2.  Information adopted solely from a paper by BOTUSA(Botswana-USA) http://www.cdc.gov/botusa/ http://www.cdc.gov/botusa/  Photojournalist James Nachtwey and his powerful photographs of XDR-TB, a drug-resistant strain of tuberculosis that’s touching off a global medical crisis.  What is TB, MDR-TB,XDR-TB ?  How is TB spread?  How does drug resistance happen and who is at risk?  How can MDR-TB and XDR-TB be prevented and effectiveness of vaccine against this strains  What are symptoms of TB  How long does it take to find out if you have XDR-TB or MDR  What risks do health care workers face with XDR-TB  What is the link between XDR-TB and HIV/AIDS  What is the evidence relating to XDR/TB (further reading)

3. What is TB,MDR-TB,XDR-TB?  TB: various mycobacteria (Mycobacterium tuberculosis) caused disease that is airborne. Usually affects the lungs, brain, the kidneys or the spine. Mostly treatable.  MDR-TB: Multi-Drug Resistant TB, resistant to isoniazid and rifampicid.  XDR-TB: Extensively Drug Resistant TB,resistant to isoniazid and rifampin plus fluoroquinolene and injectable second line drugs.Its of special concern to HIV infected.

4. How is TB Spread?  Drug susceptible TB and MDR-TB are spread in the same way, i.e. airborne (aerosol droplets).

5. How Does Drug Resistance Happen And Who is At Risk?  Resistance :occurs when anti-TB drugs are misused or mismanaged Risk Group : In people who  Irregular dosage  Not adhere to prescription  Develop TB,post treatment  Prolonged exposure

6. How Can MDR-TB and XDR-TB be Prevented and Effectiveness of Vaccine Against This Strains?  Prevention: Adherence to medication(coherence) Improved effectiveness of health-care providers Avoiding exposure  Vaccine: Bacille Calmette –Guerin(BCG) is used in Botswana, to prevent TB in children but it does not prevent TB in adults.

7. What Are Symptoms of TB?  Weakness  Weight loss  Loss of appetite  Fever  Night sweats Pulmonary/lung TB  Coughing  Chest pains  Coughing up blood In other parts of the body depends on the area affected.

8. How Long Does It Take To Find Out if You Have XDR- TB or MDR  Drug susceptible (regular TB): a day or two  Final diagnosis for MDR-TB and XDR-TB may take upto six to sixteen weeks

9. What Risks Do Health-Care Workers Face With XDR-TB?(particularly those who maybe HIV positive themselfs) On account of the nature of their work,they are constantly in contact with XDR-TB patients,thus they are regularly exposed to the bacteria and hence run a risk of contracting the disease.

10. What is The Link Between XDR-TB and HIV/AIDS ? In places where XDR-TB is most common,people living with HIV are at a greater risk of developing TB and dying because of their weakened immunity.

11. What is The Evidence Relating To XDR/TB (further reading) Findings from a joint WHO/U.S. Centers for Disease Control and Prevention (CDC) survey of 14 supranational TB reference laboratories using samples from 48 countries were published in CDC's Morbidity and Mortality Weekly Report in March 2006. It documented XDR TB in all regions of the world, with high rates in some former Soviet Union countries and parts of Asia.

12. http://www.cdc.gov/botusa/ Photojournalist James Nachtwey