169013 Extensive Drug Resistant Tuberculosis and the impact on public health nursing practice

Wednesday, October 29, 2008: 10:30 AM

Cynthia L. Stone, DrPH , School of Medicine, Department of Public Health, Indiana University, Indianapolis, IN

Tuberculosis (TB) is a respiratory illness that is spread primarily by coughing, talking, and sneezing. Nearly 2 billion people worldwide are thought to have latent TB infections. An estimated 8.8 million new cases are diagnosed each year and 1.6 million die each year from TB, which means one death every 18 seconds. Multi drug-resistant tuberculosis (MDR-TB) emerged as a global issue during the 1990's. MDR-TB is resistant to isoniazid and rifampin requiring treatment with second line drugs. As of 2004, there were 424,203 cases of MDR worldwide. In 2006, a cluster of cases in South Africa occurred that were identified as extensive drug resistant TB (XDR-TB). In those cases 52 of 53 patients died and 44 of them had tested positive for HIV. It is estimated that 2 percent of all drug-resistant TB cases are classified as XDR-TB. XDR-TB is resistant to at least two of the first line TB medications isoniazid and rifampin, fluroquinolones and any one of the second-line anti-TB injectable drugs (Amikacin, Kanamycin or Capreomycine). In a WHO survey in 2007, XDR-TB was found in 41 countries including USA, two thirds of the XDR-TB cases are estimated to be in Russia and China.


Public health nurses have been instructed on TB skin testing (TST) as part of their TB prevention and treatment programs. They also need to be aware of the use of QuantiFERON-TB Gold test. The QFT-Gold test has been approved by the CDC and is becoming more available for local health departments. Public health nurses in Indiana received this content in a recent TB symposium and as part of a TB education program offered through the American Lung Association Indiana Affiliate.


A total of 200 nurses attended the symposium and received the information. Annually public health nurses can participate in the Basic Mantoux Skin Test courses.


Public health nurses need to be aware of the emerging infection XDR-TB measures to detect this infection and how to provide treatment to protect their communities.

Learning Objectives:
At the end of the session the participants will be able to: 1. Verbalize the impact of XDR-TB on public health nursing practice. 2. Identify the advantages and disadvantages of TB testing with QuantiFERON-TB Gold test.

Keywords: TB, Public Health Nursing

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked with the Indiana TB education sub-committee for ten years. I have completed a TB instructor course offered in Indiana.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.