In early 2005, physicians at a rural hospital in KwaZulu-Natal,a province of South Africa, were concerned by a high rate ofrapid death among patients infected with the human immunodeficiencyvirus (HIV) who also had tuberculosis. A study revealed thepresence not only of multidrug-resistant (MDR) tuberculosisbut also what came to be called extensively drug-resistant (XDR)tuberculosis. XDR tuberculosis is caused by a strain of Mycobacteriumtuberculosis resistant to isoniazid and rifampin (which definesMDR tuberculosis) in addition to any fluoroquinolone and atleast one of the three following injectable drugs: capreomycin,kanamycin, and amikacin. Of 53 patients . . . [Full Text of this Article]
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Dr. Raviglione is the director of the Stop TB Department, and Dr. Smith is adviser to the director-general, at the World Health Organization, Geneva.
An interview with Dr. Smith can be heard at www.nejm.org.
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