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'Virtually Untreatable' Form Of TB Emerges

 
 
Reply Tue 12 Sep, 2006 09:00 am
Quote:
World: 'Virtually Untreatable' Form Of TB Emerges

By Jeremy Bransten

PRAGUE, September 10, 2006 (RFE/RL) -- Experts from the World Health Organization (WHO) met this week in Johannesburg, South Africa, to address a worrying development in the fight against tuberculosis -- the emergence of an extreme drug resistant strain that is virtually incurable.


It is a medical paradox that has public-health workers very worried. Powerful drugs meant to cure people of tuberculosis are indirectly killing them instead.

And the World Health Organization (WHO) is raising the alarm.

Second-Line Drugs

For years, doctors have been battling multi-drug resistant cases of tuberculosis using ever-stronger pharmaceuticals called second-line drugs.

But if those strong pharmaceuticals are not used as prescribed, they can give rise to a new strain of extreme drug-resistant tuberculosis.

And that has no cure.
In Eastern Europe and the former Soviet Union, where there has been a resurgence of tuberculosis, cases of the extreme drug-resistant variant are rising fast.


"The treatment of TB, in general, has to follow some fundamental principles," says Ernesto Jaramillo, a WHO medical officer at the Johannesburg conference. "First of all, the treatment regimen has to be properly designed and should consist of a cocktail with the right drugs, that should be delivered in the right way. If medical doctors prescribe the wrong drugs, and or if the patient does not take the drugs properly, then the obvious consequence is that -- over time -- drug resistance develops."

A recent outbreak in South Africa of what scientists call extreme drug-resistant tuberculosis, or XDR-TB, killed 52 out of 53 patients infected.

Eastern Europe, Former Soviet Union

In Eastern Europe and the former Soviet Union, where there has been a resurgence of tuberculosis, cases of the extreme drug-resistant variant are rising fast.

Latvia is one example. According to the World Health Organization, it has one of the highest rates. Every fifth case of multi-drug resistant tuberculosis in the country has already morphed into the extreme drug-resistant type.

Russia, Ukraine, and the Central Asian countries, where tuberculosis cases among prisoners have reached epidemic proportions, could soon face the same problem.

This is largely due to a breakdown of the health services in the post-Communist era.

Complex Treatment

Patients who suffer from multi-drug resistant tuberculosis have to take a cocktail of medicines for a long period of time. That is expensive and requires close doctor supervision.

If treatments are skipped or medicines are taken out of sequence, the disease is not cured and can metamorphose into the extreme drug-resistant variety.

Jaramillo says the meeting in Johannesburg will start working on guidelines for health-care workers worldwide, to stop the rise of extreme drug resistant tuberculosis.
In the meantime, he says the most important thing doctors and patients can do is to follow the precise course of treatment. Jaramillo emphasizes that this will save money and lives in the long run.

"What we are going to do is to set up a task force that will be reviewing the current situation and making precise recommendations by the end of the year about how to tackle [extreme drug-resistant TB]," he says. "But in the meantime, what we are strongly recommending is to ensure that second-line drugs -- the drugs used to treat [multi-drug resistant] TB -- are properly used. The rational use of second-line drugs is the most powerful way to prevent the creation of extreme drug-resistant TB."

Working With Drug Companies

The WHO is also trying to persuade pharmaceutical companies to offer discounted drugs to countries in need, to avoid an epidemic of extreme drug-resistant tuberculosis, before it is too late.

"There has been important progress in recent years," Jaramillo says. "One major pharmaceutical company has embarked on transferring technology for producing two key drugs. However, the treatment regimens for multi-drug resistant TB consist of at least four drugs. So although there is progress it is still not enough for what we need."

In one piece of good news earlier this year, U.S. tycoon Bill Gates announced a gift of $600 million to fund antituberculosis programs around the world.
source: Radio Free Europe/Radio Liberty
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Walter Hinteler
 
  1  
Reply Tue 12 Sep, 2006 09:05 am
From todays The Wrap, one of Guardian Unlimited's paid-for services.
Quote:

The Wrap: A worm's eye view

Tuesday September 12, 2006
Guardian Unlimited


A new strain of incurable TB could kill the rich as well as the poor, says Andrew Brown

The thing that books don't tell you about tuberculosis is that it smells disgusting. I once had to carry the feet of a man who was dying of it down a flight of stairs and when he raised his head a bit he breathed on me. That's how I knew his lungs were really rotting. He died about a fortnight later, and in hippy Glastonbury, in 1972 or thereabouts, this was shocking. TB was one of the diseases no one died of. Actually, we didn't really believe in those days that there were still any diseases that killed people like us. We thought that they had all been conquered. Yet this immunity is very recent. In the nineteenth century the disease was responsible for a quarter of all the deaths in England. George Orwell died in 1948. One of his last letters mentions being tested with streptomycin, but it came too late for him.

Until antibiotics, the only cures involved rest and good hygiene, fresh air and hope. This meant, of course, that for most poor people, the disease was more or less incurable. You need bad luck or a weakened immune system to develop the full-blown disease, but it's very easy indeed to catch the bacillus, which is spread, like colds, by coughing. The news last week that a strain of TB is flourishing that will not be cured by any known combination of antibiotics might thus be a harbinger of a really nasty future. It is particularly dangerous in countries where Aids has taken root, because so many people there are living with weakened immune systems. Of 553 TB patients studied in rural South Africa recently, a tenth were found to have the incurable TB - and all but one of these 53 patients were dead within a month. With that kind of plague around, the extremely expensive and complex retroviral drugs developed to keep people alive till a cure for Aids is found just won't work. They will keep patients alive only until the TB catches them.

The disease was not first found in Africa. It had been reported from Latvia and Russia, and is suspected all over the world. But it was first identified in the US and may well become established there. This raises some interesting and unpleasant possibilities. By and large, America is the best place in the world to be ill if you're rich, and one of the worst if you're poor or insufficiently insured. A perfectly privatised health system like that made perfect sense for most of history, when no one knew how diseases were spread. Now that we understand that disease comes from pathogens and parasites, it makes sense only as long as there are no real plagues. So far, that's true. Dangerous infectious diseases are almost entirely confined to the poor. You may say that people of all classes get Aids but it is only a partial exception to this rule, because the rich, if they get it, can live with it: they have the drugs. Nor is it really terribly infectious. Nowadays it is hard to catch if you avoid sharing needles and bodily fluids.

Imagine, though, the social impact of a plague that rich people could get from poor people who just breathed on them. It's not just tube trains, nor even pavements, that would be dangerous then. In an age of mass air travel, a single drug-resistant TB patient sitting on a plane for eight hours is a threat to five or six hundred other passengers, even the ones in first class. At this point we are back to socialism as self-preservation. The health of the poor directly affects the health of the rich, since a patient whose immune system has overcome the disease is not infectious. But the NHS is not immune to the strain of plagues. It is financed by a different and more diverse insurance pool than the one available under the American system. But the political dynamic works the same way: those who pay expect to benefit, and they don't want non-payers benefiting at their expense. In both Europe and the US, there is an assumption that the age of plagues is over, and that diseases will respect political boundaries. For most of history, this hasn't been true at all.

Back in 1903, when the threat of pullulating aliens was Jewish, one witness told the parliamentary commission of enquiry that the mortality rate among children less than one year old in Whitechapel was 50% (in the slums of the native poor it was only 38%). The 1905 Aliens Commission urged that "in cases where an immigrant is found to be suffering from infectious or loathsome disease ... the medical officer to have the power to debar such immigrant from landing."

It may not be drug resistant TB that pushes us back to those days. But the next time that someone tells you that bird flu is an over-rated threat, remember what a really infectious, really deadly disease could do. The fear of terrorism is not so dreadful as the fear of plague. Sometimes the one per cent doctrine - that even small risks of catastrophe can't be tolerated - is quite right.

* Andrew Brown maintains a blog.
0 Replies
 
blacksmithn
 
  1  
Reply Tue 12 Sep, 2006 09:07 am
Oh great! I'm turning 50 soon and all I need is one more reason to fear for my own mortality.
0 Replies
 
Walter Hinteler
 
  1  
Reply Sat 23 Sep, 2006 10:31 am
Quote:

Drug-resistant TB gaining ground

September 23, 2006

BY JORDAN ROBERTSON

SAN FRANCISCO -- The worst forms of the killer tuberculosis bug have been gaining ground in the United States, alarming public health officials over imported drug-resistant strains of a disease that is mostly under control in this country.

Although the number of drug-resistant TB cases in the United States is small compared with developing nations, health officials here warn that visitors from other countries who are unaware of their infections are bringing over the deadliest mutations.

Most drug-resistant infections in the United States are brought in by legal visitors.

The only visitors to the United States who are screened for tuberculosis and other medical conditions are immigrant and refugee visa applicants.

Worldwide, TB kills 2 million each year, mostly in Africa and southeast Asia.

Of gravest concern is ''extensively drug-resistant'' TB, which recently killed more than 50 in South Africa. It has been found in limited numbers in the United States -- 74 reported cases since 1993.

The strain is almost impossible to cure because it's immune to the best first- and second-line TB drugs. It is as easily transmitted through the air as garden-variety TB.

Officials here also have been jolted by a spike in a milder but still lethal form called ''multidrug resistant'' TB. It responds to more treatments but can cost up to $250,000 and take two years to cure.

AP

Source
0 Replies
 
CalamityJane
 
  1  
Reply Sat 23 Sep, 2006 10:38 am
blacksmithn wrote:
Oh great! I'm turning 50 soon and all I need is one more reason to fear for my own mortality.


As my grandfather - who got to be 95 years old - used to say: "One shot
of Schnaps a day kills all the germs".

Salute!!
0 Replies
 
Walter Hinteler
 
  1  
Reply Sat 23 Sep, 2006 10:45 am
CalamityJane wrote:

As my grandfather - who got to be 95 years old - used to say: "One shot
of Schnaps a day kills all the germs".

Salute!!


Those were the worst, as my father used to say, who headed a clinic for tuberculosis patients. (I remember times - during my childhood - when at least one of those died per week.)
0 Replies
 
ossobuco
 
  1  
Reply Sat 23 Sep, 2006 12:12 pm
Tb was a big part of our study back when I was a bacteriology major in the early sixties.

That Wrap article makes a lot of good points.
0 Replies
 
ossobuco
 
  1  
Reply Sat 23 Sep, 2006 12:17 pm
My memory may be faulty in this - re catching it from someone breathing - I didn't think tb was immediately infectious to caregivers... but could be over time. There were a lot of cautions about spitting and saliva, as the active tb would/could be found in saliva. How long it lives in the air, I don't know.
0 Replies
 
 

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