Extensively Drug-Resistant Tuberculosis (XDR TB)

Get the facts about extensively drug-resistant TB and multi drug-resistant TB.

CDC Issues Isolation Order for Man with TB

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

In May 2007, the U.S. Centers for Disease Control and Prevention(CDC) issued an order to quarantine a man who flew on two transatlantic flights with a rare, dangerous form of tuberculosisand potentially exposed passengers and crew to the infection.

The Atlanta man was believed to be infected with the form of the tuberculosis bacteria known as "extensively drug-resistant" TB, abbreviated XDR TB. Tuberculosis is a bacterial infection that primarily affects the lungs, and the infection is spread via air droplets released during coughing, spitting, sneezing, or talking. XDR TB causes the same symptoms that a person would develop with TB. If TB disease is present, cough and feverwould be the predominant symptoms. XDR TB is a rare form of the disease that is resistant to the drugs routinely used to treat tuberculosis infections and is extremely difficult to treat. The few treatment options available for XDR TB are less effective and associated with worse outcomes than traditional antibiotic therapies for TB. In 2006, there were two documented cases of XDR TB in the U.S.

Health authorities were aware of the man's condition and had warned the man against traveling, but he stated that compelling personal reasons led him to fly from Atlanta to Paris on May 13. On May 24, he returned to North America on a flight from Prague to Montreal and entered the U.S. by car. While it is not certain that passengers and crew on board the flights were infected, the CDC recommended that passengers and crew on those flights be tested for TB infection. Particularly those seated within two rows of the infected man are at greatest risk for infection.

After his return to the U.S., the man cooperated with authorities and voluntarily entered a hospital in Atlanta and was placed in respiratory isolation to prevent spread of the infection. This event marked the first time since 1963, when a patient with smallpox was quarantined, that the CDC issued this type of isolation order.

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What is XDR TB?

Extensively drug-resistant tuberculosis (XDR TB) is a relatively rare type of multidrug-resistant tuberculosis (MDR TB). It is resistant to almost all drugs used to treat TB, including the two best first-line drugs: isoniazid and rifampin. XDR TB is also resistant to the best second-line medications: fluoroquinolones and at least one of three injectable drugs (i.e., amikacin, kanamycin, or capreomycin).

How is XDR TB spread?

Drug-susceptible (regular) TB and XDR TB are spread the same way. TB germs are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. These germs can float in the air for several hours, depending on the environment. Persons who breathe in the air containing these TB germs can become infected.

TB is not spread by

  • shaking someone's hand

  • sharing food or drink touching bed linens or toilet seats

  • sharing toothbrushes

  • kissing smoking or sharing cigarettes

Why is XDR TB so serious?

Because XDR TB is resistant to the most powerful first-line and second-line drugs, patients are left with treatment options that are much less effective and often have worse treatment outcomes. XDR TB is of special concern for persons with HIV infection or other conditions that can weaken the immune system. These persons are more likely to develop TB disease once they are infected, and also have a higher risk of death once they develop TB disease.

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