• Vol. 40 No. 3, 132–135
  • 15 March 2011

Managing a Case of Extensively Drug-Resistant (XDR) Pulmonary Tuberculosis in Singapore



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Introduction: Extensively drug-resistant tuberculosis (XDR-TB) is an emerging global health risk. We present the first case report of XDR-TB in Singapore.

Clinical Picture: A 41-year-old Indonesian lady with previously treated pulmonary tuberculosis presented with chronic cough. Her sputum was strongly acid-fast bacilli positive and grew Mycobacterium tuberculosis complex resistant to first and second-line TB medications.

Treatment: She received 5 months of intensive multidrug treatment without sputum smear conversion. She then underwent resection of the diseased lung. The total cost incurred amounted to over S$100,000.

Outcome: She achieved sputum smear/culture conversion post-surgery, but will require further medical therapy for at least 18 months.

Conclusion: XDR-TB is poorly responsive to therapy and extremely expensive to manage. Its prevention by strict compliance to therapy is paramount.

Extensively drug-resistant tuberculosis (XDR-TB) is defined as TB which is resistant not only to the 2 best first-line anti-TB medications, rifampicin and isoniazid (known as multidrug-resistant or MDR-TB), but also to at least 1 of 3 injectable second-line agents (amikacin, kanamycin or capreomycin) and to any fluoroquinolone. XDR-TB is extremely difficult to treat, requiring the prolonged use of costly, but less effective and more toxic second and third-line medications. XDR-TB has already been reported in 58 countries and has emerged as a global health threat. We report our experience with the first XDR-TB case treated in Singapore since this condition was first defined by the World Health Organization (WHO) in 2006.

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