Pathophysiology: Multi-drug-resistant tuberculosis (MDR-TB) is defined as a form of TB infection caused by bacteria that are resistant to treatment with at least two of the most powerful first-line anti-TB drugs, isoniazid (INH) and rifampicin (RMP). MDR-TB infection may be classified as either primary or acquired. Primary MDR-TB occurs in patients who have not previously been infected with TB but who become infected with a strain that is resistant to treatment.
Statistics: Incidence of tuberculosis is the estimated number of new and relapse tuberculosis cases arising in a given year, expressed as the rate per 100,000 population. All forms of TB are included, including cases in people living with HIV. In Singapore the incidence of Tuberculosis reported from 2001-2005 is 41 cases, and from 2006-2011 is also reported as 44 cases and in 2015 the cases wetre reported as 47 cases.
Treatment: The principles of treatment for MDR-TB and for XDR-TB are the same. Treatment requires extensive chemotherapy for up to two years. Second-line drugs are more toxic than the standard anti-TB regimen and can cause a range of serious side-effects including hepatitis, depression, hallucinations, and deafness. Patients are often hospitalized for long periods, in isolation. In addition, second-line drugs are extremely expensive compared with the cost of drugs for standard TB treatment.
Major Research: Italy is the big laggard among MSF’s study countries, contributing only one tenth of its fair share to TB research; only one third of the country’s overall contribution is spent directly with two thirds spent indirectly via the EC. Moreover, even major institutions’ funding allocations are not transparent, and in many cases detailed breakdowns of allocations by disease or project do not seem to exist. At any rate, it is clear that the Italian government all but neglects research and development affecting poor countries.