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  • Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis

    Lancet. 2010 May 22;375(9728):1830-43.

    Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis.

    Abstract

    Although progress has been made to reduce global incidence of drug-susceptible tuberculosis, the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis during the past decade threatens to undermine these advances.

    However, countries are responding far too slowly.

    Of the estimated 440,000 cases of MDR tuberculosis that occurred in 2008, only 7% were identified and reported to WHO. Of these cases, only a fifth were treated according to WHO standards.

    Although treatment of MDR and XDR tuberculosis is possible with currently available diagnostic techniques and drugs, the treatment course is substantially more costly and laborious than for drug-susceptible tuberculosis, with higher rates of treatment failure and mortality.

    Nonetheless, a few countries provide examples of how existing technologies can be used to reverse the epidemic of MDR tuberculosis within a decade.

    Major improvements in laboratory capacity, infection control, performance of tuberculosis control programmes, and treatment regimens for both drug-susceptible and drug-resistant disease will be needed, together with a massive scale-up in diagnosis and treatment of MDR and XDR tuberculosis to prevent drug-resistant strains from becoming the dominant form of tuberculosis.

    New diagnostic tests and drugs are likely to become available during the next few years and should accelerate control of MDR and XDR tuberculosis.

    Equally important, especially in the highest-burden countries of India, China, and Russia, will be a commitment to tuberculosis control including improvements in national policies and health systems that remove financial barriers to treatment, encourage rational drug use, and create the infrastructure necessary to manage MDR tuberculosis on a national scale.

    Although progress has been made to reduce global incidence of drug-susceptible tuberculosis, the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis during the past decade threatens to undermine these advances. However, countries are responding far too slowly. Of …
    "Addressing chronic disease is an issue of human rights that must be our call to arms"
    Richard Horton, Editor-in-Chief The Lancet

    ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

  • #2
    Re: Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis


    Spanish-English translation

    Resistant Tuberculosis

    Society
    Posted on March 25
    According to data collected by Doctors Without Borders, the global reach of the multi drug-resistant TB is much higher than previously estimated. The international medical humanitarian organization warns that to combat this form of tuberculosis, the most deadly international effort is needed to consensus.

    (MSF). The wide scope that it is acquiring the multi drug-resistant tuberculosis (MDR-TB by its acronym in English) coincides with a huge lack of patient access to diagnosis and treatment methods, which also are outdated and are still too expensive for the vast majority of those in need. On the other hand, the lack of funding and funding cuts in programs to combat the disease are beginning to impact on the further spread of it.

    Less than 5% of patients with tuberculosis (TB) worldwide have access to a proper diagnosis to check whether the bacterium is resistant to drugs, and it is estimated that only 10% of patients with MDR-TB has access to necessary treatment. This percentage is even lower in areas with few resources, which are precisely the places where the disease prevalence is higher.

    "Wherever we look for cases of drug-resistant TB are alarming figures, suggesting that current statistics may reflect only a small fraction of the magnitude of the problem," said MSF President, Jose Antonio Bastos. "About 95% of TB patients worldwide have no access to proper diagnosis, but also, all efforts are being made to extend the detection of MDR-TB are being severely undermined by the withdrawal of funds, "says Bastos.

    Data collected in the field
    Data from MSF projects around the world have been presented at various forums in recent months and have caused great alarm in the international medical community.

    In northern Uzbekistan in Central Asia, 65% of people with TB treated by MSF in 2011 were diagnosed with MDR-TB. Of these patients, between 30 and 40% had never attended a medical facility for treatment, record numbers worldwide showing that resistance to drugs not only cause incorrect TB treatment, but MDR is the very form that is contagious.

    In South Africa, which has the highest burden of TB in the world, MSF has seen a 211% increase in the monthly number of people diagnosed with TB in KwaZulu Natal program, following the introduction of a new rapid diagnostic test. Of all patients who tested positive, 13.2% were resistant to rifampin, one of the first-line drugs more effective against TB.

    In India, the sale of nonprescription drugs and the existence of a private health sector is not regulated continue to promote development of drug resistance. It is estimated that each year get the MDR-TB in the country some 99,000 people, of which only 1% receive adequate treatment.

    In Myanmar, although it is estimated that there are about 9,300 new cases of MDR-TB each year, have only been treated to date about 300 people. In addition, the cancellation of the last round of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria threatens to seriously undermine the plan which aimed to reach 10,000 people treat MDR-TB over the next five years.

    Difficulties accumulate
    Several factors have exacerbated the difficulties in the fight against TB in recent days. On one side is the explosive cocktail that represent some treatments too long (about two years) with a very toxic drug, most of which were developed half a century ago and which have serious side effects. Furthermore, we find the reduced funding, especially due to recent cuts of the Global Fund, which already is beginning to seriously affect the field programs. Also a problem of the existence of a very small market in which the few manufacturers that produce drugs to treat TB have kept prices of some prohibitively high. And finally, given the fact that the new rapid diagnostic test, which would increase the early detection of resistant forms of TB, it is far less affordable, which mortgage extending its use to areas that have limited resources. That despite the fact that it is precisely in those places where it is needed the ability to detect infection within hours.

    MSF urges governments, international donors and pharmaceutical companies to combat the spread of drug resistant TB (DR-TB) and MDR-TB with new funding and renewed efforts to develop diagnostic tests and effective and affordable medicines . "It is necessary that the treatments are much shorter, they become less toxic drug, and the availability of appropriate diagnostic tests in medical centers. In addition, pediatric formulations are lacking at present, something that would to put an immediate solution. And we must also impose regulatory measures to control the spread of tuberculosis by poor management of the disease by physicians, "Bastos lists. "We need new drugs, new research, new programs and new commitments from international donors and governments to respond to this deadly disease. If you put all the means in this sense, many more people can get tested, treated and cured. The world can no longer sit idly by ignoring the threat of MDR-TB. We must act now, "says the president of MSF.

    Tuberculosis (TB): Despite being a disease that has existed since ancient times, TB is currently the second leading cause of death worldwide, with more and more cases of TB resistant to first-line drugs used to treat ( DR-TB). According to the 2011 report of the World Health Organization on global control of this disease, it is estimated that some 12 million people with TB in the world.

    MDR-TB: TB multi-drug resistant (MDR-TB by its acronym in English) is a form of the disease does not respond to standard first-line treatments. Treatment is difficult, takes place with very toxic drugs and lasts about two years. The drug-resistant tuberculosis (DR-TB by its acronym in English) is developed for the treatment of drug-susceptible TB, when patients do not complete the entire course of treatment, when there are interruptions in drug supply, or when health professionals provide inadequate doses or inappropriate drugs, outdated or of poor quality. It has been shown that MDR-TB is spread also by direct transmission from person to person.

    Funding cuts: After most of the donors defaulted on the promises made ​​in the High-Level United Nations held in June 2011 in New York, the Global Fund to Fight AIDS, Tuberculosis and Malaria had to take the unprecedented decision to cancel the 11th round of replenishment was scheduled for October last year. Without this funding round, the new subsidies for the expansion of treatment will not be disbursed until 2014, leaving the country without being able to actively respond to the needs of TB in their population.

    Comment


    • #3
      Re: Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis

      RPA takes aim at TB

      Local News
      8 Apr 12 @ 12:48pm by Alex Ward

      AN airtight laboratory in Camperdown will be the base for the battle against deadly, drug-resistant strains of tuberculosis.

      The biggest of its kind in Australia, the $1.2 million high containment lab at the Centenary Institute opened last week.

      Researchers hope to expand their work into the disease that kills three people every minute.
      ...
      ?Currently we don?t know if someone has got a resistant strain until the initial treatment fails,? Dr Bernadette Saunders said. ?I saw a case where a man contracted it in South Africa and spent seven months in a Sydney hospital?s isolation ward before he was able to be released and was then on drugs for two years.?...

      Comment


      • #4
        Re: Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis

        We are losing the fight against TB, warns WHO

        Governments told they must act to halt spread of drug-resistant strains

        GRACE LIVINGSTONE SUNDAY 13 MAY 2012

        A third of the world's population is carrying tuberculosis, and the disease could become incurable if governments fail to act, the World Health Organisation (WHO) has warned. Lack of funding for public health programmes, the sale of inaccurate blood tests and the misuse of drugs, particularly in the private health sector, are hampering the fight against the disease and leading to drug resistance, says the organisation.

        Extreme drug-resistant strains of TB have now been found in 70 countries, and doctors in India reported four patients this year who did not respond to any drugs at all. Doctors in Iran and Italy have also found patients who are apparently resistant to all drugs. Mario Raviglione, director of the WHO's Stop TB campaign, said: "What we are seeing worldwide is the emergence of strains of the bacillus causing tuberculosis that are resistant to most of the drugs we have available."


        Read more: Independent

        thanks to TBVI
        "Addressing chronic disease is an issue of human rights that must be our call to arms"
        Richard Horton, Editor-in-Chief The Lancet

        ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

        Comment


        • #5
          Re: Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis

          Source: http://www.abc.net.au/news/2012-06-2...ulosis/4087770

          India's 'untreatable' tuberculosis alarms experts
          Annabel Boyer

          Posted June 22, 2012 23:40:34
          AN TB bacillus Photo: Magnification of tuberculosis bacteria. (ABC)
          Map: India

          As Indian health authorities deny claims that an untreatable strain of tuberculosis threatens the country, an Australian expert warns that the threat of drug-resistant TB is real .

          Good treatments are now available for the ancient disease, which before World War II killed two-thirds of those who contracted it.

          India now has a fifth of the world's tuberculosis patients but also has an extensive treatment program.

          One of the country's leading authorities on the disease, Dr Zarir Udwadia, first reported the emergence of an untreatable strain of TB among his patients at a hospital in Mumbai.

          This year he said the number of patients with the superbug strain had increased.

          Public health officials have replied by denying any cause for alarm.

          Dr Ashok Kumar, head of India's tuberculosis control program, in New Delhi, told Radio Australia's Asia Pacific program: "We don't accept that."

          The terminology "total drug resistance" was " not acceptable" to the world Health Authority or Indian authorities...

          Comment


          • #6
            Re: Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis

            Source: http://www.hindustantimes.com/India-...e1-916864.aspx


            29-yr-old multi-drug resistant TB patient dies at Sewree Hospital
            Priyanka Vora, Hindustan Times
            Mumbai, August 21, 2012

            A 29-year-old man, one among 12 detected with extremely drug resident tuberculosis (XXDR-TB) by the Hinduja Hospital, Mahim, in January, died at Sewree Hospital last month, said civic officials. Four others had died earlier. Doctors are the Hinduja Hospital are screening people who might
            have come in contact with the deceased for TB.

            In February, the civic body had rolled out a TB control programme after the Mahim hospital reported cases of XXDR-TB, in which the patient is resistant to all known anti-TB drugs.

            Officials from the Central TB Division, Delhi, along with experts from Centre for Disease Control (CDC) and Prevention and USAID will visit Mumbai during the next four days to review various TB control programmes...

            Comment


            • #7
              Re: Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis

              Alarming levels of drug-resistant TB found worldwide

              By Kate Kelland

              LONDON | Thu Aug 30, 2012


              (Reuters) - Scientists have found an alarming number of cases of the lung disease tuberculosis in Africa, Asia, Europe and Latin America that are resistant to up to four powerful antibiotic drugs.

              In a large international study published in the Lancet medical journal on Thursday, researchers found rates of both multi drug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) were higher than previously thought and were threatening global efforts to curb the spread of the disease.

              "Most international recommendations for TB control have been developed for MDR-TB prevalence of up to around 5 percent. Yet now we face prevalence up to 10 times higher in some places, where almost half of the patients ... are transmitting MDR strains," Sven Hoffner of the Swedish Institute for Communicable Disease Control, said in a commentary on the study.

              TB is already a worldwide pandemic that infected 8.8 million people and killed 1.4 million in 2010.

              Drug-resistant TB is more difficult and costly than normal TB to treat, and is more often fatal.

              Read more: Reuters
              "Addressing chronic disease is an issue of human rights that must be our call to arms"
              Richard Horton, Editor-in-Chief The Lancet

              ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

              Comment


              • #8
                Re: Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis

                Source: http://www.undispatch.com/the-terrif...t-tuberculosis

                The Terrifying Spread of Resistant Tuberculosis
                April 19, 2013
                Lois Parshley
                Category: Health
                Topics: India, MDR-TB, TB

                MUMBAI ? Abylgazy Nagmadin is a slight 28-year-old who used to work at a train station in Kazakhstan, and he has never seen his son. He?s lived at a hospital in Almaty, Kazakhstan since he was diagnosed with multiple-drug resistant tuberculosis while his wife was still pregnant. He told the World Health Organization, ?the only thing I want is to get back to my family,? but because he has a disease so dangerously contagious, he must stay in quarantine...

                Comment


                • #9
                  Re: Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis

                  Source: http://www.news-medical.net/news/201...rontieres.aspx


                  Multidrug-resistant tuberculosis (MDR-TB): an interview with Dr. Jennifer Cohn, M?decins Sans Fronti?res
                  Published on April 26, 2013 at 6:19 AM

                  What is multidrug-resistant tuberculosis (MDR-TB) and when did it first arise?

                  MDR-TB is tuberculosis, a mycobacterial infection, that has developed resistance to two important and powerful first-line anti-TB drugs, INH and rifampin...

                  Comment


                  • #10
                    Re: Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis

                    Source: http://www.radioaustralia.net.au/int...threat/1205434

                    Drug-resistant TB a growing threat
                    Updated 16 October 2013, 12:44 AEST


                    A visiting tuberculosis expert is warning that Australia and other low-infection countries should not be complacent about the disease.

                    TB kills an estimated one and a half million people each year, with 60 percent of new cases in Asia.

                    Dr Mel Spigelman who heads the Global Alliance for TB Drug Development, is visiting Australia to warn that drug-resistant cases of the disease pose a threat not just to the countries affected, but the wider world.

                    Presenter:Bill Birtles

                    Speakerr Mel Spigelman, head, Global Alliance for TB Drug Development; Curt von Boguslawski, Country Program Manager, World Vision, Papua New Guinea...

                    Comment

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