Thread: TB on the rise

Dangerous TB spreading at alarming rate in Europe - WHO
By Kate Kelland | Reuters – 9 hours ago


LONDON (Reuters) - Multidrug-resistant and extensively drug-resistant forms of tuberculosis (TB) are spreading at an alarming rate in Europe and will kill thousands unless health authorities halt the pandemic, the World Health Organisation(WHO) said on Wednesday.
Launching a new regional plan to find, diagnose and treat cases of the airborne infectious disease more effectively, the WHO's European director warned that complacency had allowed a resurgence of TB and failure to tackle it now would mean huge human and economic costs in the future.
"TB is an old disease that never went away, and now it is evolving with a vengeance," said Zsuzsanna Jakab, the WHO's Regional Director for Europe.
"The numbers are scary," Lucica Ditiu, executive secretary of the Stop TB Partnership told a news conference in London. "This is a very dramatic situation."
TB is currently a worldwide pandemic that kills around 1.7 million people a year. The infection is caused by the bacterium Mycobacterium tuberculosis and destroys patients' lung tissue, causing them to cough up the bacteria, which then spreads through the air and can be inhaled by others.
Cases of multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB) -- where the infections are resistant to first-line and then second-line antibiotic treatments -- are spreading fast, with about 440,000 new patients every year around the world.
According to the WHO and Stop TB, 15 of the 27 countries with the highest burden of MDR-TB are in the WHO's European region, which includes 53 countries in Europe and Central Asia.
More than 80,000 MDR-TB cases occur in the region each year -- almost a fifth of the world's total. The WHO said precise figures for XDR-TB are not available because most countries lack the facilities to diagnose it, but officially reported cases of XDR-TB increased six-fold between 2008 and 2009.
Rates are highest in eastern Europe and Central Asia, but many countries in western Europe have increasing rates of TB and drug-resistant TB, Ditiu said. Britain's capital, London, has the highest TB rate of any capital city in western Europe with around 3,500 cases a year, 2 percent of which are MDR-TB.
Treating even normal TB is a long and unpleasant process, with patients needing to take a combination of powerful antibiotics for 6 months. Many patients fail to correctly complete the course of medicines, a factor which has fuelled a rise in drug-resistant forms of the disease.
Treatment regimes for MDR-TB and XDR-TB can stretch into two or more years, costing up to $16,000 in drugs alone and up to $200,000 to $300,000 per patient if isolation hospital costs, medical care and other resources are taken into account.
Experts say around 7 percent of patients with straightforward TB die, and that death rate rises to around 50 percent of patients with drug-resistant forms.
The WHO's action plan for tackling tuberculosis emphasises the need for doctors and patients to be more aware of the disease and its symptoms, to diagnose and treat cases promptly with the right drugs, and follow patients up over many months or years to ensure they take their medications.
If that doesn't happen "not only are these people quietly and painfully dying, they are also spreading the disease," Ditiu said.
The WHO said that if the plan is fully implemented -- at an estimated cost of $5 billion -- 127,000 people will be successfully treated for drug-resistant TB and 120,000 deaths will be averted by 2015.
The cost would also be recouped, since 250 000 MDR-TB and 13,000 XDR-TB cases will be prevented, saving $7 billion in averted treatment costs, the WHO said. It added that prevention of premature deaths among TB patients would add to economic productivity in the region and generate an extra $5 billion.
(Reporting by Kate Kelland)

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A couple of months ago a poster here (or perhaps on TV forum) said that there were many people in his area in Thailand with TB. It's quite a contagious disease.

Totally drug resistant TB surfaces in Mumbai, govt in denial
Sonal Matharu
18 January 2012

Indian health ministry says neither WHO nor government tuberculosis control programme recognise TDR-TB.

The Union ministry of health has denied the presence of totally drug resistant tuberculosis (TDR-TB) reported in Mumbai. Researchers at the Hinduja Hospital in Mumbai documented the presence of this strain of TB in India for the first time in the December 21, 2011 edition of the journal, Clinical Infectious Diseases. Patients suffering from it are resistant to all available drugs to cure the deadly disease.


A high-tech, low-cost TB lab in a shipping container
Photo: Barry Kosloff,

ZAMBART Since October 2011, Mumbai has reported 14 instances of patients carrying the TDR-TB strain; of them, four patients have died, including a 13-year-old boy. Twelve cases are from the Hinduja hospital in Mahim and the remaining two are from Jamshedji Jijibhoy Hospital in Byculla.

But the health ministry in its press release on January 17 said that the term TDR-TB is “non-standardised” and “misleading”. It added that the term is neither recognised by the World Health Organisation (WHO) nor by the government-run national programme for TB control—Revised National TB Control Programme (RNTCP).

TDR TB does exist, say experts

However, doctors and public health experts say the term used to classify the 14 Mumbai patients is not new and has been used earlier in other countries.

“Cases of TDR-TB do exist. There is nothing extra-ordinary that these cases have come up. Many patients do not complete the treatment under RNTCP or the drugs they may be taking are not appropriate.

Resistance to drugs develops in such cases. TDR-TB cases in India are expected. But the government is always in a denial mode,” says Sarman Singh, head of clinical microbiology department in the All India Institute of Medical Sciences (AIIMS).

TDR-TB cases are similar to extensively drug-resistant TB (XDR-TB), in which resistance develops to the second-line drugs for TB as well, says Soumya Swaminathan, scientist with the department of clinical research at the Tuberculosis Research Centre in Chennai, Tamil Nadu. “TDR-TB is very similar to the XDR-TB. It is very difficult to treat these cases,” she says.

Mortality in cases resistant to second-line drugs is more than 80% and the only options left to treat these patients are either surgery or by giving patients drugs that have not been tried before.

The first-line drugs for TB are isoniasid, rifampicin, ethambutol, pyrasinamide and streptomycin. Once patients develop resistance to these drugs, they are given second-line of drugs—ofloxacin, moxifloxacin, kanamycin, amikacin, capreomycin, para-aminosalicylic acid and ethionamide.

Lab tests contested

The ministry has also contested the laboratory tests carried out by the doctors at Hinduja Hospital.

“The Hinduja Hospital Laboratory is not accredited by the RNTCP for culture and sensitivity for second line drugs to diagnose XDR-TB or TDR-TB cases, and is only accredited for conducting Drug Susceptibility Testing (DST) by liquid culture and sensitivity for first line drugs,” the release says.

The authors of the study, Zarir Udwadia, Camilla Rodrigues, Rohit Amale and Kanchan Ajbani, performed DST through bacteria culture at different concentrations of the antibiotic and found that the patients were resistant to all the WHO prescribed first and second line of drugs for treating TB. In addition, three of the patients underwent genotypic DST analysis using more advanced tests. They added in the study that the laboratory at the hospital is a referral laboratory and a RNTCP-accredited laboratory for Mumbai.

Besides DST, they also audited the prescriptions of the patients that revealed that three patients had received “erratic, unsupervised second-line drugs, added individually and often in incorrect doses, from multiple private practitioners (average of four physicians during a 18-month period) in an attempt to cure their multi-drug resistant TB (MDR-TB).”

The Maharashtra health department joint director for TB control, P Y Gaikwad, said the state government is planning to conduct field visits to assess how widespread the problem is in the state. “The state health department will be sending teams to the field and identifying more such cases, including cases in TB hospital in Sewri, Mumbai. Samples collected may even be sent to National TB Institute at Bengaluru.

Samples collected will be those that are resistant to second-line TB drugs,” he said.

Most docs can't prescribe correctly

India has become the third country in the world to identify patients with TDR-TB. Earlier, TDR-TB cases were first identified in 15 patients in Iran in 2006 and then in Iraq in 2007.

The authors write, “Only 5 of 106 private practitioners practising in a crowded area called Dharavi could prescribe a correct prescription for a hypothetical patient with MDR tuberculosis. The majority of prescriptions were inappropriate and would only have served to further amplify resistance, converting MDR tuberculosis to XDR tuberculosis and TDR tuberculosis. We would urge that patients with MDR tuberculosis only be treated within the confines of government sanctioned DOTS-Plus programmes to prevent the emergence and spread of this untreatable form of tuberculosis.”

As per the 2007 WHO global resistance report, only one per cent of patients in India with multi-drug resistance tuberculosis have to the Directly Observed Treatment, Short-course (DOTS)–Plus initiatives, treatment regime prescribed under RNTCP. India accounts for 20 per cent of the world’s MDR tuberculosis load.

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