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JAMA Reports TB on the Rise and Still a Global Threat

The Journal of the American Medical Association reports that tuberculosis (TB) remains a global health threat. Even more alarming is the emergence of a new form of TB that's harder to treat and more likely to cause death.

Tuberculosis is a respiratory disease that's generally treatable with medication, but some patients have what is called multidrug resistant TB.

Dr. Richard Granich says that patients with this kind of TB are four times more likely to die, and treatment is extremely expensive. "You have an 18 to 24 month treatment with multiple drugs that can be toxic at times," explains the doctor, "and also it's very expensive, and so each case of multidrug resistant tuberculosis can sometimes end up costing over $1 million to treat and to control."

In a recent study published in the Journal of the American Medical Association (JAMA), Dr. Granich and colleagues from the US Centers for Disease Control analyzed about 38,000 cases of tuberculosis reported in California over the last 10 years.

Of those, about two percent, or 407 cases, were diagnosed as multidrug resistant. "One to two percent seems like a very low percentage," explains Dr. Granich. "However, you have to remember that each one of those cases is maybe a hundred times more complicated that a normal TB case."

Multidrug resistance usually occurs when a tuberculosis patient receives either incomplete or inadequate treatment during the initial stages of the disease. It can also be spread by infected persons, through breathing or coughing. Dr. Granich says the best way to prevent multidrug resistance is thorough treatment, once tuberculosis has been diagnosed.

Dr. Frederick Corder says his preferred method is called directly observed therapy. "Observing the patient and making certain that each day they get the correct medicine and take it for the length of time that's required," he explains.

Tuberculosis kills about two million people every year. JAMA says the numbers are declining - except for the multidrug resistant cases, which have now been found in over 30 countries.