Published Date: 2007-06-23 23:50:00
Subject: PRO/EDR> Tuberculosis, XDR - worldwide (02)
Archive Number: 20070623.2034
TUBERCULOSIS, XDR - WORLDWIDE (02)
**********************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Fri 22 Jun 2007
Source: Reuters Foundation AlertNet [edited]
<http://www.alertnet.org/thenews/newsdesk/L21785571.htm>
A new, untreatable form of tuberculosis is striking up to 30 000
people a year, the World Health Organisation (WHO) said on Friday [22
Jun 2007], and warned it could spark an "apocalyptic scenario" if
unchecked.
The United Nations agency appealed for USD 2.15 billion to combat
drug-resistant TB under a programme which it said could save up to
134 000 lives over 2 years.
Extensively drug resistant TB (XDR-TB), a form virtually immune to
antibiotics, has been reported in 37 countries in all regions since
emerging in 2006, according to the WHO. "There are somewhere between
25 000 and 30 000, we roughly estimate, cases of extensive drug
resistant TB each year," Paul Nunn, coordinator of WHO's Stop TB
Department, told a briefing. "Ultimately, to face down this epidemic,
we need new tools -- we need new drugs, we need new diagnostics," he
added.
The recent case of an American man with XDR-TB who travelled abroad
triggered an international health scare, highlighting the potential
risks of rapid spread.
XDR-TB cases are particularly difficult to treat, and a patient could
infect other people for years, according to Mario Raviglione,
director of the WHO's Stop TB Department. "That is the big threat
here. If you have more and more of these cases, you will
automatically magnify the problem by having transmission going on to
other individuals ... Once they become infected they are sort of a
time bomb," Raviglione said.
"If this is kept unchecked and goes on, then you may also see an
apocalyptic scenario where the present epidemic of TB is replaced by
an epidemic of TB which is now fully resistant to everything," he
added.
"Pre-antibiotic era"
--------------------
Some 8.8 million people each year develop normal TB, a bacterial
infection that usually attacks the lungs and which kills 1.6 million
people a year, according to the WHO.
About 450 000 get a multidrug-resistant form (MDR-TB) each year,
which resists the main 1st-line drugs, but XDR-TB occurs when there
is resistance to even 2nd-line drugs. "The possibility is that you
could replace that epidemic with a drug-resistant epidemic, in other
words you could have 8 million cases of drug-resistant TB wandering
around. And then you will be back to the pre-antibiotic era," said
Nunn.
An outbreak in KwaZulu-Natal province of South Africa last year
[2006] confirmed the WHO's fears about XDR-TB, which killed 52 of the
53 patients, mainly carriers of the HIV virus, he said.
"We really now have to focus on problems of infection control. We
can't allow drug-resistant MDR or XDR to get into populations of
HIV-infected people," he added.
Regular TB can be diagnosed with a microscope, but drug-resistant
forms require laboratories that can do more sophisticated tests -- a
capacity lacking in many poor countries, especially in sub-Saharan
Africa, he said.
"The reality of the situation right now is that we only have the
drugs that we have and very likely we will not have new drugs for at
least another 5 to 10 years," Nunn said.
[Byline: Stephanie Nebehay]
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
[The XDR strains of _Mycobacterium tuberculosis_ are resistant to the
2 most important 1st-line drugs (INH (isoniazid) and RIF (rifampin),
any of the fluoroquinolones, and at least one of the following
injectable antibiotics, amikacin (AK), kanamycin (KM), or capreomycin
(CM). Use of other antibiotics to which the XDR may be susceptible,
such as ethionamide, cycloserine (CS), viomycin (VM), or
para-aminosalicylic acid (PAS), to treat XDR tuberculosis is
associated with poorer outcomes. Outcomes depend on the extent of
drug resistance, severity of disease, and the status of the patient's
immune system. Surgery may be curative if the area of involved lung
is small enough to be removed without causing deterioration in
pulmonary function.
If patients with uncontrolled XDR tuberculosis who produce sputum with
a high _M. tuberculosis_ density -- as reflected by positive acid-fast
smears of sputum -- are not adequately isolated, they will likely
disseminate the disease to close contacts. Rapid tests that determine
drug resistance and new potent drugs that do not have severe side
effects are urgently needed. - Mod.ML]
See Also
Tuberculosis, XDR - worldwide 20070205.0456Tuberculosis, XDR, airplane exposure - multicountry (04) 20070609.1888
Tuberculosis, XDR - South Africa (09): Western Cape 20070604.1805
Tuberculosis, XDR, airplane exposure - multicountry (03) 20070601.1778
Tuberculosis, XDR, airplane exposure - multicountry (02) 20070530.1752
Tuberculosis, XDR, airplane exposure - multicountry (USA, France,
Canada, Czech Rep.) 20070529.1738
Tuberculosis, XDR - South Africa (08): Western Cape 20070425.1349
Tuberculosis, XDR, 2003-2006 - Europe (Germany, Italy) 20070403.1132
Tuberculosis, XDR - South Africa (07): Eastern Cape 20070326.1044
Tuberculosis, XDR, 1993-2006 - USA 20070322.1005
Tuberculosis, XDR - South Africa (06) 20070319.0959
Tuberculosis, XDR, 1991-2003 - Spain 20070302.0738
Tuberculosis, XDR - South Africa (05) 20070228.0717
Tuberculosis, XDR - South Africa (04) 20070220.0638
Tuberculosis, XDR - South Africa (03) 20070209.0504
Tuberculosis, XDR - South Africa (02) 20070128.0375
Tuberculosis, XDR - South Africa: interventions 20070126.0349
.............................................ml/mj/jw
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Become a ProMED-mail Premium Subscriber at
<http://www.isid.org/ProMEDMail_Premium.shtml>
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org
(NOT to an individual moderator). If you do not give your
full name and affiliation, it may not be posted. Send
commands to subscribe/unsubscribe, get archives, help,
etc. to: majordomo@promedmail.org. For assistance from a
human being send mail to: owner-promed@promedmail.org.
############################################################
############################################################