Abstract
The actual situation of the resistant in Tuberculosis (TB) is very worrisome in a lot of part in the world, linked with bad treatments and national tuberculosis programmes (NTP) in the last decades. For this reason, there is an important worry about the future of this problem in the world, above all if these stains of M. tuberculosis have the same possibilities of transmission and virulence. However, it is a luck that M. tuberculosis only acquire resistant by mutation, and, moreover, the most frequent isoniazide mutation is in the katG gene, that also codify important enzymatic activities (catalase and peroxidase) for the survival and virulence of the bacillus. For this reason, may be the transmission of these resistant stains to the community only will have importance in the immune-suppressed patients. However, in patients with good immune system only will produce very few new cases, linked to the others genetic mutations than katG. Any way, as the treatment of an MDR-TB case is very complicated and expensive, the best is the implementation of a few simple measures in NTP conditions. Only with the application of these measures, expressed in this manuscript, it will be possible win this new battle.

Bibliografía del artículo

1. Caminero JA. Resistencia primaria a fármacos antituberculosos. Med Clin (Barc) 1989; 93: 30-36.
2. Fox W, Ellard GA, Mitchison DA. Studies on the treament of tuberculosis undertaken by the British Medical Research Council Tuberculosis Unit, 1946-1986, with relevant subsequent publications. Int J Tuberc Lung Dis 1999; 3 (10): S231-S279.
3. Cowley R, Briney R. Primary drug resistant tuberculosis in Vietnam veterans. Am Rev Respir Dis 1970; 101: 703.
4. Kim SJ, Kim SC, Bai GM. Drug resistance Mycobacterium tuberculosis isolated from patients with pulmonary tuberculosis discovered in the fourth nation-wide tuberculosis prevalence survey in 1980 in Korea. Tuberc Respir Dis 1982; 29: 1-10.
5. Mitchison DA, Nunn AJ. Influence of initial drug resistance as the response to short-course chemotherapy of pulmonary tuberculosis. Am Rev Respir Dis 1986; 133: 423-430.
6. Riska PF, Jacobs WR Jr, Alland D. Molecular deeterminants of drug resistance in tuberculosis. Int J Tuberc Lung Dis 2000; 4 (2): S4-S10.
7. Rouse DA, Morris SL. Molecular mechanisms of isoniazid resistance in Mycobacterium tuberculosis and Mycobacterium bovis. Infect Immun 1995; 63: 1427-1433.
8. Ad Hoc Committee on the Scientific Assembly on Microbiology, Tuberculosis, and Pulmonary Infections. Treatment of tuberculosis and tuberculosis infection in adults and children. Am J Respir Crit Care Med 1994; 149: 1359-1374.
9. International Union Against Tuberculosis and Lung Diseases. Committee of Treatment. Bul Int Union Tuberc Lung Dis 1988; 63: 64.
10. World Health Organization. Anti-tuberculosis Drug Resistance in the World: The WHO / IUATLD Global Project on Anti-tuberculosis Drug Resistance Surveillance 1994-1997. WHO/TB/97.229. Geneva: World Health Organization, 1997.
11. Becerra MC, Bayona J, Freeman J, Farmer PE, Kim JY. Redefining MDR-TB transmission ´hot spot´. Int J Tuberc Lung Dis 2000; 4(5): 387-394.
12. Pablos-Mendez A, Raviglione MC, Laszlo A, Binkin N, Rieder HL, Bustreo F, et al. Global surveillance for anti-tuberculosis drug resistance, 1994-1997. N Engl J Med 1998; 338: 1641-1649.
13. World Health Organization. WHO reporrt on the tuberculosis epidemic. WHO/TB/97.224. Geneva: World Health Organization, 1997.
14. Ausina V. Tuberculosis multirresistente. Puntualizaciones y reflexiones sobre un tema polémico y de candente actualidad. Med Clin (Barc) 1996; 106: 15-18.
15. March P. La transmisión de la resistencia al Mycobacterium tuberculosis en los infectados por el VIH. La llamada tercera epidemia del VIH. Med Clin (Barc) 1994; 102: 98-100.
16. Canetti G, Kreis B, Thibier R, Gay PH, Le Lirzin M. Données actuelles sur la résistance primaire dans la tuberculose pulmonaire de l´adulte in France. Deuxième enquète. Rev Tuberc Pneumol 1967; 31: 433-474.
17. March P. Resistencias primarias y secundarias a las drogas antituberculosas. Revista IBYS 1970; 28: 137-174.
18. World Health Organization. Global Tuberculosis Control. WHO Report 2001. World Health Organization, Geneva 2002.
19. Davies PDO. Tuberculosis in the United States. Am Rev Respir Dis 1993; 147: 497.
20. Styblo K. Epidemiology of Tuberculosis. Royal Netherlands Tuberculosis Association Selected Papers. Royal Netherlands Tuberculosis Assocaition, The Haghe.
21. American Thoracic Society. Centers for Disease Control and Prevention. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 2000; 161: 1371-1395.
22. Middlebrook G. INH resistance and catalase activity of the tubercle bacilli. Am Rev Tuberc 1954; 69: 471-472.
23. Cohn ML, Oda U, Kovitz C, Middlebrook G. Studies on isoniazid and tubercle bacilli: the isolation of isoniazid-resistant mutants in vitro. Am Rev Tuberc 1954; 70: 465-475.
24. Cohn ML, Kovitz C, Oda U, Middlebrook G. Studies on isoniazid and tubercle bacilli: the growth requirements, catalase activities, and pathogenic properties of isoniazid-resistant mutants. Am Rev Tuberc 1954; 70: 641-664.
25. Schmidt LH, Grover AA, Hoffmann R, Rehm J, Sullivan R. The emergence of isoniazid-sensitive bacilli in monkeis inoculated with isoniazid- resistant strains. Trans 17th Conference on Chemotherapy of Tuberculosis, VA-Armed Forces. 1958; p. 264.
26. Steiner P, Rao M, Victoria MS, Hunt J, Steiner M. A continuing study of primary drug-resistant tuberculosis among children observed at the Kings County Hospital Medical Center between the years 1961 and 1980. Am Rev Respir Dis 1983; 128: 425-428.
27. Snider DE, Kelly GD, Thompson NJ, Kilburn JD, Good RC. Infectiousness and pathogenicity of drug resistant Mycobacterium tuberculosis. Am Rev Respir Dis 1981; 123 (Suppl 2): 254.
28. Adler GA, Lynne-Davies P, Truant JP, Muller BF. Primary drug resistant in tuberculosis. Am Rev Respir Dis 1981; 123 (Suppl. 2): 256.
29. Pitchenik AE, Burr J, Laufer M, Miller G, Cacciatore R, Bigler WJ, et al. Outbreaks of drug-resistant tuberculosis at AIDS centre. Lancet 1990; 336: 400-401.
30. Centers for Disease Control. Nosocomial transmission of multidrug- resistant tuberculosis to health care workers and HIV-infected patients in an urban hospital - Florida. MMWR 1990; 39: 718-772.
31. Center for Disease Control. Nosocomial transmission of multidrug- resistant tuberculosis among HIV-infected persons - Florida and New York, 1988-1991. MMWR 1991; 40: 585-591.
32. Edlin BR, Tokars JI, Grieco MH, Crawford JT, Williams J, Dordillo EM, et al. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the adquired immunodeficiency syndrome. N Engl J Med 1992; 326: 1514-1521.
33. Centers for Disease Control. National action Plan to combat multidrug- resistant tuberculosis. MMWR 1992; 41: RR-11: 5-8.
34. Fischt MA, Daikos GL, Uttamchandani RB, Poblete RB, Moreno JN, Reyes RR, et al. An outbreak of tuberculosis caused by multiple-drug- resistant tubercle bacilli among patients with HIV infection. Ann Intern Med 1992; 117: 177-183.
35. Clancy L. Transmisibilidad de la tuberculosis. Bol Unión Int Tuberc Enf Resp 1990, 65:77-78.
36. Riley RL, Mills CC, O´Grady F, Sultan LU, Wittsadt F, Shivpuri DN. Infectiousness of air tuberculosis ward. Am Rev Respir Dis 1962; 85:511- 525.
37. Snider DE Jr, Kelly GD, Cauthen GM, Thompson NJ, Kilburn JO. Infection and disease among contacts of tuberculosis cases with drug- resistant and drug-susceptible bacilli. Am Rev Respir dis 1985; 132: 125- 132.
38. Caminero JA. Origen, presente y futuro de la resistencias en tuberculosis. Archivos de bronconeumologia 2001; Vol 37, Num 1. 35-42.
39. Edwards D, Kirkpatrick CH. The immunology of mycobacterial diseases. Am Rev Respir Dis 1986; 134: 1062-1071.
40. Dannenberg AM. Immune mechanisms in the pathogenesis of pulmonary tuberculosis. Rev Infect Dis 1989; 11: S369-S378.
41. Telenti A, Imboden P, Marchesi F, Schmidheini T, Bodmer T. Direct, automated detection of rifampin-resistant Mycobacterium tuberculosis by polymerase chain reaction and single-strand conformation polymorphism analysis. Antimicrob Agents Chemother 1993; 37: 2054-2058.
42. Ohno H, Koga H, Kuroita T, Tomono K, Ogawa K, Yanagihara K, et al. Rapid prediction of rifampin susceptibility of Mycobacterium tuberculosis. Am J Respir Crit Care Med 1997; 155: 2057-2063.
43. Morris S, Bai G, Suffys P, Portillo-Gomez L, Fairchok M, Rouse D. Molecular mechanisms of multiple drug resistance in clinical isolates of Mycobacterium tuberculosis. J Infect Dis 1995; 171: 954-960.
44. Williams DL, Waguespack C, Eisenach K, Crawford JT, Portaels F, Salfinger M, et al. Characterization of rifampin-resistance in pathogenic mycobacteria. Antimicrob Agents Chemother 1994; 38: 2380-2386.
45. Zhang Y, Heym B, Allen B, Young D, Cole S. The catalase-peroxidase gene and isoniazid resistance of Mycobacterium tuberculosis. Nature 1992; 358: 591-593.
46. Kelley CL, Rouse DA, Morris SL. Analysis of aphC gene mutations in isoniazid-resitant clinical isolates of Mycobacterium tuberculosis. Antimicrob Agents Chemother 1997; 41: 2057-2058.
47. Sreevatsan S, Pan X, Zhang Y, Deretic V, Musser JM. Analysis of the oxyR-ahpC region isoniazid resistant and -susceptible Mycobacterium tuberculosis complex organisms recovered from diseased humans and animals in diverse localities. Antimicrob Agents Chemother 1997; 41: 600- 606.
48. Mdluli K, Slayden RA, Zhu Y, Ramaswamy S, Pan X, Mead D, et al. Inhibition of a Mycobacterium tuberculosis beta-ketoacyl ACP synthase by isoniazid. Science 1998; 280: 1607-1610.
49. Telenti A, Honore N, Bernasconi C, March J, Ortega A, Heym B, et al. Genotypic assessment of isoniazid and rifampin resistance in Mycobacterium tuberculosis: a blind study at reference laboratory level. J Clin Microbiol 1997; 35: 719-723.
50. Caminero JA. Transmisibilidad y patogenia de la tuberculosis multirresistente. XIV Congreso Centroamericano y del Caribe de Neumología. Managua, Nicaragua, 15 de Marzo del 2000.

Autoevaluación