Tuberculosis is the second most fatal infectious disease after AIDS. It is caused by the mycobacterium tuberculosis. There are numerous factors responsible for the emergence of multi-drug resistance and extensively drug resistance cases of tuberculosis, which involves high pill burden, prolonged treatment, low compliance, and stiff administration schedules. Continuous efforts have been done to develop unique antibodies and nanocarrier-based drug delivery systems that can overcome drug resistance, reduce the treatment regimen, and elevate the compliance to treatment. Therefore, there is a need for a robust system to subdue these technological drawbacks in the urge to develop therapeutically active system in terms of pharmaceutical technology. It is difficult to treat prolonged multi-drug-resistant tuberculosis giving higher side effects and expenses and more unsuccessful results. In short, the authors tried to uncover all the urgent needs in the treatment and prevention of multi-drug-resistant tuberculosis through adequate strategies.
TopIntroduction
Tuberculosis is a lethal infectious respiratory disorder which is the greatest health challenge and the 2nd leading cause of death about youth and adults worldwide. It is the second most common infectious disease which is caused by one of the major human pathogens, small aerobic non-motile bacillus bacteria i.e. Mycobacterium tuberculosis (since 1882) that infects one-third of the world population approximately 9.4 million each year and the estimated annual mortality rate 2 million people per year. Tuberculosis is the only disease which has the highest mortality rate than any other infectious disease.(Fogel, 2015)
According to World health organization (WHO) Global tuberculosis report 2018, WHO declared Tuberculosis as a global public emergency in 1993.In 2006, approximately 9.2 million cases are estimated as incident cases and 1.7 million deaths due to T.B occurred worldwide making the world-leading causes mortality. In 2012, approximately 8.6 million cases are estimated as incident cases and 1.3 million deaths from the disease (in which 320,000 deaths from HIV-positive people). In 2014, approximately 9.6 million cases are estimated as incident cases and in which 5.4 million were men, 3.2 million were women and 1.0 million were children. In 2017, approximately 10 million (range 9.0-11.1 million) people affected from T.B disease, out of which is 5.8 million are men’s and 3.2 million women and 1.0 million children and there were cases from all the countries and age groups and overall 90% were adults and 9% people were living with HIV. In 2017, an estimated 1.3 million deaths (range 1.2-1.4 million) among HIV negative people and there were an additional 300000 deaths (range 266000-335000) among HIV positive people. Globally T.B incidence is falling about 2% per year. Approximately 54 million lives were saved through TB diagnosis and treatment between 2000 and 2019.(World Health Organization, 2018a)
Tuberculosis
Tuberculosis is a contagious disease, caused by a bacterium called “Mycobacterium tuberculosis” that is transmitted from one person to others through coughing and breathing in airborne droplets that contain bacteria. The bacteria usually attack the lungs leading to the fever, severe coughing, and chest pain but this bacterium can also attack any part of the body such as kidney, spine and brain. In most of the people who inhale the Mycobacterium tuberculosis; the disease doesn’t have symptoms, an effective immune response in the lungs leading to inhibition the growth of Mycobacterium tuberculosis, resulting in the bacteria becoming dormant, this condition is referred as latent tuberculosis. From latent infection, the bacteria can progress to the active state if the immune system can’t stop them from growing. When TB bacteria become active, multiplying in your body this condition is referred to active tuberculosis.
Approximately 5-10% of latent tuberculosis cases are at risk of progressing to active tuberculosis. e.g., Those with HIV, cancer or taking any immunosuppressant drugs having a higher risk of developing active tuberculosis and also there are so many conditions that have a higher risk for susceptibility to the Mycobacterium tuberculosis infection such as diabetes, ageing, long term use of corticosteroids etc. The currently available treatment of tuberculosis requires multiple drug administration, comprising of an initially fixed-dose combination with Isoniazid, Rifampicin, Pyrazinamide, Ethambutol and Streptomycin daily for 2 months and a continuous phase of Isoniazid and Rifampicin for a further 4 months. Second line drugs are- Cycloserine, Ethionamide, Clarithromycin, Azithromycin, Ciprofloxacin, Levofloxacin, Moxifloxacin etc.(Fogel, 2015)