T can be as long as 18-24 months;

2. High treatment costs and serious side effects: MDR-T patients are treated with second-line drugs, most of which are expensive and have serious side effects;

3. Low cure rate and high risk of transmission: The cure rate of MDR-T patients is low, which also means that the risk of transmission among patients is high and the transmission cycle is long.

Can MDR-T be cured?

Although MDR-T patients are mostly treated with combined medication, their cure rate is much lower than that of ordinary pulmonary tuberculosis, about 50% or even lower. Therefore, MDR-T patients need to continue taking medication until recovery after completing 2 months of hospitalization. Patients diagnosed with tuberculosis must cherish the opportunity for treatment and must not stop taking medication without authorization, which will not only reduce the cure rate, but also give multidrug-resistant Mycobacterium tuberculosis the opportunity to infect more healthy people.

Together we fight multidrug-resistant tuberculosis

1. Early detection and standardized treatment: Tuberculosis patients should be detected early and given standardized treatment to avoid single medication and reduce the risk of drug resistance.

2. Short-term chemotherapy under direct supervision: ensure that patients receive regular and systematic treatment without hospitalization and complete the prescribed course of treatment, thereby effectively preventing the occurrence of MDR-T.

3. Self-protection: MDR-T is mainly transmitted through droplets. In public places and crowded places, good ventilation should be maintained. When in contact with tuberculosis patients, keep a certain distance and take good self-protection measures.

4. Preventive treatment: For people who have close contact with MDR-T patients, preventive treatment can be considered to reduce the risk of infection.

5. Public education and training: Strengthen public education on tuberculosis and its prevention measures, increase public awareness of MDR-T, and promote early medical treatment and treatment.

References

[1] Chen Ling. Epidemiological overview, diagnosis and treatment status, research direction and prospects of multidrug-resistant tuberculosis[J]. Journal of Practical Cardiovascular Diseases, 2018, 26(11): 1-4.

[2] Diao Tingting, Liu Chao, Zhang Hongji, et al. Advances in chemotherapy for multidrug-resistant tuberculosis[J]. Journal of Lanzhou University (Medical Edition), 2024, 50(11): 87-94.

[3] Wang Chunlei, Jin Tao, Zhao Pengpeng, et al. Analysis of medication compliance and influencing factors in patients with multidrug-resistant tuberculosis in Huai'an City, Jiangsu Province[J]. Chinese Journal of Antituberculosis, 2022, 44(10): 1057-1062.

[4] Expert consensus on drug resistance detection of Mycobacterium tuberculosis[J]. Chinese Journal of Antituberculosis, 2019, 41(02): 129-137.

[5] Zhao Yujie, Yan Kai, Chen Jinou, et al. Analysis of quality of life and its influencing factors in patients with multidrug-resistant tuberculosis[J]. Chinese Journal of Antituberculosis, 2019, 41(01): 88-94.

[6] Akalu TY, Clements ACA, Wolde HF, et al. Economic burden of multidrug-resistanttuberculosis on patients and households: a global systematic review and meta-analysis[J]. Sci Rep, 2023, 15;13(1):22361.

[7] Chen Y, Yuan Z, Shen X, et. Time to multidrug-resistanttuberculosis treatment initiation in association with treatment outcomes in Shanghai, China[J]. Antimicrob Agents Chemother, 2018, 27;62(4):e02259-17.

Source: Chongqing Science Writers Association

Author: Zhou Xue, laboratory technician of Chongqing Tuberculosis Prevention and Control Institute, Zeng Meng, chief technician and Ran Jiyu, chief technician of Yongchuan Hospital Affiliated to Chongqing Medical University, and Zou Jingbo, chief technician of Chongqing Yongchuan District Center for Disease Control and Prevention

Audit expert: Li Hanbin

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