PROGNOSIS

Progression from multiple drug resistant TB infection to TB disease occurs when the TB
bacilli overcome the immune system defenses and begin to multiply. In primary TB
disease—1–5% of cases—this occurs soon after infection. However, in the majority of
cases, a latent infection occurs that has no obvious symptoms. These dormant bacilli can
produce tuberculosis in 2–23% of these latent cases, often many years after infection. The
risk of reactivation increases with immunosuppression, such as that caused by infection
with HIV. In patients co-infected with M. tuberculosis and HIV, the risk of reactivation
increases to 10% per year.

Prognosis
Multiple drug resistant tuberculosis that is not resistant to medication can almost always
be cured if the person complies with the treatment regimens and antibiotics are started
before major parts of the lung are destroyed. People who are infected with drug-resistant
tuberculosis strains may have less chance of being cured, depending on which drugs they
are resistant to and how much lung damage they have before effective treatment is
started.

Without proper treatment, more than half of people with active tuberculosis will die
within five years.

Prognosis
The prognosis for recovery from multiple drug resistant TB is good for most patients, if
the disease is diagnosed early and given prompt treatment with appropriate medications
on a long-term regimen. According to a 2002 Johns Hopkins study, most patients in the
United States who die of multiple drug resistant TB are older—average age 62—and
suffer from such underlying diseases as diabetes and kidney failure.
Modern surgical methods have a good outcome in most cases in which they are needed.
Miliary tuberculosis is still fatal in many cases but is rarely seen today in developed
countries. Even in cases in which the bacillus proves resistant to all of the commonly
used medications for multiple drug resistant TB, other seldom-used drugs may be tried
because the tubercle bacilli have not yet developed resistance to them.
Abstract
Multidrug-resistant tuberculosis (MDR-TB), caused by Mycobacterium tuberculosis that
is resistant to both isoniazid and rifampicin with or without resistance to other drugs, is a
phenomenon that is threatening to destabilize global tuberculosis (TB) control. MDR-TB
is a worldwide problem, being present virtually in all countries that were surveyed.
According to current World Health Organization and the International Union Against
Tuberculosis and Lung Disease estimates, the median prevalence of MDR-TB has been
1.1% in newly diagnosed patients. The proportion, however, is considerably higher
(median prevalence, 7%) in patients who have previously received anti-TB treatment.
While host genetic factors may contribute to the development of MDR-TB, incomplete
and inadequate treatment is the most important factor leading to its development,
suggesting that it is often a man made tragedy. Efficiently run TB control programs based
on a policy of directly observed treatment, short course (DOTS), are essential for
preventing the emergence of MDR-TB. The management of MDR-TB is a challenge that
should be undertaken by experienced clinicians at centers equipped with reliable
laboratory services for mycobacterial cultures and in vitro sensitivity testing as it the
requires prolonged use of costly second-line drugs with a significant potential for
toxicity. The judicious use of drugs; supervised standardized treatment; focused clinical,
radiologic, and bacteriologic follow-up; and surgery at the appropriate juncture are key
factors in the successful management of these patients. With newer effective anti-TB
drugs still a distant dream, innovative approaches such as DOTS-Plus are showing
promise for the management of patients with MDR-TB under program conditions and
appear to be a hope for future.