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Multidrug-Resistant Tuberculosis (MDR TB)
and Extensively-Drug Resistant (XDR) TB

Return to XDR/MDR Webinar

Text for PowerPoint Slides

On This Page
Welcome and Overview
MDR/XDR TB: Global Problem, Domestic Implications
Laboratory Aspects of Drug-Resistant Tuberculosis
Averting Disaster: Principles in Preventing and Managing Drug Resistant TB
Management of Contacts to Cases of MDR/XDR
Lessons and Resources

Welcome and Overview

Slide 1: Multidrug-Resistant Tuberculosis (MDR TB) and Extensively-Drug Resistant (XDR) TB: A Web-Based Seminar

Slide 2: Welcome and Introduction

Slide 3: Collaboration

Slide 4: TB Regional Training and Medical Consultation Centers

Slide 5: Learning Objectives

Slide 6: Agenda

Slide 7: Continuing Education Credits

Slide 8: Continuing Education Disclaimer Statement

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MDR/XDR TB: Global Problem, Domestic Implications

Slide 9: MDR/XDR TB: Global Problem, Domestic Implications
L. Masae Kawamura, MD

Slide 10: Timebomb

Slide 11: Definitions

Slide 12: Global Drug-Resistant TB: How Bad Is It?

Slide 13: 2006 Global Distribution of MDR TB among New Cases

Slide 14: WHO Map – Countries with XDR TB Confirmed Cases to Date

Slide 15: Global Drug-Resistant TB: MDR/XDR TB Fuel

Slide 16: Primary MDR TB, United States, 1993–2005

Slide 17: Primary MDR TB in U.S.-born vs. Foreign-born Persons, United States, 1993–2005

Slide 18: XDR TB in the US: 1993-2007*

Slide 19: XDR TB Cases in the United States (Initial DST), 1993–2007*

Slide 20: Primary U.S. XDR TB Counted Cases as Defined on Initial DST by Year, 1993–2007*

Slide 21: XDR TB Pie Chart and Table

Slide 22: Outcomes of XDR TB Counted Cases Defined on Initial DST, 1993–2007*

Slide 23: Death of XDR TB Counted Cases Defined on Initial DST, 1993–2007

Slide 24: Have germs, will travel…

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Laboratory Aspects of Drug-Resistant Tuberculosis

Slide 25: Laboratory Aspects of Drug-Resistant Tuberculosis
Thomas M. Shinnick, Ph.D.

Slide 26: Spontaneous mutations develop as bacilli proliferate to >108

Slide 27: Drug-resistant mutants

Slide 28: Drug-resistant mutants (cont.)

Slide 29: Role of the Laboratory

Slide 30: Drug Susceptibility Testing

Slide 31: Agar Proportion Method

Slide 32: Critical Concentration

Slide 33: Critical Concentrations

Slide 34: Critical Concentration

Slide 35: Reasons for Discordant DST Results

Slide 36: Problem Drugs

Slide 37: Difficult Strains

Slide 38: Summary

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Averting Disaster: Principles in Preventing and Managing Drug Resistant TB

Slide 39: Averting Disaster: Principles in Preventing and Managing Drug-Resistant TB

Slide 40: Patient History

Slide 41: Treatment History

Slide 42: Treatment History (cont.)

Slide 43: Treatment History (cont.)

Slide 44: Drug-O-Gram: Initial Regimens

Slide 45: Poor Patient Outcome with Failure to Follow Principles of Care

Slide 46: Ten Years Later…Patient History (cont.)

Slide 47: Retreatment Regimen

Slide 48: Drug Susceptibility Testing from Commercial Lab

Slide 49: Retreatment Course

Slide 50: Treatment Failure

Slide 51: Discussion of Retreatment: Appropriate Management Decisions

Slide 52: Approach to Treatment of MDR TB: Errors in Management

Slide 53: Approach to Treatment of MDR TB: Errors in Management (cont.)

Slide 54: Building a Treatment Regimen

Slide 55: Building a Treatment Regimen (cont)

Slide 56: Building a Treatment Regimen (cont)

Slide 57: Retreatment Course Continued

Slide 58: Drug Susceptibility Test Results from National Reference Lab

Slide 59: Retreatment Course

Slide 60: Drug-O-Gram: Retreatment

Slide 61: Approach to Treatment of MDR TB: Errors in Management

Slide 62: Principles for Managing MDR TB

Slide 63: Principles for Managing MDR TB (cont.)

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Management of Contacts to Cases of MDR/XDR

Slide 64: Management of Contacts to Cases of MDR and XDR

Slide 65: Transmission of Tuberculosis

Slide 66: Challenges to an Evidence-Based Approach to Management of Contacts to MDR and XDR TB

Slide 67: Are drug-resistant strains as transmissible as drug-susceptible strains?

Slide 68: Are drug-resistant strains likely to progress to active disease once infection is established?

Slide 69: Secondary Case Rate Ratio (SR) of Drug-Resistant (DR) Strains, by (HIV) Serostatus and Place of Birth

Slide 70: Are drug-resistant strains likely to progress to active disease once infection is established?

Slide 71: Conflicting Data

Slide 72: Are drug-resistant strains likely to progress to active disease once infection is established?

Slide 73: Are drug-resistant strains as likely to progress to active disease?

Slide 74: Are all MDR and XDR strains equally virulent?

Slide 75: Should we treat or follow contacts to MDR/XDR?

Slide 76: Practical Points in Treating MDR/XDR Contacts

Slide 77: Treatment Outcomes of MDR Contacts

Slide 78: Treatment Outcomes of MDR Contacts (cont.)

Slide 79: Summary

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Lessons and Resources

Slide 80: MDR and XDR TB: Lessons & Resources

Slide 81: Lessons from US Traveler with XDR/MDR TB

Slide 82: Lessons from US Traveler with XDR/MDR TB (cont.)

Slide 83: Consultation

Slide 84: Regional Training and Medical Consultation Centers

Slide 85: Regional Training and Medical Consultation Centers

Slide 86: RTMCC Training

Slide 87: RTMCC Educational Products & Resources for XDR/MDR

Slide 88: Additional XDR and MDR TB Educational Resources

Slide 89: CDC’s Extensively Drug-Resistant Tuberculosis (XDR TB) Webpage

Slide 90: CDC’s Extensively Drug-Resistant Tuberculosis (XDR TB) Webpage

Slide 91: CDC’s XDR TB Webpage (cont.)

Slide 92: Acknowledgements

Slide 93: CDC and Regional Training and Medical Consultation Centers

Slide 94: Panel Discussion

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