EXTENSIVELY DRUG-

RESISTANCE TUBERCULOSIS
(XDR TB)

PRESENTED BY
SUPRIA GHOSH
JINNAT ARA JULLE
ANIK MAHAJON
MUNJINA MIM
AYSHA ZAFRIN
SANITA FARIA
FARZANA ALAM AKHI
 XDR TB

Extensively drug-resistant TB (XDR TB) is a rare type of multidrug-

resistant tuberculosis (MDR TB) that is resistant to isoniazid,
rifampicin, a fluoroquinolone, and a second-line injectable drug
(amikacin, capreomycin, and kanamycin).

Significance :
 Serious threat to global health.
 Limited treatment options.
 Risk of treatment failure and death.

Global Prevalence: The World Health Organization (WHO)

estimated that there were around 484,000 cases of multidrug-resistant
TB (MDR-TB), of which about 10% were XDR-TB, globally in 2019.
 Case Study

Patient Name : Tarek Hossain

Age : 45 years
Gender : Male

Medical History :

 Tarek Hossain has a history of pulmonary tuberculosis (TB) diagnosed 10 years ago. He completed
a standard course of treatment for drug-susceptible TB at that time and appeared to have made a
full recovery. However, he recently started experiencing recurrent symptoms such as persistent
cough more than 3 weeks, weight loss, night sweats, and fatigue.

Probable Diagnosis : Drug resistance tuberculosis.

Differential Diagnosis :
1. Bacterial Pneumonia
2. Pulmonary Fungal Infection
3. Sarcoidosis
 Investigation

Specimen : Sputum

Sample Collection :
 Day 1 sample 1 : Patient provides on the spot sample.
 Day 2 sample 2 : Patient brings early morning sample.

 Sputum Smear Microscopy : Acid-fast bacilli was positive.

 Drug Susceptibility Testing (DST): Resistance to
Both isoniazid (INH) and rifampicin (RIF)
Fluoroquinolones (moxifloxacin)
Second-line injectable drugs (amikacin)
 Molecular test : Drug resistance strains of tuberculosis bacteria present.
 Chest X-ray : Cavities present in the lung.

Confirmatory Diagnosis : Extensively drug-resistance Tuberculosis(XDR TB)

 Treatment Plan

 Drug Susceptibility Testing

 Combination Therapy
Combination of at least 4 drugs which contain three drugs from Group A and at
least 1 drug from Group B.
 Group A –
1.Levofloxacin
2.Linezolid
3.Bedaquiline
 Group B-
1.Clofazimine
2.Cycloserine
 Duration of Treatment (18-24 months or even longer)
 Directly Observed Therapy(DOT)
 Supportive Care
 Infection Control Measures
 Longer oral XDR TB regimen

Group Drugs Adverse Effect

Group A Levofloxacin or Nausea,vomiting,diarrhoea,headache,
Moxifloxacin sunburn
Bedaquiline Cardiac arrhythmia,liver damage,arthralgia

Linezolid Nausea,vomiting, diarrhoea,headache

Group B Clofazimine Skin discolouration
Cycloserine or Headache,dizziness,confusion,tremor
Terizidone
Group C Ethambutol Visual disturbance
Delamanid
Pyrazinamide Hepatitis
Meropenem Diarrhoea,nausea,vomiting
Amikacin Hearing loss
Ethionamide Goiter
 Doses of XDR TB Drugs

Drugs Dose

1. Levofloxacin 1000 mg (once daily)

2.Bedaquiline 400 mg (once daily)

3.Linezolid 600 mg (twice daily)

4.Clofazimine 200 mg (once daily)

 XDR TB Management & Prevention

Strong TB Control Programs

Prompt Diagnosis & Treatment
Directly Observed Therapy(DOT)
Improved Drug Management
Infection Control
Contact Tracing and Screening
Vaccination(BCG vaccine)
Health System Strengthening
Public Awareness & Education