Drug-Resistant Tuberculosis 2020: Where We Stand
The control of tuberculosis (TB) is hampered by the emergence of multidrug-resistant (MDR) <i>Mycobacterium tuberculosis</i> (Mtb) strains, defined as resistant to at least isoniazid and rifampin, the two bactericidal drugs essential for the treatment of the disease. Due to the worldwide...
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doaj-9150015be69e4253808890ac442b34a52020-11-25T03:31:06ZengMDPI AGApplied Sciences2076-34172020-03-01106215310.3390/app10062153app10062153Drug-Resistant Tuberculosis 2020: Where We StandAngelo Iacobino0Lanfranco Fattorini1Federico Giannoni2Istituto Superiore di Sanità, Department of Infectious Diseases, Via Regina Elena 299, 00161 Rome, ItalyIstituto Superiore di Sanità, Department of Infectious Diseases, Via Regina Elena 299, 00161 Rome, ItalyIstituto Superiore di Sanità, Department of Infectious Diseases, Via Regina Elena 299, 00161 Rome, ItalyThe control of tuberculosis (TB) is hampered by the emergence of multidrug-resistant (MDR) <i>Mycobacterium tuberculosis</i> (Mtb) strains, defined as resistant to at least isoniazid and rifampin, the two bactericidal drugs essential for the treatment of the disease. Due to the worldwide estimate of almost half a million incident cases of MDR/rifampin-resistant TB, it is important to continuously update the knowledge on the mechanisms involved in the development of this phenomenon. Clinical, biological and microbiological reasons account for the generation of resistance, including: (i) nonadherence of patients to their therapy, and/or errors of physicians in therapy management, (ii) complexity and poor vascularization of granulomatous lesions, which obstruct drug distribution to some sites, resulting in resistance development, (iii) intrinsic drug resistance of tubercle bacilli, (iv) formation of non-replicating, drug-tolerant bacilli inside the granulomas, (v) development of mutations in Mtb genes, which are the most important molecular mechanisms of resistance. This review provides a comprehensive overview of these issues, and releases up-dated information on the therapeutic strategies recently endorsed and recommended by the World Health Organization to facilitate the clinical and microbiological management of drug-resistant TB at the global level, with attention also to the most recent diagnostic methods.https://www.mdpi.com/2076-3417/10/6/2153tuberculosis<i>mycobacterium tuberculosis</i>rifampinisoniazidmechanisms of resistancemutationsgranulomascaseumcell envelopedormancy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Angelo Iacobino Lanfranco Fattorini Federico Giannoni |
spellingShingle |
Angelo Iacobino Lanfranco Fattorini Federico Giannoni Drug-Resistant Tuberculosis 2020: Where We Stand Applied Sciences tuberculosis <i>mycobacterium tuberculosis</i> rifampin isoniazid mechanisms of resistance mutations granulomas caseum cell envelope dormancy |
author_facet |
Angelo Iacobino Lanfranco Fattorini Federico Giannoni |
author_sort |
Angelo Iacobino |
title |
Drug-Resistant Tuberculosis 2020: Where We Stand |
title_short |
Drug-Resistant Tuberculosis 2020: Where We Stand |
title_full |
Drug-Resistant Tuberculosis 2020: Where We Stand |
title_fullStr |
Drug-Resistant Tuberculosis 2020: Where We Stand |
title_full_unstemmed |
Drug-Resistant Tuberculosis 2020: Where We Stand |
title_sort |
drug-resistant tuberculosis 2020: where we stand |
publisher |
MDPI AG |
series |
Applied Sciences |
issn |
2076-3417 |
publishDate |
2020-03-01 |
description |
The control of tuberculosis (TB) is hampered by the emergence of multidrug-resistant (MDR) <i>Mycobacterium tuberculosis</i> (Mtb) strains, defined as resistant to at least isoniazid and rifampin, the two bactericidal drugs essential for the treatment of the disease. Due to the worldwide estimate of almost half a million incident cases of MDR/rifampin-resistant TB, it is important to continuously update the knowledge on the mechanisms involved in the development of this phenomenon. Clinical, biological and microbiological reasons account for the generation of resistance, including: (i) nonadherence of patients to their therapy, and/or errors of physicians in therapy management, (ii) complexity and poor vascularization of granulomatous lesions, which obstruct drug distribution to some sites, resulting in resistance development, (iii) intrinsic drug resistance of tubercle bacilli, (iv) formation of non-replicating, drug-tolerant bacilli inside the granulomas, (v) development of mutations in Mtb genes, which are the most important molecular mechanisms of resistance. This review provides a comprehensive overview of these issues, and releases up-dated information on the therapeutic strategies recently endorsed and recommended by the World Health Organization to facilitate the clinical and microbiological management of drug-resistant TB at the global level, with attention also to the most recent diagnostic methods. |
topic |
tuberculosis <i>mycobacterium tuberculosis</i> rifampin isoniazid mechanisms of resistance mutations granulomas caseum cell envelope dormancy |
url |
https://www.mdpi.com/2076-3417/10/6/2153 |
work_keys_str_mv |
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