Published Date: 2007-06-04 19:00:01
Subject: PRO/EDR> Tuberculosis, XDR - South Africa (09): Western Cape
Archive Number: 20070604.1805
TUBERCULOSIS, XDR - SOUTH AFRICA (09): WESTERN CAPE
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Wed 30 May 2007
Source: Independent Online [edited]
An 18 year old youth has died of [extensively drug-resistant tuberculosis
(XDR TB)], the 5th death from the deadly strain of TB in the Western Cape,
as Brooklyn Chest Hospital runs out of space in its special isolation ward.
The 22 bed isolation unit, specially set up to address the rising incidence
of XDR TB in the province, is now full, as provincial health authorities
move fast to identify further space to address the demand.
The issue of isolation of patients with XDR TB and the slightly less
dangerous multi-drug resistant TB (MDR TB) is in the spotlight following
news on Mon 28 May 2007, that Delft doctors were forced to send home a
highly infectious female patient because of a shortage of isolation unit beds.
The 53 year old woman was diagnosed with MDR TB, but considering she is
still infectious after 18 months on alternative treatment, doctors suggest
she could well be another XDR TB case.
According to health department spokesperson, Faiza Steyn, the woman was to
be admitted to Brooklyn Chest Hospital today [30 May 2007].
Steyn said there were currently 37 confirmed XDR TB patients in the Western
Cape. The 18 year old boy, the most recent person to die of XDR TB, died at
Meanwhile, to cope with the shortage of beds, both confirmed and suspected
cases were being admitted into a side section of an isolation ward at
Brooklyn Chest Hospital, used for MDR TB patients. Other than the stopgap
side ward, Steyn said provincial health authorities were making plans to
convert an "ordinary" TB ward at Brooklyn Chest Hospital, which has 45
beds, into an XDR TB ward.
[As a reminder, XDR TB is now defined as an isolate resistant to INH
(isoniazid) and RIF (rifampicin) (MDR TB) that is also resistant to a
fluoroquinolone and to one or more of the following 3 injectable
anti-tuberculosis drugs: capreomycin (CM), kanamycin (KM), and amikacin (AK).
The number of cases of XDR TB continues to grow, especially in South
Africa. It is not stated in the posting how many of the total and of those
who died were infected with HIV as well.
Clearly, additional hospital space is needed to minimize community
transmission of this drug resistant pathogen.
In this latest reported death, the death at home occurred prior to the
microbiologic confirmation of XDR TB. This has been common in South Africa,
especially in the HIV co-infected cohort, a measure of the rapid
progression of TB in and profoundly cellularly immunosuppressed population.
The Western Cape Province of South Africa can be found on a map of the
country at <http://www.un.org/Depts/Cartographic/map/profile/southafr.pdf>.
Most of the country's provinces have had cases of XDR TB. - Mod.LL]