Get to know TB xdr and its treatment

When diagnosed with tuberculosis, patients must undergo long-term treatment. Usually, treatment can take up to 6 months or even more, depending on the severity of the disease. When patients are not disciplined in carrying out TB treatment, tuberculosis can pose a risk of antibiotic resistance. In more severe cases, the active pulmonary TB suffered can develop into XDR TB. How fatal is this condition?

What is XDR TB?

Extensively drug-resistant tuberculosis or XDR TB is a condition in which the patient is resistant to anti-tuberculosis drugs (OAT). Although similar, this condition is more serious than MDR TB (multi-drug resistant tuberculosis).

MDR TB patients are usually resistant to the most effective drugs such as isoniazid (INH) and rifampin (first-line drugs). Meanwhile, for XDR TB, apart from being immune to first-line TB drugs, patients can also be resistant to second-line TB drugs, such as:

amikasin
kanamycin
capreomycin
fluoroquinolone

XDR TB is very dangerous because the high level of immunity in many drugs will make the TB virus harder to kill. Not infrequently cases of XDR TB can cause death.

To make matters worse, people with XDR TB are also at a higher risk of transmitting drug-resistant TB bacteria to healthy people than people with regular active pulmonary TB. This means that the higher the risk of other people contracting antibiotic-resistant bacteria.

Based on WHO data at the end of 2016, there were about 6.2% of patients with XDR TB in 123 countries. Of the 490,000 cases of MDR TB in the same year, only a small proportion of XDR TB bacteria were detected.

However, it does not rule out the increase in the number of XDR TB cases, considering that there are still many countries that have not been able to detect this disease optimally.

What causes XDR TB?

Generally, XDR tuberculosis can be caused due to external and internal factors.

For external factors, it is usually related to the medical action performed. XDR TB can occur because of errors in the treatment given. Some of them are:

Abused TB medicine
Inadequate clinical care
Inadequate prescription medication
Poor quality medicine
Difficulty access to facilities that provide treatment
Obstructed supply of drugs to clinics
The duration of treatment is too short

Meanwhile, internal factors occur when a patient does not take TB medication regularly, such as often forgetting to take TB medication. Another factor, you do not complete the TB treatment stages as recommended by the doctor, aka stop in the middle of the road.

This is usually done when the patient feels that his condition has improved. Even though the bacteria that cause tuberculosis have not completely died so that when treatment is stopped, the symptoms of tuberculosis that have been successfully treated can reappear.

This disease can also be transmitted when you breathe in the air that contains the bacteria that cause TB that are resistant to first and second-line drugs. These bacteria are released by XDR TB sufferers when coughing, sneezing and talking.

Symptoms of XDR tuberculosis

The symptoms experienced by patients with XDR TB are actually no different from ordinary active pulmonary TB. The difference is that the symptoms of TB that were initially felt can get worse or if you are no longer experiencing symptoms, the following groups of health problems can reappear:

Cough with phlegm that is sometimes accompanied by blood for more than two weeks,
Limp body
Shortness of breath and chest pain
Weight loss drastically
Fever
Cold sweat at night

People with MDR TB conditions are more at risk of developing extra-pulmonary TB, which is a condition in which the TB bacteria also attack other organs such as the kidneys, brain, and bones. The symptoms you feel will vary depending on the organ that is infected with tuberculosis bacteria. For example, the TB bacteria that spreads in the lymphatic channels can cause pain and swelling in the area of the glands and lymph channels.

If you experience the above symptoms, you should immediately see a doctor. To confirm the diagnosis of a drug-resistant TB condition, your doctor will ask you to undergo a number of TB tests, such as the Molecular Rapid Test which specifically detects drug-resistant tuberculosis conditions.

What is the treatment for XDR TB disease?

XDR tuberculosis is of course still treatable. However, it should also be noted that treating this disease will take a longer time, cost more, and have a lower likelihood of successful treatment than regular TB or MDR. According to the CDC, the success of XDR TB treatment is rare with a percentage chance of recovery of only about 30-50 percent.

In addition to factors of resistance to certain types of OAT, the success of treatment is also influenced by the patient's condition such as the severity of the disease, the patient's immune condition, and the patient's compliance during treatment.

In the book Drug-Resistant Tuberculosis Treatment Guide, treatment given to XDR TB patients are:

Extend the duration of treatment with the use of non-resistant second-line TB drugs for up to 12 months, usually injectable drugs.
Using third-generation fluoroquinolone drugs, such as moxifloxacin .
Using a fourth class TB drug that specifically treats drug-resistant TB, such as ethionamide or prothionamide .
Combining two to three types of TB drugs from the fifth class, such as using a type of drug bedaquiline , linezolid, and clofazimine .

The use of first-line OATs that do not show a resistance effect is usually continued during XDR TB treatment. If it is known that there is serious tissue damage to the lungs, it is possible that surgery will be performed to remove the damaged tissue.

Side effects of XDR tuberculosis treatment

Because the treatment is more complicated and the drugs used are stronger, of course the side effects of TB drugs that appear can be heavier. Treatment for drug-resistant TB can cause hearing loss, depression, and kidney problems.

In addition, class five antituberculosis drugs which are often used as the main drug for XDR TB conditions such as linezolid can cause side effects in the form of:

Myelosuppression (decreased production of blood cells)
Peripheral neuropathy (peripheral nervous system disorders)
Lactic acidosis (excess lactic acid)

If these side effects occur, TB treatment must be stopped or the doctor will adjust the dosage that can be more tolerated by the patient's body.

XDR TB is a very serious condition because it can reduce the chances of recovering from TB disease. The maintenance required will cost more, energy and time. To prevent this, make sure you undergo complete TB treatment with discipline.