PROGNOSIS Progression From Multiple Drug Resistant TB Infection to TB

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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 TBdisease—1–5% of cases—this occurs soon after infection. However, in the majority of cases, alatent infectionoccurs that has no obvious symptoms. These dormant bacilli can produce tuberculosis in 2–23% of these latent cases, often many years after infection. Therisk of reactivation increases with immunosuppression, such as that caused by infectionwithHIV. In patients co-infected with

M. tuberculosis

and HIV, the risk of reactivationincreases 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-resistanttuberculosis strains may have less chance of being cured, depending on which drugs theyare resistant to and how much lung damage they have before effective treatment isstarted.Without proper treatment, more than half of people with active tuberculosis will diewithin 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 medicationson a long-term regimen. According to a 2002 Johns Hopkins study, most patients in theUnited States who die of multiple drug resistant TB are older—average age 62—andsuffer 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 developedcountries. Even in cases in which the bacillus proves resistant to all of the commonlyused medications for multiple drug resistant TB, other seldom-used drugs may be tried because the tubercle bacilli have not yet developed resistance to them.

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