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Worse Fears Realized? Completely Drug Resistant TB has emerged in India

Extensively Drug Resistant (XDR) Mycobacterium tuberculosis (MTB) was first encountered in 2006. Now as we enter 2012 we learn that a strain of MTB totally resistant (TDR) to all current antimicrobials has entered the Indian sub-continent . This new strain to India, TDR-MTB first emerged in 2009 in 15 patients in Iran. In a letter to CID (http://cid.oxfordjournals.org/content/early/2011/11/24/cid.cir889.full.pdf+html) published in late December 2011 Udwadia and colleagues describe how a strain recovered from four patients was resistant to all first line (isoniazid, frifampicin, ethambutol, pyrazinamide and streptomycin) and second-line antimicrobials (ofloxacin, moxifloxacin, kanamycin, amikacin, capreomycin, para-aminosalicyclic acid, and ethionamide. While TDR-MTB is not new to the world, its emergence in India is cause for concern.

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