Published Date: 2006-09-04 00:00:00
Subject: PRO/EDR> Tuberculosis, multi-drug resistant - South Africa (KN)
Archive Number: 20060904.2514
TUBERCULOSIS, MULTI-DRUG RESISTANT - SOUTH AFRICA (KWAZULU-NATAL)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: 1 Sep 2006
From: ProMED-mail <firstname.lastname@example.org>
Source: Mytelus [edited]
New deadly strain of TB detected in South Africa, kills 52 of 53 victims
A new, deadly strain of tuberculosis has killed 52 of 53 people
infected in the last year in South Africa, the World Health
Organization said Friday [1 Sep 2006], calling for improved measures
to treat and diagnose the virus.
The strain was discovered in the Kwazulu-Natal region of South
Africa, and is classified as extremely drug-resistant. Drugs from 3
of the 6 2nd-line medicines, used as a last line of defense against
TB, proved useless against the new strain.
"We are extremely worried about the issue of extreme drug
resistance," said Paul Nunn, coordinator of the WHO's drug resistance
department. "If countries don't have the diagnostic capacity to find
these patients, they will die without proper treatment."
Though even the most drug-resistant strains of TB have proven to be
treatable with 3 classes of drugs, those drugs are more expensive and
are toxic to the human body.
The WHO and its partners, including the U.S. Centers for Disease
Control and Prevention, planned a 2-day meeting next week in South
Africa to discuss the new TB strain in Africa and better ways to
diagnose and treat it, Nunn said. Tuberculosis is a respiratory
illness spread by coughing and sneezing. Nearly 2 billion people
worldwide are thought to be infected.
High mortality rates among TB patients in South Africa, however,
prompted medical researchers to survey the cases, and ultimately to
find the new strain.
Drug resistance is a common problem in TB treatment, but the new
strain appears particularly virulent: 52 of the 53 patients infected
all died within about 3 weeks of being tested for drug resistance.
"Genetic processes are constantly throwing up mutations of
tuberculosis [bacilli], so this may have arisen due to some
particular quirk of the environment or the way they were treated or
their genetic background," said Paul Fine, a professor of
communicable diseases at the London School of Hygiene and Tropical
Medicine. In general, drug-resistant viruses are not as easily
transmitted as those that are drug-sensitive.
Worldwide, about 2 percent of TB cases are classified as being
extremely drug-resistant. Little information is available on extreme
drug resistance in Africa, but it is believed to be increasing.
The high prevalence of HIV/AIDS in Africa also complicates the issue
of treating extremely drug-resistant TB.
"It's urgent to make the diagnosis when HIV is involved, because if
you don't make it, the combination of HIV and TB will kill," Nunn
[Mortality rates this high are not associated even with MDR TB when
treatment is available. This raises the question of either a
detection bias (i.e., only the sickest patients are being
identified), lack of appropriate drugs/medical care, a patient
population with severe co-morbidity (e.g., advanced HIV infection),
and/or perhaps a strain of _Mycobacterium tuberculosis_ with other
virulence characteristics. It is likely that more than one of these
factors is at work. ProMED would welcome additional information from
those with first-hand knowledge of the situation. - Mod.LM]