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Untreatable TB
For the past two months, the father of five who is also HIV-positive has been on short course chemotherapy to treat the disease, but his health has continued to deteriorate.
After endless visits and numerous tests at the local district hospital that specialises in infectious diseases, his doctor informed him that he was not responding to the treatment, which is regarded by health experts as the cornerstone of tuberculosis drug management in sub-Saharan Africa.
Oluya is a victim of a virulent new drug-resistant strain of tuberculosis known as Extensive Drug Resistant TB (XDR-TB).
The strain leaves patients, including many people living with HIV virtually untreatable using currently available anti-TB drugs, according to the World Health Organisation. XDR-TB is resistant to not only the two main first-line TB drugs ? isoniazid and rifampicin ? but also to three or more of the six classes of second-line drugs.
"XDR-TB poses a grave public health threat, especially in populations with high rates of HIV and where there are few healthcare resources," said WHO in a statement issued in Geneva last week.
The description of XDR-TB was first used earlier in the year, following a joint survey by WHO and the US Centres for Disease Control and Prevention.
Data on a recent outbreak of XDR-TB in an HIV-positive population in Kwazulu-Natal in South Africa, was characterised by alarmingly high mortality rates. Of the 544 patients studied, 221 had MDR-TB (multi-drug-resistant TB). Of the 221 MDR-TB cases, 53 were defined as XDR-TB. Of the 53 patients, 44 had been tested for HIV and all were HIV-positive. As many as 52 of 53 patients died, on average, within 25 days including those benefiting from anti-retroviral drugs.
In addition, recent findings from a survey conducted by WHO and CDC found that XDR-TB has been identified in all parts of the world but is most frequent in the countries of the former Soviet Union. In the United States, 4 per cent of MDR-TB cases met the criterion for XDR-TB.
In Latvia, a country with one of the highest rates of MDR-TB, 19 per cent of MDR-TB cases met the XDR-TB criteria.
WHO noted that its recommendations for managing drug-resistant strains of TB include strengthening basic TB care, ensuring prompt diagnosis and treatment of drug resistant cases; increasing collaboration between HIV and TB control programmes, and boosting investment in laboratory infrastructure.
XDR-TB DESCRIBES strains of tuberculosis that are resistant to at least the two main first-line TB drugs ? isoniazid and rifampicin. XDR-TB, or Extensive Drug Resistant TB (also referred to as Extreme Drug Resistance) is MDR-TB that is also resistant to three or more of the six classes of second-line drugs.
Resistance to anti-TB drugs in populations is a phenomenon that occurs primarily due to poorly managed TB care. This improper use is a result of a number of actions, including administration of improper treatment regimens by healthcare workers and failure to ensure that patients complete the whole course of treatment. In most cases, drug resistance arises in areas with poor TB control programmes.
The scarce drug resistance data available from Africa indicate that while population prevalence of drug resistant TB appears to be low compared with Eastern Europe and Asia, drug resistance in the region is on the rise. Given the underlying HIV epidemic, drug-resistant TB could claim many lives in Africa and requires urgent preventative measures.
Last week, WHO joined other TB experts at a two-day meeting in Johannesburg, South Africa, to assess the response required to address TB drug resistance, particularly in Africa.
The meeting was meant to outline WHO Guidelines for the Programmatic Management of Drug Resistant Tuberculosis, which include strengthening basic TB care to prevent the emergence of drug-resistance and to ensure prompt diagnosis and treatment.
Increase collaboration between HIV and TB control programmes to provide necessary prevention and care to co-infected patients and increase investment in laboratory infrastructures to enable better detection and management of resistant cases were also to be discussed.
Kenya ranks 12th among the world's 22 countries with a high tuberculosis burden. According to the WHO's Global Tuberculosis Control: WHO Report 2004, in 2002, Kenya had more than 170,000 TB cases and an incidence rate of 223 new sputum smear-positive (SS+) cases per 100,000 people. Approximately half of new estimated SS+ cases were detected in 2002, and 80 per cent of SS+ cases received treatment in 2001.
http://www.nationmedia.com/eastafrican/current/Magazine/Magazine301020062.htm
The strain leaves patients, including many people living with HIV, virtually untreatable using currently available anti-TB drugs, reports PHILIP NGUJIRI
DESPITE TAKING UP TO 16 tablets a day to treat tuberculosis, 45-year old Kanyanga Oluya is yet to get any reprieve from the infectious disease that affects approximately 10 million people globally every year. For the past two months, the father of five who is also HIV-positive has been on short course chemotherapy to treat the disease, but his health has continued to deteriorate.
After endless visits and numerous tests at the local district hospital that specialises in infectious diseases, his doctor informed him that he was not responding to the treatment, which is regarded by health experts as the cornerstone of tuberculosis drug management in sub-Saharan Africa.
Oluya is a victim of a virulent new drug-resistant strain of tuberculosis known as Extensive Drug Resistant TB (XDR-TB).
The strain leaves patients, including many people living with HIV virtually untreatable using currently available anti-TB drugs, according to the World Health Organisation. XDR-TB is resistant to not only the two main first-line TB drugs ? isoniazid and rifampicin ? but also to three or more of the six classes of second-line drugs.
"XDR-TB poses a grave public health threat, especially in populations with high rates of HIV and where there are few healthcare resources," said WHO in a statement issued in Geneva last week.
The description of XDR-TB was first used earlier in the year, following a joint survey by WHO and the US Centres for Disease Control and Prevention.
Data on a recent outbreak of XDR-TB in an HIV-positive population in Kwazulu-Natal in South Africa, was characterised by alarmingly high mortality rates. Of the 544 patients studied, 221 had MDR-TB (multi-drug-resistant TB). Of the 221 MDR-TB cases, 53 were defined as XDR-TB. Of the 53 patients, 44 had been tested for HIV and all were HIV-positive. As many as 52 of 53 patients died, on average, within 25 days including those benefiting from anti-retroviral drugs.
In addition, recent findings from a survey conducted by WHO and CDC found that XDR-TB has been identified in all parts of the world but is most frequent in the countries of the former Soviet Union. In the United States, 4 per cent of MDR-TB cases met the criterion for XDR-TB.
In Latvia, a country with one of the highest rates of MDR-TB, 19 per cent of MDR-TB cases met the XDR-TB criteria.
WHO noted that its recommendations for managing drug-resistant strains of TB include strengthening basic TB care, ensuring prompt diagnosis and treatment of drug resistant cases; increasing collaboration between HIV and TB control programmes, and boosting investment in laboratory infrastructure.
XDR-TB DESCRIBES strains of tuberculosis that are resistant to at least the two main first-line TB drugs ? isoniazid and rifampicin. XDR-TB, or Extensive Drug Resistant TB (also referred to as Extreme Drug Resistance) is MDR-TB that is also resistant to three or more of the six classes of second-line drugs.
Resistance to anti-TB drugs in populations is a phenomenon that occurs primarily due to poorly managed TB care. This improper use is a result of a number of actions, including administration of improper treatment regimens by healthcare workers and failure to ensure that patients complete the whole course of treatment. In most cases, drug resistance arises in areas with poor TB control programmes.
The scarce drug resistance data available from Africa indicate that while population prevalence of drug resistant TB appears to be low compared with Eastern Europe and Asia, drug resistance in the region is on the rise. Given the underlying HIV epidemic, drug-resistant TB could claim many lives in Africa and requires urgent preventative measures.
Last week, WHO joined other TB experts at a two-day meeting in Johannesburg, South Africa, to assess the response required to address TB drug resistance, particularly in Africa.
The meeting was meant to outline WHO Guidelines for the Programmatic Management of Drug Resistant Tuberculosis, which include strengthening basic TB care to prevent the emergence of drug-resistance and to ensure prompt diagnosis and treatment.
Increase collaboration between HIV and TB control programmes to provide necessary prevention and care to co-infected patients and increase investment in laboratory infrastructures to enable better detection and management of resistant cases were also to be discussed.
Kenya ranks 12th among the world's 22 countries with a high tuberculosis burden. According to the WHO's Global Tuberculosis Control: WHO Report 2004, in 2002, Kenya had more than 170,000 TB cases and an incidence rate of 223 new sputum smear-positive (SS+) cases per 100,000 people. Approximately half of new estimated SS+ cases were detected in 2002, and 80 per cent of SS+ cases received treatment in 2001.
http://www.nationmedia.com/eastafrican/current/Magazine/Magazine301020062.htm