South Africa risks spreading totally drug-resistant TB - study

LONDON Thu Jan 16, 2014 7:01pm EST

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LONDON Jan 17 (Reuters) - Patients with contagious and highly drug-resistant tuberculosis (TB) are being routinely discharged from hospitals across South Africa, exposing others in their communities to potentially deadly infections, researchers said on Friday.

In a study in the medical journal The Lancet, they said the patients, with strains of TB known as extensively-drug resistant (XDR) and totally drug resistant (TDR) TB, have exhausted all available treatment options and are sent home.

"These patients can survive for months or even years and are contributing to the community-based spread of XDR-TB," said Keertan Dheda, who led the study at the University of Cape Town's department of medicine.

Tuberculosis infects the lungs and can spread through coughing and sneezing. In recent years, drug-resistant strains have spread around the world, batting off standard antibiotics and posing an increasingly urgent public health threat.

The World Health Organisation (WHO) estimates that in Eastern Europe, Asia and South Africa, 450,000 people have MDR-TB, and around half of these will fail to respond to existing treatments.

Dheda's team followed 107 patients with XDR-TB from three provinces in South Africa between March 2008 and August 2012 to establish their fate.

They also took samples from 56 patients and tested them to find out which and how many of 10 first- and second-line anti-TB drugs they were susceptible to.

Despite being treated intensively with an average of eight anti-tuberculosis drugs, many of the patients fared poorly, with high rates of treatment failure and death. Five years after treatment initiation, only 12 of the patients had favourable outcomes and 74 percent had died.

DISCHARGED WHILE INFECTIOUS

The researchers found that almost two-thirds of the tested patients had resistance to at least eight drugs, and there was one case of totally drug-resistant TB that was not susceptible to any of the 10 drugs tested.

More worrisome, Dheda said, was that of the XDR-TB patients discharged into the general community, some 42 percent had failed to get better on treatment and were testing positive for active TB, and of these almost a third were at high risk of transmitting the disease.

The patients also survived in the community for an average of 20 months - plenty of time to infect others. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. Another person needs to inhale only a few of these germs to become infected.

"Alarmingly, we have shown for the first time that... treatment failure and discharge of such patients into the wider community is occurring systematically on a country-wide level in South Africa," Dheda said in a statement about the findings.

In one case where the researchers followed a genetic trail of transmission, they found that a patient with XDR-TB who was discharged after failing treatment went on to infect his brother, who also eventually died.

Dheda said the reason many TB patients are being sent away from hospitals appeared to be lack of bed space in designated tuberculosis hospitals. "And alternative long-term residential and palliative care facilities are scarce."

Commenting on the findings in The Lancet, Max O'Donnell from New York's Albert Einstein College of Medicine in the United States said they should serve as an "urgent alarm".

"MDR-TB (multi-drug-resistant TB) in all its forms is an out-of-control problem with potentially vast and devastating consequences for global public health," he wrote. "The situation regarding MDR and XDR-TB is bleak." (Editing by Kevin Liffey)

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Comments (2)
RobWilk wrote:
Dr Dheda and team should be applauded for their courage to expose the inadequacies and inhumane way in which the South African government is dealing with their TB patients. Shameful to say the least that a country with the largest resources in Africa cannot show leadership of a major health disaster. this is reminscent of the HIV epidemic where South African government denied the esistence of the epidemic leaving people to die rather than get them onto ARV treatment. Discharging patients with untreatable TB into the community is a basic violation of human rights. Wakeup call as the US authors say –

Jan 17, 2014 2:08am EST  --  Report as abuse
mauroy wrote:
The last article of Kate Kelland from Reuters (17th of January) shows how much it is urgent to react face to the fast tuberculosis (TB) spreading. Drug-resistant TB is of course the major cause of this main issue for global public health. It is time the World Health Organisation and the scientific community understand that there exists a medical solution to solve this problem.

For all those which have a minimum of competence in microbiology it’s well-known that the Koch bacillus (KB), which is responsible for TB, like the other bacteria, needs a specific media to growth in vitro. In vivo it is the same. The populations which are contaminated with KB are neglected populations. It is true in Europe, Africa or Asia. For this disease it is important to note that TB does not relate to the higher social classes. Why KB does develop in certain populations and not in all the populations? Because it finds in the populations in malnutrition and lack of hygiene the milieu favorable to its growth. Today the medium favorable to the growth of the BK maybe easily identified using one drop of blood.

The only solution to catalyst the drugs anti-TB is to add new molecules or neutraceuticals to modify the nature of the biological milieu of tuberculous patients. If the patient’s medium is modify, coupled with anti-TB drug, BK will be eliminated since the parameters favorable to its development will have disappeared. It is time the pharmaceutical industries must be interested in this urgent problem.

Didier Mauroy

The last article of Kate Kelland from Reuters (17th of January) shows how much it is urgent to react face to the fast tuberculosis (TB) spreading. Drug-resistant TB is of course the major cause of this main issue for global public health. It is time the World Health Organisation and the scientific community understand that there exists a medical solution to solve this problem.

The only solution to catalyst the drugs anti-TB is to add new molecules or neutraceuticals to modify the nature of the biological milieu of tuberculous patients. If the patient’s medium is modify, coupled with anti-TB drug, BK will be eliminated since the parameters favorable to its development will have disappeared. It is time the pharmaceutical industries must be interested in this urgent problem.

Jan 19, 2014 6:52am EST  --  Report as abuse
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