Extensively drug-resistant tuberculosis

From Ask Dr Wiki

Extensively drug-resistant tuberculosis (XDR-TB) is defined as tuberculosis that has evolved resistance to rifampicin and isoniazid (resistance to these first line anti-TB drugs defines Multi-drug-resistant tuberculosis, or MDR-TB), as well as to any member of the quinolone family and at least one of the following second-line TB treatments: kanamycin, capreomycin, or amikacin.^[1] The old case definition of XDR-TB is MDR-TB that is also resistant to three or more of the six classes of second-line drugs.^[2] This definition should no longer be used, but is included here because many older publications refer to it.

The principles of treatment for MDR-TB and for XDR-TB are the same. The main difference is that XDR-TB is associated with a much higher mortality rate than MDR-TB, because of a reduced number of effective treatment options.^[2] The epidemiology of XDR-TB is currently not well studied, but it is believed that XDR-TB does not transmit easily in healthy populations, yet is capable of causing epidemics in populations which are already stricken by HIV and therefore more susceptible to TB infection.^[3]

Contents 1 Epidemiology of drug-resistant TB 2 South African epidemic 3 See also 4 References 5 External links

Epidemiology of drug-resistant TB

A 1997 survey of 35 countries found death rates above 2% in about a third of the countries surveyed. The highest rates were in the former USSR, Argentina, India and China, and was associated with poor or failing national tuberculosis control programs. Likewise, the appearance of high rates of MDR-TB in New York city in the early 1990s was associated with the dismantling of public health programmes.^[4][5]

MDR-TB can develop in the course of the treatment of fully sensitive TB and this is always the result of patients missing doses or failing to complete a course of treatment.

MDR-TB strains appear to be less fit and less transmissible.^[6] It has been known for many years that INH-resistant TB is less virulent in guinea pigs, and the epidemiological evidence is that MDR strains of TB do not dominate naturally. A study in Los Angeles found that only 6% of cases of MDR-TB were clustered. MDR-TB has a mortality rate comparable to lung cancer.Template:Fact People who have weakened immune systems (because of diseases such as HIV or because of drugs) are more susceptible to catching TB.

South African epidemic

Since late 2006, there has been an epidemic of XDR-TB in South Africa. The outbreak was first reported as a cluster of 53 patients in a rural hospital in KwaZulu-Natal of whom 52 died.^[3] What was particularly worrisome was that the median survival from sputum specimen collection to death was only 16 days and that the majority of patients had never previously received treatment for tuberculosis. This is the epidemic for which the acronym XDR-TB was first used, and although TB strains that fulfill the current definition have been identified retrospectively,^[7][8] this was the largest group of linked cases ever found. Since the initial report in September 2006,^[9] cases have now been reported in most provinces in South Africa. As of 16 March 2007, there were 314 cases reported, with 215 deaths.^[10] It is clear that the spread of this strain of TB is closely associated with a high prevalence of HIV and poor infection control; in other countries where XDR-TB strains have arisen, drug resistance has arisen from mismanagement of cases or poor patient compliance with drug treatment instead of being transmitted from person to person.^[11] This strain of TB does not respond to any of the drugs currently available in South Africa for first- or second-line treatment. It is now clear that the problem has been around for much longer than health department officials have suggested, and is far more extensive.^[12] By 23 November 2006, 303 cases of XDR-TB had been reported, of which 263 were in KwaZulu-Natal.^[13] Serious thought has been put to isolation procedures that may deny some patients their mobility, but which may be necessary to prevent further spread of this strain of TB.^[14]

See also

• Tuberculosis treatment
• Endobronchial valve

• Drug resistance
• Antibiotic resistance
• Andrew Speaker
• Multi-drug-resistant tuberculosis
• Drug resistant diseases
  • MRSA
  • VRE

References

1. ↑ {{
   1. if: {{#if: http://www.who.int/mediacentre/news/notes/2006/np29/en/index.html | {{#if: WHO Global Task Force outlines measures to combat XDR-TB worldwide |1}}}}
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   | {{#if: {{#if: | {{#if: |1}}}} ||You must specify archiveurl = and archivedate = when using {{cite web}}. {{#if: ||}} }} }}{{#if: World Health Organisation | {{#if: | [[{{{authorlink}}}|{{#if: | {{{last}}}{{#if: | , {{{first}}} }} | World Health Organisation }}]] | {{#if: | {{{last}}}{{#if: | , {{{first}}} }} | World Health Organisation }} }} }}{{#if: World Health Organisation | {{#if: | ; {{{coauthors}}} }} }}{{#if: World Health Organisation| {{#if: | ({{#ifeq:{{#time:Y-m-d|{{{date}}}}}|{{{date}}}|[[{{{date}}}]]|{{{date}}}}}) | {{#if: | {{#if: | ({{{month}}} {{{year}}}) | ({{{year}}}) }} }} |}} }}{{#if: World Health Organisation | . }}{{ #if: | {{{editor}}}: }}{{#if: | {{#if: | {{#if: WHO Global Task Force outlines measures to combat XDR-TB worldwide | [{{{archiveurl}}} WHO Global Task Force outlines measures to combat XDR-TB worldwide] }}}} | {{#if: http://www.who.int/mediacentre/news/notes/2006/np29/en/index.html | {{#if: WHO Global Task Force outlines measures to combat XDR-TB worldwide | WHO Global Task Force outlines measures to combat XDR-TB worldwide }}}} }}{{#if: | () }}{{#if: | ({{{language}}}) }}{{#if: | . {{{work}}} }}{{#if: | {{{pages}}} }}{{#if: | . {{{publisher}}}{{#if: World Health Organisation | | {{#if: || }} }} }}{{#if: World Health Organisation ||{{#if: | ({{#ifeq:{{#time:Y-m-d|{{{date}}}}}|{{{date}}}|[[{{{date}}}]]|{{{date}}}}}) | {{#if: | {{#if: | ({{{month}}} {{{year}}}) | ({{{year}}}) }} }} }} }}.{{#if: | Archived from the original on [[{{{archivedate}}}]]. }}{{#if: | DOI:{{{doi}}}. }}{{#if: 2006-10-21 | Retrieved on 2006-10-21{{#if: | , [[{{{accessyear}}}]] }}. }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}}. }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}}. }}{{#if: |  “{{{quote}}}” }}
2. ↑ ^{2.0 2.1} {{#if:Center for Disease Control |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Center for Disease Control }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Center for Disease Control }} }} }}{{#if:Center for Disease Control |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2006 |{{#if: | ({{{month}}} 2006) | (2006) }} }} }}{{#if:Center for Disease Control | . }}{{#if:Center for Disease Control2006 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if:http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5511a2.htm |Emergence of Mycobacterium tuberculosis with Extensive Resistance to Second-Line Drugs — Worldwide, 2000–2004 |Emergence of Mycobacterium tuberculosis with Extensive Resistance to Second-Line Drugs — Worldwide, 2000–2004 }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:MMWR Weekly |. MMWR Weekly }}{{#if:55 | 55 }}{{#if:11 | (11) }}{{#if:301–305 |: 301–305 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:{{{doi}}} }}{{#if: |. ISSN {{{issn}}} }}{{#if: |. PMID {{{pmid}}} }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
3. ↑ ^{3.0 3.1} {{
   1. if: {{#if: http://go.reuters.com/newsArticle.jhtml?type=healthNews&storyID=13448940&src=rss/healthNews | {{#if: New TB strain could fuel South Africa AIDS toll |1}}}}
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   | {{#if: {{#if: | {{#if: |1}}}} ||You must specify archiveurl = and archivedate = when using {{cite web}}. {{#if: ||}} }} }}{{#if: Sarah McGregor | {{#if: | [[{{{authorlink}}}|{{#if: | {{{last}}}{{#if: | , {{{first}}} }} | Sarah McGregor }}]] | {{#if: | {{{last}}}{{#if: | , {{{first}}} }} | Sarah McGregor }} }} }}{{#if: Sarah McGregor | {{#if: | ; {{{coauthors}}} }} }}{{#if: Sarah McGregor| {{#if: | ({{#ifeq:{{#time:Y-m-d|{{{date}}}}}|{{{date}}}|[[{{{date}}}]]|{{{date}}}}}) | {{#if: | {{#if: | ({{{month}}} {{{year}}}) | ({{{year}}}) }} }} |}} }}{{#if: Sarah McGregor | . }}{{ #if: | {{{editor}}}: }}{{#if: | {{#if: | {{#if: New TB strain could fuel South Africa AIDS toll | [{{{archiveurl}}} New TB strain could fuel South Africa AIDS toll] }}}} | {{#if: http://go.reuters.com/newsArticle.jhtml?type=healthNews&storyID=13448940&src=rss/healthNews | {{#if: New TB strain could fuel South Africa AIDS toll | New TB strain could fuel South Africa AIDS toll }}}} }}{{#if: | () }}{{#if: | ({{{language}}}) }}{{#if: | . {{{work}}} }}{{#if: | {{{pages}}} }}{{#if: Reuters | . Reuters{{#if: Sarah McGregor | | {{#if: || }} }} }}{{#if: Sarah McGregor ||{{#if: | ({{#ifeq:{{#time:Y-m-d|{{{date}}}}}|{{{date}}}|[[{{{date}}}]]|{{{date}}}}}) | {{#if: | {{#if: | ({{{month}}} {{{year}}}) | ({{{year}}}) }} }} }} }}.{{#if: | Archived from the original on [[{{{archivedate}}}]]. }}{{#if: | DOI:{{{doi}}}. }}{{#if: 2006-09-17 | Retrieved on 2006-09-17{{#if: | , [[{{{accessyear}}}]] }}. }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}}. }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}}. }}{{#if: |  “{{{quote}}}” }}
4. ↑ {{#if:Frieden TR, Sterling T, Pablos-Mendez A, et al. |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Frieden TR, Sterling T, Pablos-Mendez A, et al. }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Frieden TR, Sterling T, Pablos-Mendez A, et al. }} }} }}{{#if:Frieden TR, Sterling T, Pablos-Mendez A, et al. |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:1993 |{{#if: | ({{{month}}} 1993) | (1993) }} }} }}{{#if:Frieden TR, Sterling T, Pablos-Mendez A, et al. | . }}{{#if:Frieden TR, Sterling T, Pablos-Mendez A, et al.1993 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} The emergence of drug-resistant tuberculosis in New York City] |The emergence of drug-resistant tuberculosis in New York City }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:N Engl J Med |. N Engl J Med }}{{#if:328 | 328 }}{{#if:8 | (8) }}{{#if:521–56 |: 521–56 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:{{{doi}}} }}{{#if: |. ISSN {{{issn}}} }}{{#if: |. PMID {{{pmid}}} }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if:PMID 8381207 |. PMID 8381207 }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
5. ↑ {{ #if: Laurie Garrett | {{ #if: | [[{{{authorlink}}}|{{ #if: | {{{last}}}{{ #if: | , {{{first}}} }} | Laurie Garrett }}]] | {{ #if: | {{{last}}}{{ #if: | , {{{first}}} }} | Laurie Garrett }} }} }}{{ #if: Laurie Garrett | {{ #if: | ; {{{coauthors}}} }} }}{{ #if: | [{{{origdate}}}] | {{ #if: | {{ #if: | [{{{origmonth}}} {{{origyear}}}] | [{{{origyear}}}] }} }} }}{{ #if: | ({{{date}}}) | {{ #if: 2000 | {{ #if: | ({{{month}}} 2000) | (2000) }} }} }}{{ #if: Laurie Garrett | . }}{{ #if: | "{{ #if: | [{{{chapterurl}}} {{{chapter}}}] | {{{chapter}}} }}",}}{{ #if: | in {{{editor}}}: }} {{ #if: | [{{{url}}} Betrayal of trust: the collapse of global public health] | Betrayal of trust: the collapse of global public health }}{{ #if: | ({{{format}}}) }}{{ #if: | , {{{others}}} }}{{ #if: | , {{{edition}}} }}{{ #if: | , {{{series}}} }}{{ #if: | (in {{{language}}}) }}{{ #if: Hyperion | {{#if: | , | . }}{{ #if: New York | New York: }}Hyperion }}{{ #if: 268ff | , 268ff }}{{ #if: | . DOI:{{{doi}}} }}{{ #if: | . {{{id}}} }}{{ #if: 0786884407 | . ISBN 0786884407 }}{{ #if: | . OCLC {{{oclc}}} }}{{ #if: | {{ #if: | . Retrieved on [[{{{accessdate}}}]] | {{ #if: | . Retrieved {{ #if: | on [[{{{accessmonth}}} {{{accessyear}}}]] | during [[{{{accessyear}}}]] }}}} }} }}.{{ #if: |  “{{{quote}}}” }} 
6. ↑ {{#if:Iseman MD |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Iseman MD }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Iseman MD }} }} }}{{#if:Iseman MD |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:1994 |{{#if: | ({{{month}}} 1994) | (1994) }} }} }}{{#if:Iseman MD | . }}{{#if:Iseman MD1994 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Evolution of drug-resistant tuberculosis: a tale of two species] |Evolution of drug-resistant tuberculosis: a tale of two species }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Proc. Natl. Acad. Sci. U.S.A. |. Proc. Natl. Acad. Sci. U.S.A. }}{{#if:91 | 91 }}{{#if:7 | (7) }}{{#if:2428-9 |: 2428-9 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[1] }}{{#if: |. ISSN {{{issn}}} }}{{#if:8146134 |. PMID 8146134 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }} Free Full Text.
7. ↑ {{#if:Shah NS, Wright A, Drobniewski F, et al. |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Shah NS, Wright A, Drobniewski F, et al. }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Shah NS, Wright A, Drobniewski F, et al. }} }} }}{{#if:Shah NS, Wright A, Drobniewski F, et al. |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2005 |{{#if: | ({{{month}}} 2005) | (2005) }} }} }}{{#if:Shah NS, Wright A, Drobniewski F, et al. | . }}{{#if:Shah NS, Wright A, Drobniewski F, et al.2005 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Extreme drug resistance in tuberculosis (XDR-TB): global survey of supranational reference laboratories for _Mycobacterium tuberculosis_ with resistance to second-line drugs] |Extreme drug resistance in tuberculosis (XDR-TB): global survey of supranational reference laboratories for _Mycobacterium tuberculosis_ with resistance to second-line drugs }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Int J Tuberc Lung Dis |. Int J Tuberc Lung Dis }}{{#if:9(Suppl 1) | 9(Suppl 1) }}{{#if: | ({{{issue}}}) }}{{#if:S77 |: S77 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:{{{doi}}} }}{{#if: |. ISSN {{{issn}}} }}{{#if: |. PMID {{{pmid}}} }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
8. ↑ {{#if:Centers for Diseases Control |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Centers for Diseases Control }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Centers for Diseases Control }} }} }}{{#if:Centers for Diseases Control |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2006 |{{#if: | ({{{month}}} 2006) | (2006) }} }} }}{{#if:Centers for Diseases Control | . }}{{#if:Centers for Diseases Control2006 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if:http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5611a3.htm?s_cid=mm5611a3_e |Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs-worldwide, 2000-2004 |Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs-worldwide, 2000-2004 }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Morb Mort Wkly Rep |. Morb Mort Wkly Rep }}{{#if:55 | 55 }}{{#if: | ({{{issue}}}) }}{{#if:301–5 |: 301–5 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:{{{doi}}} }}{{#if: |. ISSN {{{issn}}} }}{{#if: |. PMID {{{pmid}}} }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
9. ↑ {{#if:Gandhi NR, Moll A, Sturm AW, et al. |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Gandhi NR, Moll A, Sturm AW, et al. }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Gandhi NR, Moll A, Sturm AW, et al. }} }} }}{{#if:Gandhi NR, Moll A, Sturm AW, et al. |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2006 |{{#if: | ({{{month}}} 2006) | (2006) }} }} }}{{#if:Gandhi NR, Moll A, Sturm AW, et al. | . }}{{#if:Gandhi NR, Moll A, Sturm AW, et al.2006 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa] |Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Lancet |. Lancet }}{{#if:368 | 368 }}{{#if: | ({{{issue}}}) }}{{#if:1575–80 |: 1575–80 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:{{{doi}}} }}{{#if: |. ISSN {{{issn}}} }}{{#if: |. PMID {{{pmid}}} }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
10. ↑ {{
    1. if: {{#if: http://uk.f233.mail.yahoo.com/dc/launch?.rand=4a7p82180g9tg | {{#if: 314 XDR-TB cases reported in SA |1}}}}
    ||You must specify title = and url = when using {{cite web}}. {{#if: ||}} }}{{
    1. if:
    | {{#if: {{#if: | {{#if: |1}}}} ||You must specify archiveurl = and archivedate = when using {{cite web}}. {{#if: ||}} }} }}{{#if: Angela Quintal | {{#if: | [[{{{authorlink}}}|{{#if: | {{{last}}}{{#if: | , {{{first}}} }} | Angela Quintal }}]] | {{#if: | {{{last}}}{{#if: | , {{{first}}} }} | Angela Quintal }} }} }}{{#if: Angela Quintal | {{#if: | ; {{{coauthors}}} }} }}{{#if: Angela Quintal| {{#if: | ({{#ifeq:{{#time:Y-m-d|{{{date}}}}}|{{{date}}}|[[{{{date}}}]]|{{{date}}}}}) | {{#if: | {{#if: | ({{{month}}} {{{year}}}) | ({{{year}}}) }} }} |}} }}{{#if: Angela Quintal | . }}{{ #if: | {{{editor}}}: }}{{#if: | {{#if: | {{#if: 314 XDR-TB cases reported in SA | [{{{archiveurl}}} 314 XDR-TB cases reported in SA] }}}} | {{#if: http://uk.f233.mail.yahoo.com/dc/launch?.rand=4a7p82180g9tg | {{#if: 314 XDR-TB cases reported in SA | 314 XDR-TB cases reported in SA }}}} }}{{#if: | () }}{{#if: | ({{{language}}}) }}{{#if: | . {{{work}}} }}{{#if: | {{{pages}}} }}{{#if: Cape Times | . Cape Times{{#if: Angela Quintal | | {{#if: || }} }} }}{{#if: Angela Quintal ||{{#if: | ({{#ifeq:{{#time:Y-m-d|{{{date}}}}}|{{{date}}}|[[{{{date}}}]]|{{{date}}}}}) | {{#if: | {{#if: | ({{{month}}} {{{year}}}) | ({{{year}}}) }} }} }} }}.{{#if: | Archived from the original on [[{{{archivedate}}}]]. }}{{#if: | DOI:{{{doi}}}. }}{{#if: 2007-04-04 | Retrieved on 2007-04-04{{#if: | , [[{{{accessyear}}}]] }}. }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}}. }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}}. }}{{#if: |  “{{{quote}}}” }}
11. ↑ {{#if:Migliori GB, Ortmann J, Girardi E, et al. |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Migliori GB, Ortmann J, Girardi E, et al. }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Migliori GB, Ortmann J, Girardi E, et al. }} }} }}{{#if:Migliori GB, Ortmann J, Girardi E, et al. |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2007 |{{#if: | ({{{month}}} 2007) | (2007) }} }} }}{{#if:Migliori GB, Ortmann J, Girardi E, et al. | . }}{{#if:Migliori GB, Ortmann J, Girardi E, et al.2007 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if:http://www.cdc.gov/EID/content/13/5/07-0200.htm |Extensively drug-resistant tuberculosis, Italy and Germany |Extensively drug-resistant tuberculosis, Italy and Germany }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if: |. {{{journal}}} }}{{#if:13 | 13 }}{{#if:5 | (5) }}{{#if: |: {{{pages}}} }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:{{{doi}}} }}{{#if: |. ISSN {{{issn}}} }}{{#if: |. PMID {{{pmid}}} }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
12. ↑ {{#if:Sidley P. |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Sidley P. }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Sidley P. }} }} }}{{#if:Sidley P. |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2006 |{{#if: | ({{{month}}} 2006) | (2006) }} }} }}{{#if:Sidley P. | . }}{{#if:Sidley P.2006 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} South Africa acts to curb spread of lethal strain of TB] |South Africa acts to curb spread of lethal strain of TB }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Brit Med J |. Brit Med J }}{{#if:333 | 333 }}{{#if: | ({{{issue}}}) }}{{#if:825 |: 825 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:{{{doi}}} }}{{#if: |. ISSN {{{issn}}} }}{{#if: |. PMID {{{pmid}}} }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
13. ↑ {{
    1. if: {{#if: http://www.news24.com/News24/South_Africa/News/0,,2-7-1442_2035020,00.html | {{#if: 300+ cases of killer TB in SA |1}}}}
    ||You must specify title = and url = when using {{cite web}}. {{#if: ||}} }}{{
    1. if:
    | {{#if: {{#if: | {{#if: |1}}}} ||You must specify archiveurl = and archivedate = when using {{cite web}}. {{#if: ||}} }} }}{{#if: News24 | {{#if: | [[{{{authorlink}}}|{{#if: | {{{last}}}{{#if: | , {{{first}}} }} | News24 }}]] | {{#if: | {{{last}}}{{#if: | , {{{first}}} }} | News24 }} }} }}{{#if: News24 | {{#if: | ; {{{coauthors}}} }} }}{{#if: News24| {{#if: | ({{#ifeq:{{#time:Y-m-d|{{{date}}}}}|{{{date}}}|[[{{{date}}}]]|{{{date}}}}}) | {{#if: | {{#if: | ({{{month}}} {{{year}}}) | ({{{year}}}) }} }} |}} }}{{#if: News24 | . }}{{ #if: | {{{editor}}}: }}{{#if: | {{#if: | {{#if: 300+ cases of killer TB in SA | [{{{archiveurl}}} 300+ cases of killer TB in SA] }}}} | {{#if: http://www.news24.com/News24/South_Africa/News/0,,2-7-1442_2035020,00.html | {{#if: 300+ cases of killer TB in SA | 300+ cases of killer TB in SA }}}} }}{{#if: | () }}{{#if: | ({{{language}}}) }}{{#if: | . {{{work}}} }}{{#if: | {{{pages}}} }}{{#if: | . {{{publisher}}}{{#if: News24 | | {{#if: || }} }} }}{{#if: News24 ||{{#if: | ({{#ifeq:{{#time:Y-m-d|{{{date}}}}}|{{{date}}}|[[{{{date}}}]]|{{{date}}}}}) | {{#if: | {{#if: | ({{{month}}} {{{year}}}) | ({{{year}}}) }} }} }} }}.{{#if: | Archived from the original on [[{{{archivedate}}}]]. }}{{#if: | DOI:{{{doi}}}. }}{{#if: 2006-11-23 | Retrieved on 2006-11-23{{#if: | , [[{{{accessyear}}}]] }}. }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}}. }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}}. }}{{#if: |  “{{{quote}}}” }}
14. ↑ {{#if:Singh JA, Upshur R, Padayatchi N. |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Singh JA, Upshur R, Padayatchi N. }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Singh JA, Upshur R, Padayatchi N. }} }} }}{{#if:Singh JA, Upshur R, Padayatchi N. |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2007 |{{#if: | ({{{month}}} 2007) | (2007) }} }} }}{{#if:Singh JA, Upshur R, Padayatchi N. | . }}{{#if:Singh JA, Upshur R, Padayatchi N.2007 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} XDR-TB in South Africa: No Time for Denial or Complacency.] |XDR-TB in South Africa: No Time for Denial or Complacency. }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:PLoS Med |. PLoS Med }}{{#if:4 | 4 }}{{#if:1 | (1) }}{{#if:e50 |: e50 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if:10.1371/journal.pmed.0040050 |. doi:10.1371/journal.pmed.0040050 }}{{#if: |. ISSN {{{issn}}} }}{{#if: |. PMID {{{pmid}}} }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}

External links

• Video: Drug-Resistant TB in RussiaJuly 24, 2007, Woodrow Wilson Center event featuring Salmaan Keshavjee and Murray Feshbach