resistant tuberculosis cases has affected both the rich and the poor
LONDON On New Year Eve 2004, after months of losing weight and suffering fevers, night sweats and shortness of breath, student Anna Watterson was taken into hospital coughing up blood.
It was strange to be diagnosed with tuberculosis (TB) an ancient disease associated with poverty especially since Watterson was a well off trainee lawyer living in the affluent British capital of London. Yet it was also a relief, she says, finally to know what had been making her ill for so long.
After six week converse shoes s of taking pills that had no effect, Watterson was told she had multi drug resistant TB, or MDR TB, and faced months in an isolation ward on a regimen of injected drugs that left her nauseous, bruised and unable to go out in the sun.
friends were really shocked, Watterson said. of them had only heard of TB from reading Victorian novels. is often seen in the wealthy West as a disease of bygone eras evoking impoverished 18th or 19th century women and children dying slowly of a disease then commonly known as or the plague. rapidly rising rates of drug resistant TB in some of the wealthiest cities in the world, as well as across Africa and Asia, are again making history.
London has been dubbed the capital of Europe, and a startling recent study documenting new cases of so called drug resistant TB in India suggests the modern day tale of this disease could get a lot worse.
can afford this genie to get out of the bag. Because once it has, I don know how we control TB, said Ruth McNerney, an expert on tuberculosis at the London School of Hygiene and Tropical Medicine.
TB is a bacterial infection that destroys patients lung tissue, making them cough and sneeze, and spread germs through the air. Anyone with active TB can easily infect another 10 to 15 people a year.
In 2010, 8.8 million people had TB, and the Geneva based World Health Organization (WHO) has predicted that more than 2 million people will contract multi drug resistant TB by 2015. The worldwide TB death rate currently runs at between two and three people a minute.
Little surprise, then, that the apparently totally untreatable cases in India have raised international alarm.
The WHO has convened a special meeting on Wednesday to discuss whether the emergence of TB strains that seem to be resistant to all known medicines merits a new class definition of drug resistant TB, or TDR TB.
If so, it would add a new level to an evolution over the years from normal TB, which is curable with six months of antibiotic treatment, to the emergence of MDR TB, then extensively drug resistant TB (XDR TB).
What so frustrating about that progression, says Lucica Ditiu of the WHO Stop TB Partnership, is that all drug resistant TB a totally man made disease. The more treatment courses patients are given and fail to complete, the stronger and more widespread the resistance becomes.
doctors, the healthcare workers, the nurses, entire healthcare systems have produced MDR TB. It not a bug that has come from nature. It not a spontaneous mutation. It came about because patients were treated badly either with poor quality drugs, or not enough drugs, or with insufficient observation so the patient didn finish the treatment course, said Ditiu.
Ditiu is somewhat reassured that the WHO is meeting to look at recent extreme cases of drug resistance, which will at least throw a spotlight on this often forgotten disease.
But she says while definitions are central to international guidelines and treatment protocols, they make little difference to sick people.
is much more important is the drama and tragedy of the human beings. Whether it MDR, XDR or TDR TB, it doesn make much difference to the patients. A lot of them will face a very, very unfortunate fate. THE DRUGS DON WORK
The situation in India is a case in point.
Dr. Zarir Udwadia, a tuberculosis specialist at the Hinduja National Hospital in Mumbai, published a paper in the Clinical Infectious Diseases journal late last year documenting four cases of TDR TB. He told Reuters he has now identified 12 cases for which he has all but run out of treatment options. Three are already dead.
He has tested one powerful anti TB drug after another on samples cultured from these patients including first line treatments like isoniazid, rifampicin and streptomycin, and a range of second line drugs like moxifloxacin, kanamycin and ethionamide. Each medicine failed.
you add it all up, they were resistant to 12 drugs in total, he said.
Like others, Udwadia blames poor medical practice.
Non prescription and over the counter antibiotic use is rife in India and it may be no coincidence that the country now has one of the highest burdens on MDR TB in the world, with more than 100,000 cases.
Udwadia team conducted a recent study in Mumbai, home to more than 12 million people often living in harsh and overcrowded conditions, and found in one district only five out of 106 doctors in the unregulated private sec converse shoes tor could converse shoes give a correct prescription for a hypothetical patient with MDR TB.
Most of the prescriptions were and would only have made the patient worse dr converse shoes iving the conversion of MDR tuberculosis to XDR and then to TDR tuberculosis.