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Volume 13, Number 3—March 2007

Research

Worldwide Emergence of Extensively Drug-resistant Tuberculosis

N. Sarita Shah*1Comments to Author , Abigail Wright†, Gill-Han Bai‡2, Lucia Barrera§2, Fadila Boulahbal¶2, Nuria Martín-Casabona#2, Francis Drobniewski**2, Chris Gilpin††2, Marta Havelkovᇇ2, Rosario Lepe§§2, Richard Lumb¶¶2, Beverly Metchock*2, Françoise Portaels##2, Maria Filomena Rodrigues***2, Sabine Rüsch-Gerdes†††2, Armand Van Deun##2, Veronique Vincent‡‡‡2, Kayla F. Laserson*, Charles Wells*, and J. Peter Cegielski*
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †World Health Organization, Geneva, Switzerland; ‡Korean Institute of Tuberculosis, Seoul, Republic of Korea; §National Institute of Infectious Diseases, Buenos Aires, Argentina; ¶Institut Pasteur d’Algérie, Alger, Algeria; #Hospital Universitaris Vall d’Hebron, Barcelona, Spain; **Health Protection Agency, London, United Kingdom; ††Prince Charles Hospital, Brisbane, Queensland, Australia; ‡‡National Institute of Public Health, Scrobarova, Czech Republic; §§Institute of Public Health of Chile, Providencia Santiago, Chile; ¶¶Institute of Medical and Veterinary Science, Adelaide, South Australia, Australia; ##Institute of Tropical Medicine, Antwerp, Belgium; ***National Institute of Health, Porto, Portugal; †††National Reference Center for Mycobacteria, Borstel, Germany; ‡‡‡Institut Pasteur, Paris, France; 1Current affiliation: Albert Einstein College of Medicine, Bronx, New York, USA; 2Member: World Health Organization/International Union against Tuberculosis and Lung Diseases Network of Supranational Reference Laboratories

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Table 4

Extensively drug-resistant tuberculosis among multidrug-resistant tuberculosis isolates, by region, 2000–2004*

Geographic regionTotal no. isolates tested†Total MDR-TB patientsTotal XDR-TB patients
Nn (% of all isolates tested)n (% of MDR-TB patients)
Industrialized nations‡2,499821 (32.9)53 (6.5)
Latin America§985543 (55.1)32 (5.9)
Eastern Europe¶ and Russia1,153406 (35.2)55 (13.6)
Africa and Middle East#665156 (23.5)1 (0.6)
Asia (other than Republic of Korea)***391274 (70.1)4 (1.5)
Republic of Korea11,9391,298 (10.9)200 (15.4)
Total††3,418345

*Region from which isolate was submitted to Supranational Reference Laboratory. MDR-TB, multidrug-resistant tuberculosis; XDR-TB, extensively drug-resistant tuberculosis, i.e., multidrug-resistant tuberculosis (resistant to at least isoniazid and rifampin) with additional resistance to ≥3 classes of second-line drugs.
†Total no. of isolates tested for resistance to >3 second-line drug classes, including aminoglycosides (amikacin or kanamycin), polypeptides (capreomycin), fluoroquinolones (ofloxacin or ciprofloxacin), thioamides (ethionamide or prothionamide), cycloserine, and para-aminosalicyclic acid.
United States, Canada, United Kingdom, countries in Western Europe (Ireland, Portugal, Germany, France, Belgium, Spain), Japan, and Australia.
§Argentina, Bolivia, Brazil, Chile, Ecuador, Guyana, French Guiana, Peru, Mexico, Guatemala, El Salvador, Costa Rica.
Republic of Georgia, Czech Republic, Azerbaijan, Armenia.
#Afghanistan, Algeria, Egypt, Tunisia, Botswana, Burundi, Cameroon, Central African Republic, Côte d’Ivoire, Djibouti, Madagascar, Rwanda, South Africa, Senegal, Uganda.
**Bangladesh, Indonesia, Papua New Guinea, Thailand, East Timor.
††For 2 XDR-TB patients, data were missing about geographic region.

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