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Clin Chest Med. 2009 Dec;30(4):667-83, vii-viii. doi: 10.1016/j.ccm.2009.08.019.

Multidrug- and extensively drug-resistant tuberculosis in Africa and South America: epidemiology, diagnosis and management in adults and children.

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Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, and Tygerberg Children's Hospital, PO Box 19063, Tygerberg 7505, South Africa.


Available data show that Africa, together with the Americas and western and central Europe, reported the lowest prevalence of multidrug-resistant tuberculosis (MDR-TB). However, sub-Saharan Africa has a high TB incidence and the highest human immunodeficiency virus (HIV) prevalence in the world, and because of the high number of TB cases, Africa still presents 14% of the global burden of new MDR-TB cases. Until recently, Africa and South America were deprived of second-line antituberculosis drugs, preventing the development of extensively drug-resistant TB (XDR-TB). Current efforts, introducing improved laboratory infrastructure and second-line TB treatment in resource-limited countries, need to be carried out with care to minimize the development of MDR/XDR-TB in these countries. Recent diagnostic developments now need evaluation and implementation in resource-limited areas, and delays in diagnosis also need to be addressed. Outcomes for MDR/XDR-TB have improved, but prevention of MDR/XDR-TB by early diagnosis and treatment, improvement of adherence, and proper infection control remains the mainstay for the future.

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