New strains of TB raise alarm

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New strains of TB raise alarm
By Elisabeth Rosenthal International Herald Tribune

Published: September 5, 2006
PARIS The spread of a new, highly resistant form of tuberculosis that is "virtually untreatable" is causing alarm among international health officials who say that it has now been identified in "all regions of the world," according to the World Health Organization.

For two decades, health officials have been concerned about the steady rise in drug resistant tuberculosis, which has forced them to rely on more expensive and prolonged treatments in order to achieve a cure, increasing the cost of treatment 100-fold.

But the new strains, called extremely drug resistant (XDR) TB, cannot be treated at any cost. In many patients, particularly those with HIV/AIDS, the emergence of such strains has transformed tuberculosis, generally a slow, chronic lung disease, into a rapid assassin.

"With XDR-TB we have very few options left - all we can even try are very old, very ineffective drugs that we stopped using in the '50s and '60s," said Dr. Karin Weyer, director of the TB Unit at the South African Research Council. "For many people, there is no option."

Later this week, international experts from the World Health Organization and the U.S. Centers for Disease Control and Prevention will meet in Johannesburg to plot strategies to contain this new killer. Officials from the World Health Organization declined to discuss the topic until after the conference.

In one recent TB outbreak among 544 people in the South African province of Kwazulu-Natal, most of whom were HIV positive, 221 had resistant TB, and 53 of those cases involved XDR strains. Of those 53 cases, 52 patients have died, including many who were otherwise getting the most advanced therapy for AIDS.

And the problem of extreme resistance is not limited to Africa or to patients with HIV/AIDS. When the U.S. Centers for Disease Control last year asked tuberculosis labs worldwide to take a look at specimens for XDR TB, the results were alarming.

In a paper published this summer in Morbidity and Mortality Weekly, researchers reported that 15 percent of samples in South Korea had extreme drug resistance, 19 percent in Latvia, as well as 14 percent in the East European/ West Asia region. In the United States, 4 percent of sample were XDR.

"XDR TB has emerged worldwide as a threat to public health and TB control, raising concerns of a future epidemic of virtually untreatable disease," the researchers said. Extreme drug resistance is defined as strains of tuberculosis that are impervious to at least 3 of the 6 second-line drugs available to treat TB, and some are impervious to all 6.

Effective treatment of TB often requires the simultaneous administration of more than 3 drugs.

Extremely drug-resistant TB arises when a strain of tuberculosis with a less severe form of resistance is unrecognized, or is otherwise treated inadequately or incompletely.

Even standard TB needs to be treated for six months for a cure. Multidrug resistant strains required patients to take multiple drugs for two years, a treatment plan that is, for many patients, particularly those in poor countries, difficult to afford and comply with.

In South Africa, the cost of the six- month treatment is about €50, or $64, while the cost of the two-year course is €4,000, Weyer said.

If that treatment is not adhered to, the patient is not cured though his condition may improve. But most worrying, the tuberculosis bacterium that remain in his body learn to defy those drugs. These germs can then be passed to others setting off untreatable epidemics, like that in South Africa.


PARIS The spread of a new, highly resistant form of tuberculosis that is "virtually untreatable" is causing alarm among international health officials who say that it has now been identified in "all regions of the world," according to the World Health Organization.

For two decades, health officials have been concerned about the steady rise in drug resistant tuberculosis, which has forced them to rely on more expensive and prolonged treatments in order to achieve a cure, increasing the cost of treatment 100-fold.

But the new strains, called extremely drug resistant (XDR) TB, cannot be treated at any cost. In many patients, particularly those with HIV/AIDS, the emergence of such strains has transformed tuberculosis, generally a slow, chronic lung disease, into a rapid assassin.

"With XDR-TB we have very few options left - all we can even try are very old, very ineffective drugs that we stopped using in the '50s and '60s," said Dr. Karin Weyer, director of the TB Unit at the South African Research Council. "For many people, there is no option."

Later this week, international experts from the World Health Organization and the U.S. Centers for Disease Control and Prevention will meet in Johannesburg to plot strategies to contain this new killer. Officials from the World Health Organization declined to discuss the topic until after the conference.

In one recent TB outbreak among 544 people in the South African province of Kwazulu-Natal, most of whom were HIV positive, 221 had resistant TB, and 53 of those cases involved XDR strains. Of those 53 cases, 52 patients have died, including many who were otherwise getting the most advanced therapy for AIDS.

And the problem of extreme resistance is not limited to Africa or to patients with HIV/AIDS. When the U.S. Centers for Disease Control last year asked tuberculosis labs worldwide to take a look at specimens for XDR TB, the results were alarming.

In a paper published this summer in Morbidity and Mortality Weekly, researchers reported that 15 percent of samples in South Korea had extreme drug resistance, 19 percent in Latvia, as well as 14 percent in the East European/ West Asia region. In the United States, 4 percent of sample were XDR.

"XDR TB has emerged worldwide as a threat to public health and TB control, raising concerns of a future epidemic of virtually untreatable disease," the researchers said. Extreme drug resistance is defined as strains of tuberculosis that are impervious to at least 3 of the 6 second-line drugs available to treat TB, and some are impervious to all 6.

Effective treatment of TB often requires the simultaneous administration of more than 3 drugs.

Extremely drug-resistant TB arises when a strain of tuberculosis with a less severe form of resistance is unrecognized, or is otherwise treated inadequately or incompletely.

Even standard TB needs to be treated for six months for a cure. Multidrug resistant strains required patients to take multiple drugs for two years, a treatment plan that is, for many patients, particularly those in poor countries, difficult to afford and comply with.

In South Africa, the cost of the six- month treatment is about €50, or $64, while the cost of the two-year course is €4,000, Weyer said.

If that treatment is not adhered to, the patient is not cured though his condition may improve. But most worrying, the tuberculosis bacterium that remain in his body learn to defy those drugs. These germs can then be passed to others setting off untreatable epidemics, like that in South Africa.


This article raises alarm to Public Health officials as TB has been on the rise worldwide. Something that sometimes we don't think about, that we are invincible and the likes, but with how small our global world has become, it only takes one person on a plane to start a pandemic (SARS).

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This article raises alarm to Public Health officials as TB has been on the rise worldwide. Something that sometimes we don't think about, that we are invincible and the likes, but with how small our global world has become, it only takes one person on a plane to start a pandemic (SARS).

But SARS wasn't a pandemic. The "Alarm" (read: hysteria) sure was, though. I'm always reading about "Public Health Officials" who always seem to be "Alarmed" about something. I think the majority of these people would qualify as severely mysophobic by DSM-IV criteria. Sometimes I think the CDC is being run by Howie Mandel. (How else do you explain the CDC putting time and effort into investigating "Morgellons Disease"?)

Seriously, with all this fear-mongering by public health bureaucracies, I'm not sure what I really should be concerned about anymore. I wonder if the fact that these people are severely immunocompromised is what makes these TB strains so drug resistant. Almost all antibiotics rely on a functioning immune system to some extent to clear infections. The article doesn't seem to speculate on this. Go figure.
 
I was using SARS as an example as it was carried across the world. But the point is still taken all the same. Immunocompromised people are a factor I'm sure, but take the former soviet union in point. They have had an incidental increase in TB throughout their prison system which has now overflowed into the public with the fall of communism. Close quarter breeding grounds are perfect for TB which many parts of the world seem to thrive on.

With this resistant strain, some people will not be able to afford treatment and this is a call pretty much for the rich to help the poor (again). As well as information for the public.

As for Morgellons ... well now, THAT should have its own thread ;)

Its not fear mongering here, its other parts of the world so you have to keep the perspective.
 
I was using SARS as an example as it was carried across the world. But the point is still taken all the same. Immunocompromised people are a factor I'm sure, but take the former soviet union in point. They have had an incidental increase in TB throughout their prison system which has now overflowed into the public with the fall of communism. Close quarter breeding grounds are perfect for TB which many parts of the world seem to thrive on.

With this resistant strain, some people will not be able to afford treatment and this is a call pretty much for the rich to help the poor (again). As well as information for the public.

As for Morgellons ... well now, THAT should have its own thread ;)

Its not fear mongering here, its other parts of the world so you have to keep the perspective.

Ah, Moregellons!

Has anyone EVER been able to demonstrate the so-called fiber coming out of their body? Even once?

And if the rich are going to help the poor, we better not plan on using the poor to help. Thats just throwing money away, as has been demonstrated over and over again since the end of WWII.
 
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