MODULE B
1. Identify MDR-TB suspects MDR-TB suspects are TB symptomatics with an identified risk to develop MDR-TB. To detect these patients, high-risk groups for MDR-TB based on findings from the DOTS-Plus pilot project and the nationwide drug resistance survey (DRS) have been identified as shown in Box 1. In general, previous anti-TB treatment is a risk factor for resistance and therefore, all previously treated patients should be referred to the MDR-TB Treatment Center for screening and diagnosis. By asking a few basic questions to TB suspects and by correctly monitoring current TB patients, DOTS facilities will be able to detect a large number of patients with high risk for MDR-TB in a timely manner. The symptoms of pulmonary TB are the same as for MDR-TB, in particular, cough for two weeks or more. Other symptoms of TB include fever, chest and/or back pain, hemoptysis (coughing up of blood), weight loss and others such as night sweats, fatigue, body malaise, and shortness of breath. Being a contact of an MDR-TB case puts both new and retreatment patients at high risk for MDR-TB. Experience at the Tropical Disease Foundation (TDF) showed that among 1,737 MDR-TB contacts, 251 (14%) had radiographic evidence of TB. From these, 181 who submitted sputum and had available results, 42 (23%) turned out culture-positive, with MDR noted in 24 (57.1%), drug resistance other than MDR-TB in 7 (16.7%) and pan-susceptibility in 11 (26.2%). For retreatment cases, some patient types have higher MDR-TB prevalence than others. In the Philippines, information regarding this is still being gathered, and all retreatment cases are considered at risk of being MDR-TB. Among patients receiving DOTS Category II treatment, MDR-TB is suspected if there is non sputum smear-conversion on the third month of treatment. A limited study from the TDF DOTS-Plus pilot project showed that of 22 Category II non-converters among 226 enrolled patients, MDR-TB was noted in 73% (16). On the other hand, of 36 Category I non-converters on month 2 among 181 enrolled cases, MDR-TB was noted in only 6%. Additionally, if a patient presents to a DOTS facility with TB and reports that he has already received two or more courses of anti-TB treatment that were self-administered upon prescription of a doctor, that patient should be suspected of having MDR-TB and be referred to an MDR-TB Treatment Center. A treatment course is defined as at least a month of intake of anti-TB drug(s) excluding prophylactic treatment. While HIV is not by itself a risk factor for MDR-TB, since TB/HIV coinfected patients usually have negative sputum smear results, HIV-positive individuals who have TB symptoms should be investigated for resistance using culture and DST. Furthermore, HIV co-infection with MDR-TB is a severe disease with a very high mortality rate and should be diagnosed promptly for immediate treatment. Without proper detection and treatment of persons who are at high risk for DR-TB, there is a great danger that DR-TB will continue to spread in the community.
Detect Cases of MDR-TB
7
