Published Date: 2007-10-04 15:00:09
Subject: PRO/EDR> Tuberculosis - Uganda (02): MDR, susp. RFI
Archive Number: 20071004.3284
TUBERCULOSIS - UGANDA (02): MDR, SUSPECTED, REQUEST FOR INFORMATION
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Wed 3 Oct 2007
Source: Daily Monitor [edited]
A new but rare multi-drug resistant strain of tuberculosis is on the
rise in the country, medical experts have revealed. The disease is
highly contagious. The alarm bells were sounded over the weekend by
10 Ugandan nurses, who have just completed a refresher course in
Nairobi, Kenya, on how to handle patients with the
multidrug-resistant chronic disease. The nurses said the most
affected districts are Kampala, Gulu, Hoima, Soroti, Kabale, Mbarara,
Mbale, and Arua.
At a press conference in Entebbe, the nurses under their umbrella
organisation, the Uganda National Association for Nurses and
Midwives, said medical reports suggest that the disease, currently on
the increase in Uganda, has metamorphosed from the globally known TB
-- an infectious disease that attacks the lungs, to a drug-resistant version.
Ms Janet Obuni, a nurse who led the team, said the disease is on the
increase in Uganda because TB patients are misusing drug regimes
meant to cure the lung illness, making them ineffective in treating
the disease, "hence the emergence of multidrug-resistant tuberculosis
(MDR-TB) which is becoming a serious global public health concern."
"For this TB to be contained, the nurses need to be trained on how to
handle it before it spreads," Ms Obuni said.
A nurse from Soroti Hospital, Ms Mary Asio, told reporters that she
is currently handling 3 patients suffering from the disease, one of
whom has failed to respond to TB treatment 4 times. "We have nothing
to do now because he has received the treatment for 32 months yet it
is supposed to be for 8 months," Ms Asio said, adding that doctors
are now worried that the patient "may infect his family members." The
nurses, however, provided no statistical data to back up their claims
of the disease increase.
The WHO (World Health Organization) has described the
multidrug-resistant TB when the TB bacteria are resistant to at least
isoniazid and rifampicin, the 2 most powerful anti-TB drugs.
Dr Sam Zaramba, the director general of health services in the
Ministry of Health confirmed the occurrence of the strain in a
telephone interview. Without going into specifics he said a number of
cases had been registered at "some treatment centres," adding that
the government had responded by sending the team of nurses to Kenya
for training on how to handle patients. The MDR-TB is much more
difficult and costly to treat than drug susceptible TB, with a single
patient requiring between USD 10 000-20 000, (UGX 17.6m-UGX 35.2m)
according to medical reports from cases being handled in neighbouring Kenya.
Back home [in Kenya], TB drugs are given free to patients in all
government hospitals, but patients reportedly fear to swallow them
because they claim that they have side effects such as burns on the
body. But patients can avoid the side effects of the drugs by feeding
on a balanced diet, said Dr Clare Ojoru, the officer in charge of the
TB ward at Mulago. She, however, added that "because there is laxity
in patients to take their drugs, the multiresistant TB is on increase."
The nurses appealed to the government to provide them with protective
gear so that "we don't acquire the disease", and called for a routine
screening especially in schools around the country, to quickly
identify any new cases. Early this year , the WHO country
office called for a declaration of TB as a national emergency in
efforts to combat the disease.
[Byline: Alice Lubwama]
Gustaf Rydevik, M.Sc.
[ProMED-mail thanks Gustaf Rydevik for bringing this news release to
our attention. Whether the strains that are causing tuberculosis
unresponsive to medical therapy in Uganda are MDR (resistant to
isoniazid and rifampin) or XDR (resistant to isoniazid, rifampin,
fluoroquinolones, and at least one of the 3 injectable
anti-tuberculosis drugs capreomycin, kanamycin, and amikacin) will
depend on results of drug susceptibility testing. From the news
releases, it is unknown if drug susceptibility testing has actually
been performed in these cases.
recommends drug susceptibility testing as follows:
"Drug susceptibility testing (DST) to the first-line antituberculosis
drugs should be performed in specialized reference laboratories that
participate in an ongoing, rigorous quality assurance program. DST
for first-line drugs is currently recommended for all patients with a
history of previous antituberculosis treatment: patients who have
failed treatment, especially those who have failed a standardized
retreatment regimen, and chronic cases are the highest
priority...Patients who develop tuberculosis and are known to have
been in close contact with persons known to have MDR tuberculosis
also should have DST performed on an initial isolate. Although HIV
infection has not been conclusively shown to be an independent risk
factor for drug resistance, MDR tuberculosis outbreaks in HIV
settings and high mortality rates in persons with MDR tuberculosis
and HIV infection justify routine DST in all HIV-infected
tuberculosis patients, resources permitting."
WHO estimates that of the 424 000 cases of MDR-TB that occur
annually, 17 percent are actually XDR
According to the WHO, however, "few national TB programmes have
capacity for drug-susceptibility testing (DST) for the 1st-line drugs
and even fewer have the capacity to test for 2nd-line drug resistance."
Other issues raised by the news release are the availability of fully
potent 2nd-line drugs, availability of personal protective equipment
(such as, disposable class N95 face masks) for healthcare
professionals, as well as knowledge about tuberculosis and actual
practice of optimal patient care of tuberculosis patients among
healthcare professionals in developing countries. In regard to the
last issue, a recent study documented inadequate knowledge and
practice concerning tuberculosis among recent Pakistani medical
school graduates (<http://www.thenews.com.pk/print1.asp?id=74470>). - Mod.ML]
[Information on actual sensitivity testing on the drug resistant
cases mentioned in the above newswire would be greatly appreciated. - Mod.MPP]