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jdljr1 
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 Topic: Off topic, but who says next pandemic must be flu?
Posted: January 27 2007 at 3:06pm |
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Virulent TB in South Africa May Imperil Millions
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By MICHAEL WINES
Published: January 28, 2007
JOHANNESBURG, Jan. 27 — More than a year after a virulent strain of tuberculosis killed 52 of 53 infected patients in a rural South African hospital, experts here and abroad say the disease has most likely spread to neighboring countries, and some say urgent action is essential to halt its advance.
Several expressed concern at what they called South Africa’s sluggish response to a health emergency that, left unchecked, could prove hugely expensive to contain and could threaten millions across sub-Saharan Africa.
The director of the government’s tuberculosis programs called those concerns unfounded and said officials were doing everything reasonable to combat the outbreak.
The form of TB, known as XDR for extensively drug-resistant, cannot be effectively treated with most first- and second-line tuberculosis drugs, and some doctors consider it incurable.
Since it was first detected last year in KwaZulu-Natal Province, bordering the Indian Ocean, additional cases have been found at 39 hospitals in South Africa’s other eight provinces. In interviews on Friday, several epidemiologists and TB experts said the disease had probably moved into Lesotho, Swaziland and Mozambique — countries that share borders and migrant work forces with South Africa — and perhaps to Zimbabwe, which sends hundreds of thousands of destitute refugees to and from South Africa each year.
But no one can say with certainty, because none of those countries have the laboratories and clinical experts necessary to diagnose and track the disease. Ominously, none have the money and skills that would be needed to contain it should it begin to spread.
Even in South Africa, where nearly 330 cases have been officially documented, evidence of the disease’s spread is mostly anecdotal, and epidemiological work needed to trace its progress is only now beginning.
“We don’t understand the extent of it, and whether it’s more widespread than anyone thinks,” Mario C. Raviglione, the director of the Stop TB Department of the World Health Organization in Geneva, said in a telephone interview. “And if we don’t know what has caused it, then we don’t know how to stop it.”
Cases of XDR TB exist elsewhere, in countries like Russia and China where inadequate treatment programs have allowed drug-resistant strains of the disease to emerge. The South African outbreak is considered far more alarming than those elsewhere, however, because it is not only far larger, but has surfaced at the center of the world’s H.I.V. pandemic.
Although one third of the world’s people, by W.H.O. estimates, are infected with dormant tuberculosis germs, the disease thrives when immune systems are weakened by H.I.V. At least two in three South African TB sufferers are H.I.V. positive. Should XDR TB gain a foothold in the H.I.V.-positive population, it could wreak havoc not only among the five million South Africans who carry the virus, but the tens of millions more throughout sub-Saharan Africa.
People without H.I.V. have a far smaller chance of contracting tuberculosis, even if they are infected with the bacillus that causes TB. But because tuberculosis is spread through the air, anyone in close contact with an active TB sufferer is at some risk of falling ill.
Most if not all of the 52 people who died in the initial outbreak of XDR TB, at the Church of Scotland Hospital in a KwaZulu-Natal hamlet called Tugela Ferry in 2005 and early 2006, had AIDS. Most died within weeks of being tested for drug-resistant tuberculosis, a mortality rate scientists called unprecedented.
Since then, South African health officials say, they have confirmed a total of 328 cases of XDR TB, all but 43 in KwaZulu-Natal. Slightly more than half the patients have died.
Those numbers are deceptive, however. The Tugela Ferry outbreak was reported in part because the hospital there was part of a Yale University research project involving H.I.V.-positive patients with tuberculosis. Because South Africa’s treatment and reporting programs for tuberculosis are notoriously poor — barely half of TB patients are cured — virtually all experts contend the true rate of infection is greater.
“We’re really concerned that there may be similar outbreaks to the one in Tugela Ferry that are currently going undetected because the patients die very quickly,” said Dr. Karin Weyer, who directs tuberculosis programs for South Africa’s Medical Research Council, a semiofficial research arm of the government.
Some other researchers and experts say they share Dr. Weyer’s concern. They say South African health officials have lagged badly in assembling the epidemiological studies, treatment programs and skilled clinicians needed to combat the outbreak, and say the government has responded slowly to international offers of help.
Dr. Weyer said the council “shares the concern that not enough is being done, quickly enough, to get on top of the problem.” In particular, she said, officials have yet to carry out epidemiological studies or address a “shocking” lack of infection controls in hospitals that could allow TB and other infections to spread freely among H.I.V.-positive patients
“It’s an emergency, and we’re not reacting as if it were an emergency,” said Dr. Nesri Padayatchi, an epidemiologist and expert on drug-resistant TB for Caprisa, a Durban-based consortium of South African and American AIDS researchers. “I think we have the financial resources to address the issue, and we’ve been told the Department of Health has allocated these resources.
Although the government was first told of the outbreak 20 months ago, in May 2005, “to date, on the ground in clinics and hospitals, we are not seeing the effect,” she said. “But to date, on the ground in clinics and hospitals, we are not seeing the effect.”
In KwaZulu-Natal’s major city, Durban, the sole hospital capable of treating XDR TB patients has a waiting list of 70 such cases, she said.
Dr. Weyer said the waiting list indicates that “capacity is becoming a problem” in KwaZulu-Natal, the outbreak’s center. “I’m quite sure we may find a similar situation in other provinces,” she added.
A spokesman at the hospital said it could not easily determine how many patients were awaiting treatment.
But the manager of South Africa’s national tuberculosis program, Dr. Lindiwe Mvusi, said such complaints were misplaced. The Durban hospital in question, she said, is under renovation, and officials are “looking for accommodations in other hospitals” while construction proceeds.
Hospitals in other provinces have enough beds now for XDR TB patients, and some are expanding isolation wards to handle any spread of the disease, she said.
She said other responses to the outbreak were under way, including a rough assessment of TB cases in hospitals nationwide. A more comprehensive national survey of TB cases may be conducted late this year, she added, and health officials in KwaZulu-Natal have begun surveillance programs to detect new cases of drug-resistant TB in the province.
Dr. Mvusi also rejected the notion that the tuberculosis had moved beyond South Africa’s borders. But in interviews, a number of TB experts and epidemiologists raised that concern, including Mr. Raviglione at the world health organization, Dr. Padayatchi, Dr. Weyer and Dr. Gerald Friedland, director of the AIDS program at the Yale University School of Medicine.
Dr. Raviglione of W.H.O. said that South African health officials were cooperating on responses to the outbreak, and that an official of his organization would arrive in Pretoria within days to discuss placing a team of global TB experts in the country.
“W.H.O. is ready to come to South Africa and to help in any place, for anything, whether surveillance, or detection, or infection control,” he said. However, those arrangements have not been completed.
Dr. Mvusi, the government’s TB program head, said that global health experts were welcome, but “in an advisory role, because we want the capacity locally.”
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John L
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Posted: January 27 2007 at 6:04pm |
| Posted: 16 January 2007 at 2:24am |
............................................................................................................
from Happy Camper.... Topic: Hush-Hush Epidemic of 2006
"...By 1918 on the other hand, relates Lawrence Broxmeyer, it could be said, in so far as tuberculosis was concerned, that the world was a supersaturated sponge ready to ignite and that among its most vulnerable parts was the very Midwest where the 1918 unknown pandemic began.
It is theorized that the lethal pig epidemic that began in Kansas just prior to the first human outbreaks was a disease of avian and human tuberculosis genetically combined through mycobacteriophage interchange, with the pig, susceptible to both, as its unwilling living culture medium.
“What are the implications of mistaking a virus such as Influenza A for what mycobacterial disease is actually causing?” asked Lawrence Broxmeyer. They would be disastrous, with useless treatment and preventative stockpiles The obvious need for further investigation is presently imminent and pressing.. Lawrence Broxmeyer’s editorial, published, this month at the express request of the Editor-In-Chief of the respected medical journal in which it appeared, can be viewed along with his other research at http://medamericaresearch.orgDistribution: Lawrence Broxmeyer, Researcher Lawrence Broxmeyer, Bird Flu, Drug resistant tuberculosis...............................................................................................................
And an excerpt from the restricted newsletter from HONG KONG....
(We can't ignore this..... TB is becoming Pandemic.)
Mycobacterium tuberculosis and Non-Tuberculous Mycobacterial Lung Disease among Newly Diagnosed HIV-Infection Patients from Mozambique, Africa E.A. Nunes, E.M. Capitani, E. Coelho,A.C. Panunto, E.P.A. Bensi, O.A. Joaquim, I. Figueiredo, A. Cossa, M.C. Ramos Campinas (Brazil); Maputo (Mozambique)
61.006 Access to Tuberculosis Care in Rural China—Comparing the Impact of Alternative
Control Projects
B. Xu, Q. Zhao,Q.W. Jiang
Shanghai (China)
61.007 Molecular Epidemiology of Mycobacterium tuberculosis Strains in Lisbon: Monitoring
Family Lisboa
R. Macedo, E. Fernandes, C. Furtado, I. Portugal, L. Brum
Lisboa (Portugal)
61.008 Laboratory Based Notification of Tuberculosis in the Czech Republic—Six Years
Analysis
V. Prikazsky, K. Kotrbova, M. Havelkova
Ceske Budejovice, Prague (Czech Republic)
61.009 Predictors of the Lethal Outcome of Pulmonary Tuberculosis in a Brazilian
Metropolitan Area
A.A.B. Portela-Lindoso, S. Figueiredo, N.K. Komatsu, M.Taniguchi, E.A.Waldman
Sao Paulo (Brazil)
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Newsletter of....
Hong Kong College of Physicians
SYNAPSE
SEPTEMBER 2005 RESTRICTED TO MEMBERS ONLY
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Posted: January 27 2007 at 6:06pm |
Several people made interesting contributions ..if you want to have a look.
http://www.avianflutalk.com/forum_posts.asp?TID=12139&KW=tuberculosis+pandemic
Posted: 09 September 2006 at 9:20pm
good point Linda-Ann, it has been here a while...and they say -
"It is estimated that between (yrs) 2000 and 2020, nearly one billion people will be newly infected, 200 million will get sick, and 35 million will die from TB – if control measures are not significantly improved."
http://whqlibdoc.who.int/hq/2002/WHO_CDS_STB_2001.16_ch1.pdf
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Posted: January 27 2007 at 6:19pm |
http://en.wikipedia.org/wiki/Tuberculosis
Mycobacterium tuberculosis
Mycobacterial infections are notoriously difficult to treat.
they are naturally resistant to a number of antibiotics that utilize the destruction of cell walls, such as penicillin.
Also, because of this cell wall, they can survive long exposure to acids, alkalis, detergents, oxidative bursts, lysis by complement and antibiotics which naturally leads to antibiotic resistance.
Most mycobacteria are susceptible to the antibiotics
clarithromycin and
rifamycin,
but antibiotic-resistant strains are known to exist.
Mycobacteria can be classified into several major groups for purpose of diagnosis and treatment:
M. tuberculosis complex which can cause tuberculosis:
M. tuberculosis, M. bovis,
M. africanum, and
M. microti;
M. leprae which causes Hansen's disease or leprosy;
.................................
http://www.mansfield.ohio-state.edu/~sabedon/biol4045.htm#mycoplasma_pneumoniae
Mycobacterium tuberculosis
type:
bacteria
shape:
bacilli
transmission:
inhalation of respiratory secretions or dried sputum (very desication-resistant organism)
other:
approximately 1.5 billion (yes, with a "b") have tuberculosis world-wide
history:
"With its yearly death toll of about 3 million,
Mycobacterium tuberculosis now ends more human life than any other species of pathogen, and its annual toll is expected to rise (World Health Organization, 1992). . . in Africa . . . one out of three people is infected with M. tuberculosis." (pp. 65 and 66, Ewald, 1994 )
references:
p. 597, Bergy's, 1994; pp. 59, 261, 395, 591, Black, 1996
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Posted: January 27 2007 at 6:45pm |
| Archive Number |
20070124.0318 |
| Published Date |
24-JAN-2007 |
| Subject |
PRO/EDR> Tuberculosis, extensively drug-resistant - Canada (ON) |
TUBERCULOSIS, EXTENSIVELY DRUG-RESISTANT - CANADA (ONTARIO)
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail, a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Wed 24 Jan 2007
From: Mary Marshall <tropical.forestry@btinternet.com>
Source: Chronicle Herald (Nova Scotia) [edited]
<http://thechronicleherald.ca/Canada/554590.html>
A Toronto hospital is treating several cases of extensively drug
resistant tuberculosis, with one of the patients being held in
isolation under court order, the doctor overseeing the treatment said
Mon 22 Jan 2007.
Public health experts fear the dangerous strain of tuberculosis,
which is susceptible to very few of the anti-tuberculosis medications
normally used to treat TB, is a global health crisis in the making.
Dr. Monica Avendano, the physician in charge of the tuberculosis
service at West Park Healthcare Centre, said since 2004, her unit has
treated 5 or 6 patients with XDR TB, as it is called. All the
patients were either infected abroad or infected by a family member
who picked up the highly resistant strain elsewhere, she said.
"Currently, I am treating 3," said Avendano. "All of them have a
previous history of tuberculosis that was not well managed."
Multi-drug resistant TB and the more difficult extensively drug
resistant TB can arise one of 2 ways. A person with tuberculosis can
fail to take all their medication, as in the case of the "not-well
managed" patients to which Avendano referred. This spotty treatment
allows the bacterium to survive the assault of the drugs and develop
resistance to them. Or a person can be infected by contact with a
person sick with XDR TB. Two of the cases Avendano has treated fall
into this latter category.
"Both of the cases are young women who went to their country of
origin to look after their ailing grandmothers. And the ailing
grandmothers gave them TB. And it was XDR TB," she said.
She did not identify the countries involved. XDR TB has been found in
a number of places, including China, South Africa, and many republics
of the former Soviet Union. It is believed to have spread, still at
low levels, from these jurisdictions to developed countries.
The Public Health Agency of Canada currently doesn't know the scope
of the problem in this country. The last time Canadian TB statistics
were gathered, the provinces and territories were not asked to report
XDR TB cases. The TB statistics for 2006 -- which will be reported
sometime in 2007 -- will include XDR TB figures, agency spokesperson
Alain Desroches said in an e-mail.
Where such cases arise, they are treated in isolation, either with
the consent of the patient or with the help of the courts. "All
provinces and territories will use their public health legislation if
necessary to ensure treatment of XDR TB," said Dr. Edward Ellis,
manager of tuberculosis prevention and control with the public health
agency. "With TB, in my experience, there's never a problem getting a
court order if necessary. And nobody stands there saying: 'Oh, no,
let them go.'"
Avendano said treatment with alternative drug regimes is effective,
but it can take months of in-hospital care. Even then, it's not clear
whether these patients -- who will be required to be seen on an
ongoing basis -- are cured for life. That's because the strain hasn't
been around long enough, and the treatment regime being used is too
new to gauge its long-term efficacy.
[Byline: Helen Branswell]
--
ProMED-mail
<promed@promedmail.org>
[ProMED thanks Mary Marshall for this posting. A relevant discussion
on the XDR problem in tuberculosis can be found at: CDC: Emergence of
_Mycobacterium tuberculosis_ with Extensive Resistance to 2nd-Line
Drugs --- Worldwide, 2000-2004. 2006;55: 301-305. Parts of the report
are found below:
"17 690 isolates from the period 2000-2004 were tested for
susceptibility to at least 3 of the 6 2nd line drugs (SLD) classes.
Of these, 11 939 were from South Korea, of which 1298 (11 percent)
were multidrug-resistant (MDR, defined as resistance to at least
isoniazid and rifampin). From the other Global Supranational TB
Reference Laboratory (SRLs), 2222 (39 percent) of 5751 isolates were MDR.
Of the 3520 MDR isolates, 347 (10 percent) were XDR (defined as cases
in persons with TB whose isolates were resistant to isoniazid and
rifampin and at least 3 of the 6 main classes of SLDs
(aminoglycosides, polypeptides, fluoroquinolones, thioamides,
cycloserine, and para-aminosalicyclic acid), including 200 (15
percent) of 1298 from South Korea and 147 (7 percent) of 2222 from
other SRLs. The drug-susceptibility testing results were tabulated by
year and geographic region (on the basis of the country of origin of
the isolates) (Table 1; for table, see original URL. - Mod.LL).
XDR TB was identified in all regions but was most common in South
Korea (n = 200; 15 percent of all MDR TB isolates) and countries of
eastern Europe/western Asia (Armenia, Azerbaijan, Czech Republic,
Republic of Georgia, and Russia, n = 55; 14 percent of all MDR TB
isolates). The total number and proportion of XDR TB isolates
observed worldwide (excluding South Korea) increased from 14 (5
percent of MDR TB isolates) in 2000 to 34 (7 percent of MDR TB
isolates) in 2004. Year-specific proportions were stratified by
geographic region. Increasing proportions of XDR TB were found among
isolates from countries of eastern Europe/western Asia (n = 5 [9
percent] in 2000; n = 11 [17 percent] in 2003) and the group of
industrialized nations (Australia, Belgium, Canada, France, Germany,
Ireland, Japan, Portugal, Spain, UK, and USA, n = 3 [3 percent] in
2000; n = 25 [11 percent] in 2004).
USA national TB surveillance data included 169 654 patients with
drug-susceptibility testing results. During 1993-2004, a total of
2689 (1.6 percent) MDR TB cases were identified, of which 1814 (67
percent) had results reported for 3 or more SLD classes. Of these, 74
(4.1 percent) had resistance to 3 or more SLD classes and thus met
the criteria for XDR TB. Despite an overall decline in MDR TB
incidence in the USA, the proportion of XDR TB increased slightly,
from 37 (3.9 percent) of 944 cases during 1993-1996 to 20 (4.1
percent) of 489 during 1997-2000, to 17 (4.5 percent) of 381 in
2001-2004 (chi-square test for trend = 0.20; p = 0.66). During
1993-2002, patients with XDR TB were 64 percent more likely to die
during treatment (relative risk [RR] = 1.6; 95 percent confidence
interval [CI] = 1.2-2.2) than patients with MDR TB.
Among 605 MDR TB patients in Latvia who initiated therapy during
2000-2002, 115 (19 percent) had XDR TB. The proportion with XDR TB
increased from 30 (15 percent) of 204 in 2000, to 46 (21 percent) of
215 in 2001, to 39 (21 percent) of 186 in 2002 (chi-square test for
trend = 2.57; p = 0.11). Patients with XDR were 54 percent more
likely to die or have treatment failure (RR = 1.5; CI = 1.1-2.2)."
A map of Ontario, Canada showing the location of Toronto can be found at:
<http://us.i1.yimg.com/us.yimg.com/i/travel/dg/maps/a2/750x750_ontario_m.gif>.
- Mod.LL]
[see also:
2006
----
Tuberculosis, multiresistant - Hungary 20061110.3233
Tuberculosis, multiresistant - South Africa (KN)(04):nationwide 20061019.3003
Tuberculosis, multi-drug resistant - South Africa (KN) 20060904.2514]
........................................................................ll/msp/jw
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muriel46
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Posted: January 28 2007 at 1:23am |
Another candidate for non-H5N1 pandemic is the newest strain of methicillin-resistant staphylococcus aureus. To distinguish it as the most lethal strain, it is called PVL-producing methicillin-resistant staphylococcus aureus. I have read several articles lately (no link, just in my memory lol) stating that some doctors fear this form of staph much more than avian flu.
New Strain Of MRSA
Can Kill In Just 24 Hours
* Cases of drug-resistant PVL likely to rise in Britain
* Fear that GPs will not recognise lethal infection
By Ian Sample
Science Correspondent
The Guardian - UK
1-19-7
Scientists have unravelled the workings of a deadly superbug that attacks healthy young people and can kill within 24 hours.
PVL-producing MRSA, a highly-virulent strain of the drug-resistant superbug, methicillin-resistant staphylococcus aureus, has spread around the world and caused deaths in the UK, Europe, the US and Australia. PVL or panton-valentine leukocidin toxin destroys white blood cells and usually causes boils and other skin complaints. But if it infects open wounds it can cause necrotising pneumonia, a disease that rapidly destroys lung tissue and is lethal in 75% of cases.
Thousands of infections have been recorded across the US, but scientists believe the number is likely to rise in Britain.
In 2004 the bug claimed the life of Richard Campbell-Smith, a fit 18-year-old Royal Marine, who died three days after scratching his legs on gorse during a training exercise in Devon. In December an outbreak at Norfolk and Norwich University hospital killed a baby and infected five others. According to the Health Protection Agency there were 106 cases of PVL-MRSA in England and Wales in 2005 and one confirmed death from necrotising pneumonia caused by the infection.
[snip]
Marina Morgan, consultant medical microbiologist at Royal Devon and Exeter hospital, said PVL- MRSA was a particular threat because it was spreading outside hospitals, where doctors were not familiar with it. "A lot of patients die because it is unexpected. A doctor will probably prescribe a standard antibiotic that won't kill it, so it has time to get worse. The bottom line is it's coming and it's going to spread." PVL- MRSA can only be tackled with treatments that attack the bacteria on three fronts. The drugs must kill the bacteria, destroy their ability to make PVL toxins, and mop up the toxins already released into the bloodstream. Patricia A. Doyle DVM, PhD Bus Admin, Tropical Agricultural Economics Univ of West Indies Please visit my "Emerging Diseases" message board at: http://www.emergingdisease.org/phpbb/index.php
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tony m
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Posted: January 28 2007 at 11:54am |
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"Another candidate for non-H5N1 pandemic is the newest strain of methicillin-resistant staphylococcus aureus."
Although indeed a serious problem, MRSA, including this latest strain has never caused anything approaching a true world pandemic. What is of more concern is that cell-wall-deficient forms of tuberculosis can simulate Staph, even in their staining and morphology and thereby be mistaken for them.
Also:
"It is widely recognized that the tubercle bacillus may be accompanied by other pathogens as described by Agarwal and others. Similarly, in a recent series of seven cases of tubercular meningitis, a pyogenic bacterium was present in two instances. Accordingly, it was not unexpected that we demonstrate evidence of the tubercle bacillus in pulmonary disease concurrent with Staph Aureus." (Judge and Mattman, 1982)
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roni3470
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Posted: January 28 2007 at 3:55pm |
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Not certain but don't we have a immunication for TB...and nothing for BF?
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NOW is the Season to Know
that Everything you Do
is Sacred
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roni3470
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Posted: January 28 2007 at 3:55pm |
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oops,meant immunization! too much red wine this afternoon! haha
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NOW is the Season to Know
that Everything you Do
is Sacred
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tony m
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Posted: January 28 2007 at 6:09pm |
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BCG, named for its French discoverers: Boquet, Calmete and Guerin is the only recognized vaccine for tuberculosis in the world and is made from watered-down cow or bovine tuberculosis.
BCG is used in many countries, but it is not generally recommended in the United States. There is more than one reason for this. BCG vaccination does not completely prevent people from getting TB and it can lead to many sequella (also called complications). As one example, suppurative lymphadenitis, or pus associated inflamation of the lymph nodes, is a common complication of BCG vaccination. (Nazir Z, Qazi SH. J Ayub Med Coll Abbottabad. 2005 Oct-Dec;17(4):16-8) and, according to Nazir, such BCG lymphadenitis, once the involved lymph nodes grow to greater than 3 cm., is no longer curable by TB drugs alone but must be surgically evacuated as well. A third, probably less important, but frequently used reason given for not using BCG is that it can create a false positive test in any subsequent TB skin tests that the BCG recipient is sent for.
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Posted: January 28 2007 at 7:10pm |
Please note...
WHO says-
TB is a worldwide pandemic
Excerpts-
2 billion people, equal to one-third of the world’s
total population, are infected with TB bacilli, the microbes
that cause TB.
TB is contagious and spreads through the air; if
not treated, each person with active TB infects on
average 10 to 15 people every year.
TB is a worldwide pandemic; though the highest
rates per capita are in Africa (29% of all TB cases), half
of all new cases are in 6 Asian countries (Bangladesh,
China, India, Indonesia, Pakistan, the Philippines).
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Posted: January 28 2007 at 7:14pm |
| Posted: 23 January 2007 at 1:30pm |
"...Professor Edginton said that medical authorities in the US and other countries can obtain a court order to detain a person with infectious TB or someone who is non-infectious but has failed to adhere to treatment. "The Americans are much better at enforcing their laws on this," she said...."
.....................................................................................................................
hmmm... wasn't aware that the the USA is giving a tuberculin skin test to all people getting off the planes. (We are not safe.)
.............................................
A TB vaccine (bacille Calmette-Guerin, or BCG) is used in many countries to prevent TB. However, this vaccination is almost never used in the United States because:
The vaccine is not effective in adults who receive it.
The BCG vaccine may cause a person to have a positive tuberculin skin test even if he or she is not infected with TB. This complicates the use of the tuberculin skin test to check people for TB.
..................................................
...and if you want that vaccine... I have some land in Florida you might like to buy.
......................................................
This is a very good idea...
.............................................
Avoid getting active TB
Active tuberculosis (TB) is an infection that is spreading in a person's body, and it is very contagious.
The World Health Organization (WHO) estimates that one-third of the world's population is infected with the bacteria that causes TB.
To avoid getting an active TB infection:
Do not spend long periods of time in stuffy, enclosed rooms with anyone who has active TB until that person has been treated for at least 2 weeks.
...............................................................................................
with anyone who has active TB? .... "Excuse me, do you mind if I use this
tuberculin skin test on your inner arm before I spend time with you in a
stuffy room?"
Read in full at...
http://www.everettclinic.com/kbase/topic/major/hw207301/prevent.htm
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Posted: January 28 2007 at 8:50pm |
Upsetting.... This Map...was 6 years ago- 2001
.
and later in 2004....
Based on surveillance and survey data, we estimate that there were 8.9 million new cases of TB in 2004 (140 per 100 000)
and in 2006...
One-third of the world’s total population, are infected with
TB bacilli, the microbes that cause TB.
.
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tony m
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Posted: January 28 2007 at 10:28pm |
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What lovely graphics.
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Posted: January 29 2007 at 10:37pm |
A short, feverish war
While the war on bird flu is far from being won, dengue fever has sneaked in almost unnoticed. Within a few weeks, the disease has infected almost 1,500 people and killed at least eight in Jakarta alone.
Outside the capital, the virus has spread fear in Lampung, West Java, Central Java, East Java and other provinces. The resurgence has prompted provincial governments to take all necessary measures to fight the disease, which has claimed at least 51 lives nationwide.
Dengue outbreaks have been routine in Indonesia for decades. The virus strikes during rainy season, and subsides during dry season.
So routine are the outbreaks that nothing has changed in the efforts to eradicate the mosquito-borne disease. The government sings the same old song when it orders fogging in residential areas, calls for people to clean their neighborhoods and promises funds to pay for anti-dengue measures.
People quickly lose their steam, however, when it comes to carrying out the best defense against dengue hemorrhagic fever and other communicable diseases: good sanitation. Once the dengue outbreak eases, things go back to business as usual.
It comes as no surprise, therefore, if the virus spreads quickly once an aedes aegypti mosquito transmits it to a human. Neither the government nor the community is prepared. This happens despite the fact that Law No. 23/92 on health which says the government is responsible for totally eradicating preventable diseases.
This unchanged mindset is probably the reason why we have been unable to get rid of the disease. Chronic complacency might have played a role in the resurgence of polio in 2004, too, after the country saw no cases for a decade, or the unabated spread of avian flu, which has so far killed more than 60 people.
Lack of commitment has reduced to mere rhetoric the government's pledge to send 10,000 village medical workers across the country in 2005. The program was aimed at training people and raising their awareness of various common diseases, such as dengue, TB and bird flu.
Some patients are confused by the different standard operating procedures adopted by different hospitals in dealing with dengue fever. One hospital may require a patient to undergo intensive treatment once symptoms of the disease appear, while another may take a few days before diagnosing and treating dengue fever.
Changes in the way we fight dengue fever are imperative, too, now that some patients may not display the usual symptoms found in the past. The characteristic bright red rashes have not appeared in some infected people, which may prompt doctors to diagnose them with ordinary flu. Regular dissemination of information to the public pertaining to new developments in dengue fever is therefore a must, in a bid to further raise awareness of the disease.
There is also a need for a sense of urgency among government and medical workers in this fight against dengue fever. Needless to say, dengue is as dangerous as bird flu or other communicable diseases, so a campaign against one of them must not weaken efforts against the other.
In view of the fact that late admission to the hospital is responsible for most of the fatalities in dengue fever, the government should equip community health centers (Puskesmas) with necessary first aid medicines. If possible, the government should require the Puskesmas to share the burden of providing treatment for dengue patients, since hospitals may lack room and resources to save the lives of infected people.
With dengue fever coming on the heels of the natural disasters that have struck the country almost relentlessly, such a sense of crisis is the minimum effort the country can make. The government may have spent a lot, and will continue to dig deeper into its pockets to help thousands of survivors of natural disasters, but it cannot ignore thousands more whose lives are threatened by dengue fever.
Dengue Fever sure has been on a rampage. This seems to be a serious issue, too.
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tony m
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Posted: January 30 2007 at 3:11am |
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Serious, as with Malaria, indeed... and that's for sure, But vector limited, in many cases self-limited, and not the stuff of world pandemic.
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pcusick
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Posted: January 30 2007 at 6:20am |
Global warming is allowing the advance of mosquitoes known to carry dengue and malaria into areas previously free of these diseases. Dengue has popped up in the continental US in Texas in individuals with no known travel exposures into Mexican areas with endemic disease. This recent cold wave freezing areas down to the borders of semitropical climate helps keep these types of diseases in check.
Once (or if) a mosquito borne disease gets into a population of mosquitoes that are able to overwinter and are capable of harboring the dengue or malaria bug, the problem will become a worldwide issue.
Keep in mind, West Nile spread across the US in about 3 years once it became endemic, and it is generally considered a "bird disease".
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Accept responsibility for your choices and actions. Failure to choose is in itself a choice for non-action.
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tony m
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Posted: January 30 2007 at 6:22am |
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But, while on the subject of Dengue and its related Aedes mosquito vector, there's this consideration as well. Seems like mosquito's pack way more than just the flavivirus of Dengue or the plasmodium of malaria:
Pneumoftiziologia. 1991 Oct-Dec;40(4):11-3. Links
The role of coccoid ultrafine forms of mycobacteria in the transmission of the mycobacterial infection.
Golyshevskaya VI.
Central Tuberculosis Research Institute, Ministry of Health, Moscow, USSR.
The present study is devoted to the variability of the mycobacterial population in nature by transformation of typical mycobacteria into ultrafine forms with a dense cellular membrane in the organism of mosquitos and of their larvae. Mosquitos of the genus Aedes are known to be mechanical carriers of bacterial infections. Most of the infectious diseases are characteristic of rural districts and have the character of natural foci. An attempt has been made to determine the possibility of the transmission of the mycobacterial infection through the stings of bloodsucking mosquitos of the genus Aedes. It is shown that transmission of the mycobacterial infection is possible through the stage of coccoid ultrafine mycobacteria detected in the mosquito larvae of different stages. The reversion of the coccoid forms of mycobacteria into the typical rod-shaped ones is possible in separate cases and occurs at later stages of the mosquito larvae development. The study may be of scientific and practical interest both in medicine and agricultural practice.
PMID: 1842499 [PubMed - indexed for MEDLINE]
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Posted: February 03 2007 at 7:38am |
First two cases of super TB hit Cape
February 03, 2007 Edition 1
Melanie Peters
THE Western Cape has identified its first two cases of the killer strain of extremely drug resistant tuberculosis, or XDR-TB, the provincial health department said yesterday.
One case, that of an 11-month-old baby girl, was being treated in Brooklyn Chest TB Hospital, said spokeswoman Miranda Anthony.
The other patient, a woman from the Eastern Cape, was being treated at the Carnation ward at Lentegeur Hospital. She was in isolation.
XDR-TB made headlines last year when it was first identified in South Africa at Tugela Ferry in KwaZulu-Natal, with 52 of the first 53 patients dying. The disease is complicated by the presence of HIV/Aids.
Late last year over 300 cases of XDR-TB were confirmed across the country, the national health department said. It recorded 263 cases in KwaZulu-Natal, 10 cases each in the Eastern Cape and the North West, eight in Gauteng, six in the Free State, three in Limpopo and two in the Northern Cape. But none were reported in Mpumalanga and the Western Cape. XDR-TB is defined by the World Health Organisation as TB which is resistant to the main first-line TB drugs and to three or more of the six second-line drugs.
Anthony said precautions have been taken to protect staff caring for the two patients. The department was following up all people who had been in close contact with them. If they had contracted the disease then treatment would involve drugs to which the person was likely to respond.
She said: "Because XDR-TB is resistant to first and second-line drugs, treatment options are seriously limited. It is vital that TB control is managed properly."
Anthony said someone who already had ordinary TB could avoid getting the MDR or XDR strains by taking all their TB treatment exactly as prescribed.
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tony m
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Posted: February 03 2007 at 5:04pm |
Actually WHO’s estimate of 1/3 of the people in the world as being infected with TB might be a bit on the conservative side. In her Cell Wall Deficient Forms - Stealth Pathogens (3re Edition, p.189 CRC press, 2001), Lida Mattman quotes J. L. Fox: “Nearly half the world’s population is infected with TB”(J.L. Fox, TB: a grim disease of numbers ASM News, 56:363-364, 1990).
Also, on the link supplied above http://www.who.int/tb/publications/2006/tb_facts_2006.pdf
One notes that it is WHO's intention for its global plan to stop TB 2006-2015 to not only treat 800,000 people for MDR-TB, but to:
1) Produce the first new anti-TB drug IN 40 YEARS by 2010.
Perhaps this should be no problem, as any major US big Pharma firm could have easily come up with one with the span of 2 to 3 years. For one potential example, a study done in 2006:
Chem Pharm Bull (Tokyo). 2006 Feb;54(2):278-9. Links
Larvicidal, antimycobacterial and antifungal compounds from the bark of the Peruvian plant Swartzia polyphylla DC.
* Rojas R,
* Bustamante B,
* Ventosilla P,
* Fernadez I,
* Caviedes L,
* Gilman RH,
* Lock O,
* Hammond GB.
Departamento de Ciencias Farmaceuticas, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru.
The 95% ethanol extract of the bark of Swartzia polyphylla DC (Fabaceae) possesses important larvicidal, antimycobacterial and antifungal activity in vitro. Bioassay-guided studies performed on the crude ethanol extract afforded T-cadinol as the larvicidal and anti-Mycobacterium tuberculosis principle, while the antifungal activity of the extract is due to the presence of the flavonoids biochanin A and dihydrobiochanin A.
PMID: 16462085 [PubMed - indexed for MEDLINE]
But also:
2. WHO mentions that it intends to produce a new TB vaccine by 2015. For any of us familiar with the burocracy and red-tape that make up WHO's scientific apparatus, this might not be as possible as it sounds, at least through WHO, although there are solid ideas out there as to just how an effective TB vaccination should be put together which wouold probably be good for both regular and resistant strains of TB.
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jdljr1
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Posted: February 03 2007 at 8:31pm |
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It is I guess time that I responded to my own post. The problem with the BCG vaccine is that it is a 20th century vaccine once again facing a now 21st century enemy, same as the current primative egg-based flu vaccines. TB is now stronger than its vaccine, which can now only attenuate (reduce in probable severity) the MDR resistant TB, not block it. And sometimes, the BCG can kill the person it is given to...
Fortunately, the (Bill) Gates foundation among others have been pooring BIG money into a new TB vaccine, far more effective with far less risk. This is expected to be generally available within 10 years. This could be much sooner-the problem is that big pharmi Inc. sees far more money in keeping 65 year old investment bankers able to sexually function for their 30 year old trophy wives than it sees in new TB vaccines, or new types of flu vaccines for that matter.
Thus, since the effort to create 21st century vaccines for vicious 21st century diseases must lag for other, higher priorities, ALL of our lives are put in jeopardy...
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John L
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Posted: February 03 2007 at 8:50pm |
Actually WHO’s estimate of 1/3 of the people in the world as being infected with TB might be a bit on the conservative side.
..........................................................................................
:(
sounds like the bad old days.
Consumption - A progressive wasting away of the body, especially that attended upon pulmonary phthisis, called pulmonary consumption; hence pulmonary phthisis or tuberculosis. See Phthisis, Tuberculosis.
Alex G. Bell....
Suddenly, however, in the midst of all his high hopes, Bell was struck down by incipient consumption—a disease which had already caused the death of his two elder brothers. Medical men decided that nothing except a complete change of climate could save his life.
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Posted: February 03 2007 at 8:54pm |
..
.
hi John... my response is no. 11....
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tony m
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Posted: February 04 2007 at 5:14am |
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jdljr1 is right on target with his assessment of the BCG. Regarding the proposed Gates vaccine, not knowing its particulars regarding composition, method, mode and experimental track record, I am ill-equiped to comment, although I imagine it has mycobacterial content.
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tony m
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Posted: February 04 2007 at 5:25am |
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J. L. Fox's statement: “Nearly half the world’s population is infected with TB”(J.L. Fox, TB: a grim disease of numbers ASM News, 56:363-364) was made in 1990, before WHO declared TB to be a global emergency. Little has happened since to feel that its incidence, even by WHO standards, has decreased.
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Posted: February 05 2007 at 11:32pm |
If you just want to read the comments look for the grey area followed by this Discussion: This study represents the first assessment of the
widespread occurrence of _M. tuberculosis_ with such extensive drug
resistance as to be nearly untreatable with currently available
drugs, according to international guidelines.
| Archive Number |
20070205.0456 |
| Published Date |
05-FEB-2007 |
| Subject |
PRO/EDR> Tuberculosis, XDR - worldwide |
TUBERCULOSIS, XDR - WORLDWIDE
*****************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail, a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Mon, 5 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: Emerging Infectious Diseases, in press [edited]
<http://www.cdc.gov/eid/content/13/3/06-1400.htm>
[This paper on XDR-TB, Shah NS, Wright A, Bai G-H, et al: Worldwide
emergence of extensively drug-resistant tuberculosis. Emerg Infect
Dis, in press, is posted in edited form. - Mod.LL]
Multidrug-resistant tuberculosis (MDR TB) has been documented in
nearly 90 countries and regions worldwide (1); 424 203 cases of MDR
TB were estimated to have occurred in 2004, which is 4.3 percent of
all new and previously treated TB cases (2). Treatment for MDR TB
patients requires use of 2nd line drugs (SLDs) for more than 24
months. These drugs are more costly, toxic, and less effective than
1st-line drugs used for routine treatment of TB (3-6). As with other
diseases, resistance to TB drugs results primarily from nonadherence
by patients, incorrect drug prescribing by providers, poor quality
drugs, or erratic supply of drugs (7).
To facilitate treatment of MDR TB in resource-limited countries,
where most TB cases occur (1,2), the WHO and its partners developed
the Green Light Committee, which helps ensure proper use of SLDs, to
prevent further drug resistance (8). Nonetheless, the Green Light
Committee encountered numerous anecdotal reports of MDR TB cases with
resistance to most SLDs. Once a strain has developed resistance to
SLDs, these new TB strains are even more difficult to treat with
existing drugs. Untreated or inadequately treated patients are at
increased risk of spreading their disease in the community, which
could lead to outbreaks in vulnerable populations and widespread
emergence of a lethal, costly epidemic of drug-resistant TB,
reminiscent of the MDR TB outbreaks in the early 1990s (9-13).
Therefore, to determine whether these anecdotal reports were isolated
events, early evidence of an emerging epidemic, or the occurrence of
virtually untreatable forms of drug-resistant TB that had not been
described previously in different parts of the world, we
characterized and quantified the frequency of SLD resistance in
several geographic regions.
We sought to determine the extent to which highly resistant _M.
tuberculosis_ strains have been identified by the international
laboratories that participate in the Network of Supranational
Reference Laboratories (SRLs). The SRL Network consists of 25 highly
proficient TB laboratories on 6 continents. These laboratories
collaborate with national reference laboratories to strengthen
culture and drug-susceptibility testing capacity and to provide
quality control for the WHO/International Union Against Tuberculosis
and Lung Diseases Global Project on Anti-TB Drug Resistance (14).
Methods: From November 2004 through November 2005, we surveyed the
global SRL Network. All SRL directors were invited to participate
during the 2004 annual SRL directors meeting, by individual mailings,
and by personal phone calls. Drug-susceptibility testing results were
requested for _M. tuberculosis_ isolates that had been tested for
resistance to 1st-line drugs and SLDs during 2000-2004. Two SRLs were
not eligible because they did not test for SLDs or tested for less
than 3 classes of SLDs.
The 14 SRLs that provided data for this study support 112 TB
laboratories in 80 countries worldwide (Fig. 1 [for figures and
tables, see original URL - Mod.LL]). SRLs serve as international
reference laboratories to a wide geographic area, performing
drug-susceptibility testing that may not be available in a country
(e.g., for SLDs) and providing quality assurance for 1st-line drug
testing. Most SRLs also serve as the national reference laboratory
for the country in which they are located; they receive varying
proportions of isolates from their own and other countries for
surveillance, clinical diagnosis, and quality assurance. First-line
drug susceptibility testing is performed on all isolates; SLD
susceptibility testing is usually limited to isolates from patients
known or suspected to have drug-resistant TB. Of the 14 participating
SRLs, not all tested for all 6 classes of SLDs, and 4 did not submit
data for the entire survey period.
To best compare data for the study samples with data from the Global
Drug Resistance Survey and other population-based drug-resistance
surveillance, we analyzed 1st-line drug resistance patterns according
to standard methods used in anti-TB-drug resistance surveys (1).
These patterns included any drug resistance, monoresistance
(resistance to only the one specified drug), polyresistance
(resistance to more than 2 1st-line drugs, but which drugs not
specified), and multidrug resistance (resistance to at least
isoniazid (INH) and rifampin (RIF), with or without other drugs).
We defined 6 classes of SLDs as follows: aminoglycosides other than
streptomycin (eg, kanamycin and amikacin), cyclic polypeptides (eg,
capreomycin), fluoroquinolones (eg, ofloxacin, ciprofloxacin,
levofloxacin, and moxifloxacin), thioamides (eg, prothionamide and
ethionamide), serine analogs (eg, cycloserine and terizidone), and
salicylic acid derivatives (eg, para-aminosalicyclic acid).
For this survey we created a consensus definition that incorporates
SLD susceptibility results and is based on international guidelines
for management of drug-resistant TB (15). The mainstay of an MDR TB
treatment regimen consists of one injectible drug (eg, aminoglycoside
or cyclic polypeptide) and a fluoroquinolone; additional drugs from
the remaining classes are added until the total reaches 4-6 drugs to
which the organism is susceptible. If the infecting organism is
resistant to 3 or more SLD classes, designing a treatment regimen
with sufficient drugs that are known to be effective against TB is
difficult. Thus, we defined extensively drug-resistant TB (XDR TB)
isolates as those meeting the criteria established for MDR TB plus
resistance to 3 or more of the 6 classes of SLDs.
SLD resistance patterns were analyzed by geographic region from which
the isolate was submitted to the SRL. Regions were grouped into
epidemiologically meaningful categories on the basis of prevalence of
TB and MDR TB (1,16). This retrospective survey was evaluated and
approved as public health surveillance by the CDC.
Results: We received data for 18 462 patients from 14 (61 percent) of
23 eligible SRLs. We excluded those patients tested before 2000
(n=223), tested after 2004 (n = 14), or tested for resistance to less
than 3 classes of SLDs (n = 535). Our final study sample consisted of
17 690 patients whose isolates were tested for resistance to 3 or
more SLDs during 2000-2004 (Figure 2). Of these, 11 939 (67.5
percent) patients were from the Republic of Korea and 5751 (32.5
percent) were from the remaining SRLs.
[Data on resistance patterns for other than XDR TB can be found in
the original URL. - Mod.LL]
Among patients from the 13 SRLs, resistance to aminoglycosides was
detected in 489 (8.7 percent) isolates and to fluoroquinolones in 298
(5.3 percent) (Table 2). Among isolates from Republic of Korea
patients, resistance was most commonly seen to fluoroquinolones (n
=524, 4.4 percent) and thioamides (n = 259, 2.2 percent).
From all SRLs, isolates that were resistant to at least INH and RIF
(ie, MDR TB; n = 3520) and tested for susceptibility to 3 or more
SLDs were combined for analysis of SLD resistance patterns.
Resistance to one or more class of SLD was present in 1542 (43.8
percent) MDR TB patients (Table 3). The most commonly observed
patterns were resistance to aminoglycosides (n = 630, 18.3 percent),
fluoroquinolones (n = 673, 19.3 percent), and thioamides (n = 605,
19.3 percent).
MDR TB patients whose isolates had further resistance to 3 or more
classes of SLDs were classified as XDR TB (Table 3). A total of 347
(9.9 percent) MDR TB patients met criteria for XDR TB. According to
the revised Global XDR TB Task Force definition
(<http://www.who.int/mediacentre/news/notes/2006/np29/en/index.html>),
234 (6.6 percent) isolates met criteria for XDR TB. Among XDR TB
patients, combination drug-resistance patterns included 90 (3.4
percent) with resistance to aminoglycosides, capreomycin and
fluoroquinolones; 102 (3.4 percent) with resistance to
aminoglycosides, fluoroquinolones, and thioamides; and 94 (3.8
percent) with resistance to fluoroquinolones, thioamides, and
para-aminosalicyclic acid. Nearly half (n = 167, 48.1 percent) of all
XDR TB isolates were resistant to all 4 1st-line drugs, bringing the
total to 7 or more drugs to which the isolate was resistant.
The proportion of XDR TB patients by region is shown in Table 4.
Among the group of industrialized nations, 53 (6.5 percent) MDR TB
patients met criteria for XDR TB. Among patients from Russia and
Eastern Europe, 55 (13.6 percent) MDR TB patients met criteria for
XDR TB. Among patients from the Republic of Korea, 200 (15.4 percent)
MDR TB patients, who accounted for 1.7 percent of all _M.
tuberculosis_ isolates tested, met criteria for XDR TB.
In evaluating the accuracy of SLD susceptibility testing, we found
that 7 (0.1 percent) of 11 426 patients fully susceptible to all
1st-line drugs were resistant to 2 SLDs, and 109 (1 percent) were
resistant to 1 STD. Most of these patients were resistant to fluoroquinolones.
Discussion: This study represents the first assessment of the
widespread occurrence of _M. tuberculosis_ with such extensive drug
resistance as to be nearly untreatable with currently available
drugs, according to international guidelines. We provide data on SLD
resistance for the largest sample of patients to date, including more
than 5000 patients from 47 countries, apart from the Republic of
Korea. The definition of XDR TB in this survey is based on WHO
guidelines for the programmatic management of drug-resistant TB; the
guidelines recommend treatment with 4 or more drugs known to be
effective (15). Therefore, with 3 or less remaining classes of SLDs
to which the infecting organism is susceptible, treatment of these
patients cannot meet international standards. XDR TB has been
detected in all regions of the world. XDR TB strains in this study
also have high rates of resistance to pyrazinamide and ethambutol,
thereby severely limiting the treatment options available.
Analysis of combination SLD resistance patterns is critical for
clinicians and policymakers who design treatment regimens for these
patients. Although limited data exist in the literature about SLD
resistance patterns among MDR TB patients, data from patients
undergoing retreatment for TB in Hong Kong showed that 30 (17
percent) MDR TB isolates were resistant to 3 or more SLDs (17),
thereby meeting criteria for XDR TB. A drug-resistance survey of 447
culture-positive new patients and patients undergoing retreatment in
Abkhazia, Republic of Georgia, found that of 63 MDR TB patients, 2 (3
percent) had additional resistance to 3 or more SLD classes,
consistent with XDR TB (18). More recently, clusters of XDR TB have
been reported in South Africa and Iran (19,20) and have been
associated with HIV infection and rapid and high death rates.
The emergence of new strains of TB that are resistant to SLDs,
especially in settings where TB control programs have become unable
to adequately monitor treatment regimens for MDR TB, is cause for
concern. After the resurgence of TB in industrialized countries
during the 1980s and increased awareness of this global problem,
implementation of strong TB control programs based on the principles
of the global directly observed treatment strategy, short course
(DOTS) improved treatment outcomes and reduced TB and MDR TB
incidence in several countries. This framework for DOTS, promulgated
by WHO, and the pilot MDR TB management projects (DOTS-Plus projects)
became the basis for programmatic management of MDR TB, which has
demonstrated feasibility and effectiveness in low- and middle-income
countries (5,15). However, 2nd-line drugs are available worldwide
outside of well-organized TB-control programs (WHO, unpub. data).
Improper treatment of drug-resistant TB, such as using too few drugs,
relying on poor-quality SLDs, and failing to ensure adherence to
treatment, will likely lead to increases in XDR TB. Strengthening
basic TB programs and infection control measures is crucial for
preventing the selective pressure and environments in which resistant
strains are transmitted from person to person. Additionally, MDR TB
programs that rely on quality-assured and internationally recommended
treatment regimens according to WHO guidelines must be scaled up and
strengthened to stem further SLD resistance and spread of XDR TB. The
Green Light Committee provides a global mechanism to help affected
countries achieve these steps. A commentary published in 2000
predicted that "failure to institute [the] entire DOTS-Plus package
is likely to destroy the last tools available to combat [TB], and may
ultimately result in the victory of the tubercle bacillus over
mankind" (21). XDR TB is an indirect indicator of program failure to
adequately diagnose, prevent, and treat MDR TB.
Documenting the emergence of XDR TB requires a laboratory-based
diagnosis that relies on 1st- and SLD susceptibility testing. A
limitation to accurate detection of XDR TB is that existing tests for
resistance to SLDs are not yet standardized and are less reproducible
than tests for resistance to INH and RIF. Lack of international
recommendations for use, as well as lack of standardization and the
historical unavailability of MDR TB treatment in the public sector,
has limited use of SLD susceptibility testing on a wider scale. As
access to treatment with SLDs increases, standardized methods,
improved diagnostics, and quality assurance for SLD susceptibility
testing are urgently needed to enable reliable testing and design of
appropriate treatment regimens. Although internationally accepted
methods were used by all laboratories, the precise methods and drug
concentrations used varied among participating SRLs (22). Because
these SRLs represent some of the most highly performing laboratories
on 6 continents, results of drug-susceptibility testing are credible
within the context of stated limitations. Initial studies that
standardized different methods for SLD susceptibility testing have
been completed (23-26), but more are needed.
Our study has other limitations. The numbers reported for XDR TB
probably represent an underestimate of the true number of cases
because not all labs and not all national reference laboratories test
for all 6 classes of SLDs. In the absence of test results for all 6
classes of SLDs, we speculate, on the basis of a patient's TB
treatment history and known patterns of drug cross-resistance, that
many other unidentified patients are likely to have had and died from
XDR TB. For example, an MDR TB isolate that is also resistant to an
aminoglycoside and a fluoroquinolone but that has not been tested for
the other SLD classes is very likely to be resistant to an additional
SLD class for the following reasons: INH and ethionamide have a 15-20
percent rate of cross-resistance (27); kanamycin and capreomycin
cross-resistance is common, ranging from 20-60 percent (CDC, unpub.
data) (28,29); and in this study, isolates that were resistant to all
4 1st line drugs as well as an aminoglycoside and a fluoroquinolone
were 70-80 percent likely to be resistant to at least one additional
class of SLD.
Lastly, we had limited clinical information about each patient
because information submitted to each SRL varied and was not reliably
available for inclusion in the analysis. Data about TB treatment
history, patient age and sex, or HIV status are not routinely
collected by all laboratories. Genotyping data were not available to
confirm whether XDR TB isolates are related to W variant of the
Beijing strain, a highly drug-resistant strain of _M. tuberculosis_
responsible for large nosocomial outbreaks in New York in the early 1990s (30).
Despite these limitations, our survey provides the 1st documentation
of the emergence of XDR TB as a serious worldwide public health
threat. XDR TB was identified on 6 continents and is significantly
associated with worse treatment outcomes than MDR TB (31,32). The
emergence of XDR TB, coupled with the increased use of SLDs, suggests
that urgent measures are needed to improve rational use of
quality-assured SLDs. In addition, population-based surveillance for
SLD susceptibility testing is needed to better describe the magnitude
of XDR TB worldwide, track trends, and plan a public health response.
Indeed, the convergence of XDR TB with the HIV epidemic may undermine
gains in HIV prevention and treatment programs and requires urgent
interventions. These interventions include ensuring adherence to
recommended international standards of care aimed at promptly and
reliably diagnosing TB, ensuring adherence to recommended treatment
regimens with demonstrated efficacy, implementing infection control
precautions where patients congregate, and improving laboratories'
capacity to accurately and rapidly detect drug-resistant _M.
tuberculosis_ isolates so that patients can receive effective
treatment (33). Other unmet needs include further development of
international standards for SLD susceptibility testing, new anti-TB
drug regimens, and better diagnostic tests for TB and MDR TB. Such
measures are crucial if future generations are to be protected from
potentially untreatable TB.
--
ProMED-mail
<promed@promedmail.org>
[Reference citations are available at the original URL.
The future epidemiology of these frighteningly drug resistant (FDR is
not used as yet) strains of _M. tuberculosis_, especially in the
HIV-infected cohort in the developing world may put XDR TB much
higher up on the list of emerging diseases in the near future.
XDR TB, in the latest WHO publications, is now defined slightly
differently as mentioned above (an isolate resistant to INH and
rifampin that was also resistant to a fluoroquinolone and to one or
more of the following 3 injectable anti-tuberculosis drugs:
capreomycin, kanamycin and amikacin)
According to the WHO meeting in Oct 2006
(<http://www.who.int/tb/xdr/news_release_17oct06/en/index.html>), a
number of considerations were used in revising the definition, including:
- technical feasibility and reproducibility of testing for SLDs
- efficacy and availability of SLDs
- the need for a definition with significant worse treatment outcome
than MDR-TB alone. - Mod.LL]
[see also:
Tuberculosis, XDR - South Africa (02) 20070128.0375
Tuberculosis, XDR - South Africa: interventions 20070126.0349
Tuberculosis, extensively drug -resistant - Canada (ON)(02) 20070125.0340
Tuberculosis, extensively drug-resistant - Canada (ON) 20070124.0318
2006
----
Tuberculosis, multiresistant - Hungary 20061110.3233
Tuberculosis, multiresistant - South Africa (KN)(04):nationwide 20061019.3003
Tuberculosis, multi-drug resistant - South Africa (KN) 20060904.2514]
......................ll/pg/dk
http://www.promedmail.org/pls/promed/f?p=2400:1000
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tony m
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Posted: February 06 2007 at 5:33am |
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Traditionally, when all else failed, second-line drugs like amikacin, which TB and the mycobacteria have trouble gaining resistance to, didn't. And there are still studies out there which attest to Amikacin's prowess:
Int J Tuberc Lung Dis. 2005 Feb;9(2):216-9. Links
Second-line drug susceptibilities of Thai multidrug-resistant Mycobacterium tuberculosis isolates.Prammananan T, Arjratanakool W, Chaiprasert A, Tingtoy N, Leechawengwong M, Asawapokee N, Leelarasamee A, Dhiraputra C.
Drug-Resistant Tuberculosis Research Fund, Siriraj Foundation, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand.
The emergence of multidrug-resistant tuberculosis (MDR-TB) is increasing and is exacerbated by the human immunodeficiency virus (HIV) epidemic. The standard short-course regimen used for the treatment of tuberculosis is likely to be ineffective against MDR-TB, leading to the need for second-line drugs. In such situations, drug susceptibility testing (DST) is necessary to select an appropriate treatment regimen. In this study, DST of 99 MDR-TB strains isolated in Thailand was performed using a drug-impregnated disc method. The results showed that 94.95% of the strains were susceptible to amikacin and kanamycin, 90.91% to ciprofloxacin and ofloxacin, 85.86% to para-aminosalicylic acid, and 78.79% to ethionamide.
PMID: 15732744 [PubMed - indexed for MEDLINE]
J Chemother. 2006 Dec;18(6):610-6. Links
Comparative evaluation of the in vitro antimycobacterial activities of six aminoglycoside antibiotics using an agar dilution method.
Udou T.
Given the increasing prevalence of mycobacterial resistance to aminoglycoside antibiotics, we examined the susceptibility of 76 clinical isolates of mycobacteria to arbekacin, amikacin, gentamicin, kanamycin, tobramycin and streptomycin using an agar dilution method. Only arbekacin and amikacin showed excellent therapeutic potential (minimum inhibitory concentrationis (MICs) <0.25-4 microg/ml) against 30 isolates of rapidly growing mycobacteria, including Mycobacterium fortuitum, M. chelonae and a related organism, Nocardia asteroides. The MIC(90)of tobramycin against 23 isolates of M. avium complex was 8 microg/ml, while that of the other 5 aminoglycosides ranged from 64-256 micro g/ml. Of the 23 M. tuberculosis isolates tested, 5 showed aminoglycoside resistance (MICs 128 to >1,024 microg/ml), while the others were variably susceptible (MICs <0.25-32 microg/ml) to all 6 aminoglycosides. The chemotherapeutic potential of arbekacin, amikacin and streptomycin as treatment of tuberculosis was apparent; however, proper patient management would be required to control against the emergence of the drug-resistant strains during prolonged treatment.
PMID: 17267338 [PubMed - in process]
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LCfromFL
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Posted: February 08 2007 at 5:02am |
I posted this in the General Discussion forum, but it's relevant here too, I think:
"Health Officials Confirm Stanton Student Has TB
Nearly 200 People Tested After TB Case Confirmed At High School "
"...JACKSONVILLE, Fla. -- Health officials confirmed on Wednesday that one student at Stanton College Preparatory School has contracted tuberculosis...
...Doctors found that of the 180 tested, 16 had been exposed to the disease...."
Link to full story:
http://www.news4jax.com/news/10957636/detail.html
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Guests
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Posted: March 10 2007 at 6:16pm |
TB is a worldwide pandemic
.........................................................
HIV/AIDS ..................................................... And TB...
....................................
............................................................
Drivers of the epidemic
.................................................
Injecting drug use.
A major cause for concern are the drug trafficking routes that pass through Central Asia, which have led to a surge in drug use since 2001. Experts estimate that there may be more than 500,000 drug users in Central Asia, many of whom share needles, placing them at high risk of contracting HIV/AIDS.
Tuberculosis.
TB is the main opportunistic disease for HIV/AIDS and is a major of people with HIV/AIDS. The TB situation is considered critical in Kazakhstan, Tajikistan, Turkmenistan, and Uzbekistan. TB-HIV co-infection, when it occurs, undermines treatment and care, reduces survival substantially, and increases healthcare costs. HIV also drives the TB epidemic, particularly in areas where the prevalence of both diseases is high.
Fast growth among young people.
Some 40 percent of the region’s population is young and HIV/AIDS is spreading most rapidly among them. Adolescents and young adults account for most reported cases among injecting drug users and the age at which young people start injecting drugs is falling. Moreover, they face high levels of unemployment and, with jobs in short supply, many are at special risk of joining groups of highly vulnerable people by resorting to injecting drug use and regular or occasional unprotected sex.
Increased trafficking of women, commercial sex work, and STIs.
The proportion of HIV/AIDS cases attributed to heterosexual transmission is growing, with UNAIDS reporting a narrowing of the male-female ratio of newly detected HIV/AIDS cases from 4:1 to 2:1, indicating that women are increasingly at risk.
Migration increases the risk of spread.
Porous borders and easing of travel restrictions, combined grinding poverty, have increased mobility from rural to urban areas, both within countries and within the region. Central Asia ’s large migrant population increases the risk of the spread of HIV to the general population. Truck drivers, mariners, the homeless, refugees, migrant workers, and trafficked women are among those who are highly vulnerable.
Lack of capacity in public health system.
The ability of the public health system to trace, diagnose, and treat patients with infections has significantly deteriorated since the collapse of the Soviet Union. Furthermore, HIV/AIDS STI and TB services are generally provided through vertical program structures with little or no coordination.
..................................................................................................
Positive HIV tests and AIDS diagnoses by year
| Year |
AIDS diagnoses |
Positive HIV test reports |
| Adult male |
Adult female |
Total, all ages |
Adult male |
Adult female |
Total, all ages |
| Until end 1996† |
14,843 |
1,118 |
16,148 |
30,154 |
3,855 |
38,768 |
| 1997 |
606 |
105 |
726 |
1,861 |
483 |
2,512 |
| 1998 |
541 |
100 |
645 |
1,697 |
470 |
2,343 |
| 1999 |
459 |
87 |
555 |
1,596 |
515 |
2,230 |
| 2000 |
436 |
57 |
498 |
1,538 |
486 |
2,113 |
| 2001 |
343 |
70 |
416 |
1,580 |
526 |
2,178 |
| 2002 |
341 |
60 |
404 |
1,809 |
620 |
2,495 |
| 2003 |
302 |
78 |
383 |
1,822 |
627 |
2,496 |
| 2004 |
256 |
59 |
318 |
1,825 |
655 |
2,538 |
| 2005 |
244 |
69 |
318 |
1,830 |
628 |
2,518 |
| Until June 2006 |
63 |
18 |
82 |
894 |
309 |
1,232 |
| Total |
18,434 |
1,821 |
20,493 |
46,606 |
9,174 |
61,423 |
† AIDS reporting began in 1979; HIV reporting began in 1985; annual data are not available for positive HIV test reports prior to 1995 for all jurisdictions.
.............................................................................................................
In recent years the most notable trend has been the increase in diagnoses among young women. Prior to 1996, females comprised 14% of HIV diagnoses in the age group 15-29, whereas in 2005 this proportion was 36%.
Notes
AVERT.org also has a Canada statistics summary, plus statistics for other countries, and a guide to understanding the statistics.
Sources:
- Public Health Agency of Canada. HIV and AIDS in Canada. Surveillance report to June 30, 2006. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Health Canada, November 2006
- Health Canada. HIV/AIDS EPI Updates, August 2006, Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Health Canada, 2006
http://www.avert.org/canstatr.htm
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Bill 100
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Posted: March 11 2007 at 2:35pm |
USATODAY.com - Bird flu may become latest disease to jump to humans.
Posted 2/19/2006 6:42 PM
Bird flu may become latest disease to jump to humans ST. LOUIS (AP) — Humans risk being overrun by diseases from the animal world, according to researchers who have documented 38 illnesses that have made that jump over the past 25 years. An Indian veterinarian inspects chickens Sunday, a day after the country's first outbreak was confirmed.By Sebastian D'Souza, AFP/Getty Images
That's not good news for the spread of bird flu, which experts fear could mutate and be transmitted easily among people. There are 1,407 pathogens — viruses, bacteria, parasites, protozoa and fungi — that can infect humans, said Mark Woolhouse of the University of Edinburgh in Scotland. Of those, 58% come from animals. Scientists consider 177 of the pathogens to be "emerging" or "re-emerging." Most will never cause pandemics. Experts fear bird flu could prove an exception. Recent advances in the worldwide march of the H5N1 strain have rekindled fears of a pandemic. The virus has spread across Asia into Europe and Africa. Controlling bird flu will require renewed focus on the animal world, including the chickens, ducks and other poultry that have been sacrificed by the tens of millions to stem the progress of the virus, experts said at a news conference late Sunday at the annual meeting of the American Association for the Advancement of Science. "The strategy has to be looking at how to contain it in the animal world, because once you get into the human side, you're dealing with vaccines and anti-retrovirals, which is a whole new realm," said Nina Marano, a veterinarian and public health expert with the National Center for Infectious Diseases.
Bird flu has killed at least 91 people — most of them in Asia — since 2003, according to the World Health Organization. It appears to kill about half the people it infects. However, should it mutate so it can pass from human to human, it likely will grow far less deadly, said Dr. Stanley Lemon, of the University of Texas Medical Branch at Galveston. "It is very unlikely that it would maintain that kind of case mortality rate if it made the jump," Lemon said. Each year, one or two new pathogens and multiple variations of existing threats infect humans for the first time. That pace appears to be unsustainable in the long run because it would imply that people run the risk of being overrun, Woolhouse told reporters. "Humans have always been attacked by novel pathogens. This process has been going on for millennia. But it does seem to be happening very fast in these modern times," Woolhouse said. Woolhouse argues that either many of those diseases and other afflictions will not persist in humans or that there is something peculiar today allowing so many of them to take root in humans. One explanation may be the recent and wide-scale changes in how people interact with the environment in a more densely populated world that is growing warmer and in which travel is faster and move extensive, Marano said.
Those changes can ensure that pathogens no longer stay restricted to animals, she added. Examples from recent human history include HIV, Marburg, SARS and other viruses. That prospect leaves open the question of what future threats await humans. "It always surprises us. We think that avian flu will be the next emerging disease. My guess is something else might come out before that," said Alan Barrett, of the University of Texas Medical Branch at Galveston. "It's very hard to anticipate what comes next."
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ShaRenKa
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Posted: March 11 2007 at 5:04pm |
 tony m wrote:
What lovely graphics. |
Hey Tony!? Care to share some of that good red wine? ;) lol Is it Cianti? My fav!
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Sha Ren Ka
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tony m
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Posted: November 19 2014 at 5:05am |
ShaRenKa wrote:
tony m wrote:
What lovely graphics. |
Hey Tony!? Care to share some of that good red wine? ;) lol Is it Cianti? My fav! |
I don't drink ShaRenKa .
But if you believe those HIV/AIDS statistics since they made TB an "AIDS defining illness"........than you probably have just finished a pitcher of WHO's cool-aid. http://www.avianflutalk.com/forum_s/drop_down.png - View Drop Down
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Jen147
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Posted: November 19 2014 at 6:51am |
Why are you responding to a thread that is 7 years old?
That link is bogus.
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onefluover
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Posted: November 19 2014 at 7:00am |
The mushroom threads of yesteryear. Finely came down. 
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"And then there were none."
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