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First "XDR" TB cases found in Myanmar migrants

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  • First "XDR" TB cases found in Myanmar migrants

    First "XDR" TB cases found in Myanmar migrants

    Mon Jun 11, 2007 4:41AM EDT
    By Gill Griffith-Jones

    MAE SOT, Thailand (Reuters) - Aid workers have discovered the first cases of "extensively drug resistant" TB among migrants from Myanmar, intensifying fears about untreatable infectious diseases propagating in the army-ruled former Burma.

    French aid agency Medecins Sans Frontieres (MSF) said it had confirmed two cases of "XDR" tuberculosis in the Thai border town of Mae Sot last week, and had two other suspected cases of the hard-to-treat strain.

    One of the infected patients was a refugee, the other a migrant worker, MSF said.

    MSF's discovery made no headlines, unlike the furor in the United States over bungled attempts to isolate an XDR-infected 31-year-old lawyer who flew halfway round the world despite requests not to travel.

    However, as an indicator of the growth of drug-resistant killer diseases in Myanmar due to a combination of simmering civil war, a non-existent health service and the widespread availability of fake drugs, it is arguably far more serious.

    "We cannot treat XDR here. There is no treatment for them," said Janne Krause, one of the MSF doctors responsible for dealing with the growing numbers of TB patients flocking across the border.

    MSF, which sees between 50 and 80 new TB patients from Myanmar every month, started treating "multi-drug resistant" patients in 2005.

    Throughout an arduous treatment course in a special "TB village" in a refugee camp, patients are under careful monitoring to ensure they do not deviate from prescribed dosages.

    Allowing them to miss doses, take half doses or doses with fake pills that contain only a fraction of the correct drugs is a sure way to let the TB bacterium mutate and start to build up immunity, experts say.

    Unfortunately, among refugees and the desperately poor migrant workers flooding into Thailand, ad hoc self-treatment is the norm.

    "They don't take their drugs regularly. They take them every second day because they want to save drugs. They stop taking them then start again after some weeks. They take all kinds of drugs in different combinations
    ," she said.

    Some patients have even managed to get hold of "second-line" drugs used to treat the multi-drug resistant strain.

    "This is how they become finally XDR
    ," Krause said.

    The World Health Organization has confirmed 269 cases of XDR TB in 35 countries, with 85 percent of patients expected to die. Myanmar has not had any confirmed cases.

    Long-term treatment with strong antibiotics can cure patients but in the United States the costs exceed $250,000 per patient.


  • #2
    Re: First "XDR" TB cases found in Myanmar migrants

    TB super-strain found in Myanmar migrants

    The first cases of a dangerous, highly drug-resistant form of tuberculosis among Myanmar migrants have been diagnosed in the Thai border town of Mae Sot, aid workers said Monday.

    "We had confirmation for two cases in Mae Sot,"
    said Andres Romero of the charity Doctors Without Borders (MSF).

    Romero, who heads MSF's TB programme in Mae Sot, said both men were migrants and both had disappeared before doctors received the test results confirming that they had extensively drug-resistant tuberculosis, known as XDR.

    Hundreds of thousands of people in eastern Myanmar have been displaced by decades of fighting between the military government and ethnic rebels fighting for autonomy in their regions.

    Some live as refugees in Thailand in camps strung along the border, but many more are migrants who either cross back and forth or who take jobs in Thailand.

    Without addresses or telephones, providing follow-up treatment is difficult. Treating a normal TB case takes up to nine months, but Romero said that MSF doctors in Mae Sot had no drugs to treat patients with XDR.

    "We cannot provide any treatment to them,"
    he said. "It's quite new, and it's not available everywhere," Romero said of the drugs.

    A man in the United States caused a global health scare after he was diagnosed with XDR last month but travelled to Europe and Canada against doctors' advice.

    The two Myanmar migrants' cases sparked no such clamour when they were diagnosed last week.

    The health system in military-ruled Myanmar has collapsed under decades of economic mismanagement, and the country has one of the world's highest rates of tuberculosis, with 97,000 new cases detected each year.

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