TY - JOUR T1 - Multidrug- and extensively drug-resistant tuberculosis: an emerging threat JF - European Respiratory Review JO - EUROPEAN RESPIRATORY REVIEW SP - 195 LP - 197 DO - 10.1183/09059180.00005209 VL - 18 IS - 114 AU - M. Berry AU - O. M. Kon Y1 - 2009/12/01 UR - http://err.ersjournals.com/content/18/114/195.abstract N2 - Despite dramatic improvements in public health and medical care, Mycobacterium tuberculosis remains as much of a threat in the 21st century as it was when first identified as a pathogen by Koch [1] in 1882. Tuberculosis was reported to be the seventh leading cause of death worldwide by the World Health Organization (WHO) in 2004 [2]. Recent figures show an increase in the total number of cases, with an estimated 9.2 million new cases and 1.7 million deaths attributed to tuberculosis in 2006 [3]. Drug-resistant strains of Mycobacterium tuberculosis represent an emerging problem in the struggle to contain tuberculosis. In this issue of the European Respiratory Review, Sasse and Teichmann [4] describe their experience of managing a patient infected with a strain of Mycobacterium tuberculosis with a wide spectrum of drug resistance. The latest estimates based on survey data report that 11.1% of new tuberculosis cases showed resistance to any drug, which rises to 25.1% in previously treated cases. 1.6% of new cases and 11.7% of previously treated cases met the definition of multidrug-resistant tuberculosis (MDR-TB), this being resistance to rifampicin and isoniazid, the two most potent first-line antituberculosis drugs. Much of this burden is carried by eastern Europe, where 45.5% of previously treated tuberculosis cases meet the definition for MDR-TB. The patient described by Sasse and Teichmann [4] was originally from Burma, where MDR-TB accounts for 4% of new tuberculosis cases [5]. Outcomes in MDR-TB are worse than for non-MDR-TB, with one retrospective study in Estonia finding a cure rate of 83.4% in non-MDR-TB, compared with only 57.4% in MDR-TB [6]. More recently, attention has been drawn to the emergence of a form of MDR-TB that has a more … ER -