Extract

(See the Major Article by Sun et al, on pages 1724–33.)

Highly drug-resistant strains of Mycobacterium tuberculosis (M. tuberculosis) have surfaced in the news recently. Totally drug-resistant strains, unresponsive to any current therapies, were recently identified at several locations in India [1]. Although these strains have garnered international attention, similarly pan-resistant strains have been identified in several parts of the world [2, 3]. Where they have not been found, one cannot be confident that they do not exist, as many countries do not have the laboratory capacity to diagnose resistance to second-line tuberculosis drugs. Globally, the rising rates of multidrug resistance (resistance to the 2 first-line antibiotics, isoniazid and rifampin) are alarming, suggestive of both the extent of the current problem and indicative of the future landscape of increasingly drug-resistant tuberculosis. In China, for example, nearly 6% of new tuberculosis cases are multidrug-resistant. The rates of multidrug resistance in new cases are >20% in many countries in Central Asia and Eastern Europe, where the incidence of multidrug resistance in previously treated patients soars to over 50% [4].

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