Please watch.

It'll only take you a few minutes. But you should. You might need tissues; it made me cry. I'll be waiting for you here when you're done.

XDR-TB: extremely drug resistant tuberculosis, or extensively drug resistant tuberculosis. There doesn't appear to be any particular agreement on whether it is extremely or extensively. It doesn't really matter, though. It means the same thing. It means tuberculosis that is resistant to at least two first line drugs and three second line drugs used to fight it.

There are only six second line drugs available to treat TB. There were 9.27 million incident cases of TB reported globally in 2007.

Multidrug Resistant TB (MDR-TB) has been around for a while. That's TB which is resistant to two first line drugs: isoniazid and rifampicin. There are approximately 450,000 new cases of it reported every year. It has the same infection pattern and symptoms as standard TB. XDR-TB was identified in 2006, by the WHO and US Centers for Disease Control and Prevention (CDC). It is MDR-TB that doesn't respond to fluoroquinolone, capreomycin, kanamycin, or amikacin, either. These second line drugs aren't as effective at fighting TB, and do so with more side-effects. Again, it spreads the same and looks the same as standard TB, but ultimately XDR-TB is about containment, rather than cure.

XDR-TB levels vary from place. About 4% of all MDR-TB cases in the US are identified as XDR-TB. Go to Latvia, and that figure is 19%.

Anywhere there is TB you can find XDR-TB. It is most prevalent in the former Soviet Union, India, and China. It is also extremely prevalent in cases of HIV-related TB. Fighting this disease with an already-compromised immune system is virtually impossible. This has serious implications for Africa, with over 20 million people on the continent diagnosed with HIV. A 2006 study of 544 TB patients in Kwazulu-Natal, South Africa, indicated that 221 of those had MDR-TB; 53 of those were diagnosed with XDR-TB. 44 of the XDR-TB patients also had HIV. 52 of the 53 XDR-TB patients died, on average, within 25 days of diagnosis.

This disease is virtually untreatable. I didn't say that. WHO did.

But, it is preventable. XDR-TB has arisen owing to the mismanagement of TB care. People don't prescribe drugs properly, patients don't take drugs properly, the quality of the drugs available can be variable, and that's if the drugs are consistently available at all. Yes, you should always finish your course of anti-biotics.

More than this, though, we need to understand the disease better and we need to find more effective methods to treat it. It's not as if people don't know this — there was a 2006 conference in Johannesburg and a 2009 summit in Beijing — but the world has many fish to fry. Perhaps, though, there's a pan of oil at smoking point?

Fighting the good fight

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