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Author Topic: India Reports Completely Drug-Resistant TB  (Read 1862 times)

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Offline SamaelTopic starter

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India Reports Completely Drug-Resistant TB
« on: January 14, 2012, 10:21:18 PM »
Quote
Well, this is a bad way to start the year.

Over the past 48 hours, news has broken in India of the existence of at least 12 patients infected with tuberculosis that has become resistant to all the drugs used against the disease. Physicians in Mumbai are calling the strain TDR, for Totally Drug-Resistant. In other words, it is untreatable as far as they know.

News of some of the cases was published Dec. 21 in an ahead-of-print letter to the journal Clinical Infectious Diseases, which just about everyone missed, including me. (But not, thankfully, the hyper-alert global-health blogger Crawford Kilian, to whom I hat-tip.) That letter describes the discovery and treatment of four cases of TDR-TB since last October. On Saturday, the Times of India disclosed that there are actually 12 known cases just in one hospital, the P. D. Hinduja National Hospital and Medical Research Centre; in the article, Hinduja’s Dr. Amita Athawale admits, “The cases we clinically isolate are just the tip of the iceberg.” And as a followup, the Hindustan Times reported yesterday that most hospitals in the city — by extension, most Indian cities — don’t have the facilities to identify the TDR strain, making it more likely that unrecognized cases can go on to infect others.

Why this is bad news: TB is already one of the world’s worst killers, up there with malaria and HIV/AIDS, accounting for 9.4 million cases and 1.7 million deaths in 2009, according to the WHO. At the best of times, TB treatment is difficult, requiring at least 6 months of pill combinations that have unpleasant side effects and must be taken long after the patient begins to feel well.

More after the link
http://www.wired.com/wiredscience/2012/01/invincible-tb-india/

Sounds like we really need to start getting ready for antibiotics to work less and less.

Online Callie Del Noire

Re: India Reports Completely Drug-Resistant TB
« Reply #1 on: January 14, 2012, 10:51:41 PM »
This is seriously dangerous. We're talking quarantine and burn the bodies serious. Well not quite, but getting there.

Offline Caeli

Re: India Reports Completely Drug-Resistant TB
« Reply #2 on: January 15, 2012, 12:25:39 AM »
That's really scary to hear, and makes me wonder how far in the future it will be when many diseases and sicknesses that are commonly treated by drugs will be harder to or impossible to treat because they've become resistant.

Offline Vekseid

Re: India Reports Completely Drug-Resistant TB
« Reply #3 on: January 15, 2012, 01:28:40 AM »
This is seriously dangerous. We're talking quarantine and burn the bodies serious. Well not quite, but getting there.

The problem is, most TB infections are asymptomatic. A full third of the planet's population is believed to be infected.

Offline Empyrean

Re: India Reports Completely Drug-Resistant TB
« Reply #4 on: January 15, 2012, 11:03:22 AM »
Asymptomatic? Does that mean they cannot be detected before spreading the disease?

Offline RubySlippers

Re: India Reports Completely Drug-Resistant TB
« Reply #5 on: January 15, 2012, 11:20:34 AM »
Yes, like Typhoid Mary she had it and couild spread it but she was free of symptoms which was not rare with Typhus they found a small number of people had it but was not sick but could spread it.

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Re: India Reports Completely Drug-Resistant TB
« Reply #6 on: January 15, 2012, 01:28:43 PM »
Asymptomatic? Does that mean they cannot be detected before spreading the disease?

They might still be able to be detected using the tine test or the more accurate Mantoux test, both of which involve an injection of the tuberculin antigen under the skin.  I'm not sure if 'asymptomatic' refers to all symptoms (including microscopic), or only the visible ones that send people to the doctor's office.

Offline Beguile's Mistress

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Re: India Reports Completely Drug-Resistant TB
« Reply #7 on: January 15, 2012, 01:30:20 PM »
The more that antibiotics are prescribed the less they will work.  The human body is designed to develop natural immunity to most infections, both bacterial and viral.  Antibiotic and antiviral medications help initially but the infectious organism develops an immunity to them and mutates into a resistant strain.  The medical community then has to find another medication to fight the disease.  This is why we have the super bugs.  We've educated the organisms into becoming resistant to everything we have. 

No one likes being sick, losing time from school or work or watching loved ones suffer but the more we medicate against the less-than-life-threatening diseases the more we doom ourselves to contracting diseases we CAN'T fight.

Offline Codswallop

Re: India Reports Completely Drug-Resistant TB
« Reply #8 on: January 15, 2012, 02:23:17 PM »
Holy crud.  I sent this to a guy I know whose dad travels to India once or twice a year.  Seems like something he should be aware is out there.  Yikes.

Offline Sabby

Re: India Reports Completely Drug-Resistant TB
« Reply #9 on: January 15, 2012, 02:43:52 PM »
And just after I get The Stand comics, I read this .___.

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Re: India Reports Completely Drug-Resistant TB
« Reply #10 on: January 15, 2012, 03:03:26 PM »
Holy crud.  I sent this to a guy I know whose dad travels to India once or twice a year.  Seems like something he should be aware is out there.  Yikes.

Heck, I sent it to my boss.  My job involves surface disinfectants, and I can see a lot of products wanting to claim efficacy against the new TB.

Offline DarklingAlice

Re: India Reports Completely Drug-Resistant TB
« Reply #11 on: January 15, 2012, 08:44:31 PM »
This is more a problem due to the regions where TB is common rather than due to any kind of super-bug fears.

It is incredibly simple to derive a novel antibiotic drug and package it for use in humans. We have an entire library to pick from if any kind of superbacteria pandemic looms on a global scale (not to mention at least one entirely new type of antibacterial therapy in the pipeline). The reason we have 'drug-resistant X' problems at all is that it is not profitable enough for companies to develop new antibiotics on their own (and publicly supported labs tend not to have the resources to cope with the expense and extent of government mandated safety testing so it basically has to be a private lab...there is an irony there).

Now, if this were a major threat to the US and Western Europe there would be government subsidies going out to well-equipped labs to nip this in the bud, but it isn't.
Quote
The WHO said last spring that only two-thirds of countries with resistant TB epidemics have the lab capacity to detect the resistant strains.
Which implies that those countries also don't have the capability to lead a drug discovery campaign even if the money is there (which it isn't). Fortunately though, China has been making huge progress in tuberculosis surveillance and treatment over the last few years (all the while generally producing more and more impressive biomedical research). So hopefully we will see something promising from that direction.

Offline OldSchoolGamer

Re: India Reports Completely Drug-Resistant TB
« Reply #12 on: January 16, 2012, 01:36:32 PM »
The real culprit is industrial farming--specifically, the indiscriminate use of antibiotics in animals being raised for food.

And yeah, someone wanting antibiotics anytime they have the sniffles isn't helping at all either.  But we have to bear in mind that hundreds of thousands of livestock get antibiotics from birth onwards, whether sick or not.

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Re: India Reports Completely Drug-Resistant TB
« Reply #13 on: January 16, 2012, 01:42:52 PM »
Normally, I'd raise an eyebrow at that, but one of the major strains of TB -is- Mycobacterium bovis.

Offline Zakharra

Re: India Reports Completely Drug-Resistant TB
« Reply #14 on: January 16, 2012, 02:27:58 PM »
One of the main culprits is industrial farming--specifically, the indiscriminate use of antibiotics in animals being raised for food.

And yeah, someone wanting antibiotics anytime they have the sniffles isn't helping at all either.  But we have to bear in mind that hundreds of thousands of livestock get antibiotics from birth onwards, whether sick or not.

 There. Fixed that for you. Your post suggests, fairly heavily, that industrial farming is -thee- cause, and the other stuff is minor at best.

Offline Trieste

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Re: India Reports Completely Drug-Resistant TB
« Reply #15 on: January 16, 2012, 02:53:28 PM »
Actually, I suspect that one of the main culprits is very simple: unless you're a hypochondriac or suffering from Munchausen's, you don't like being sick and you don't like taking pills. Taking a variety of pills for six months, especially pills like antibiotics, is miserable. Your gut flora suffers, and it wreaks havoc on vaginal flora as well. Who wants to keep putting up with a raging yeast infection for six months when they're already feeling better after two? Furthermore, who can afford to continue taking meds for six months? I have to say, even knowing full well the dangers and repercussions of such behavior, I would be hard-pressed to finish a 6-month course of antibiotics, especially strong ones. I don't think it's too far of a stretch.

And before people start plusone-ing my post and saying, "yeah, people are stupid! Victims of their own stupidity!" or something, I'm not saying that. It's not stupid not to want to be sick for six months from meds that you are voluntarily ingesting. It's very human, and evolutionarily wise: after all, previous to the introduction of antibiotics, voluntarily ingesting something for six months that made you feel ill would not have been a wise move, evolutionarily speaking. It's just... people are people, everywhere.

Offline DarklingAlice

Re: India Reports Completely Drug-Resistant TB
« Reply #16 on: January 16, 2012, 03:45:33 PM »
To add onto the patient compliance issue:

1) Med sharing is a major problem. Meds are expensive. Tuberculosis is contagious enough that families or social groups can often get it at the same time. So suddenly you have the situation where a husband and wife try to share one course of meds, or the one friend who can afford to go to a doctor shares with other people she knows are suffering (this is probably especially true after you have been taking the meds for a while and are feeling better). Noble idea, really bad outcome.

2) And in terms of treatment fatigue you have to remember that tuberculosis often comes on as an opportunistic infection or brings other infections/symptoms with it. Not to mention the symptoms of the antibiotics themselves. So suddenly it is not just one course of meds for six months. It becomes one course of meds for six months and the anti-nauseu and anti-fungals that go along with it. Or it is (far too often) adding a six month course of TB meds on top of the antivirals you are taking for HIV.

Offline gaggedLouise

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Re: India Reports Completely Drug-Resistant TB
« Reply #17 on: January 16, 2012, 08:53:10 PM »
The real culprit is industrial farming--specifically, the indiscriminate use of antibiotics in animals being raised for food.

And yeah, someone wanting antibiotics anytime they have the sniffles isn't helping at all either.  But we have to bear in mind that hundreds of thousands of livestock get antibiotics from birth onwards, whether sick or not.

Maybe I am being a bit thick here, but aren't the bacteria supposed to be killed when the flesh of the animal is, first, frozen and then, some time afterwards, heated in a frying pan or an oven in the kitchen? Of course, the freezing well-below-zero bit applies much less generally to less developed countries where butchering isn't done on the industrial scale or with the secure use of cooling that are normal at butching facilities in let's say Europe and America. And the renewed spread of TB we are talking about is likely to hit at first in places like  India, the Middle East or parts of rural Russia - where a good deal of butchery is done in more traditional ways.

Also, the antibiotics that count are the one that are actually alive in the beast at the time of its death, right? We don't "inherit" the full amount of antibiotics that's been fed to an animal during its lifespan, in the way a large predator fish gathers mercury from all the fish it's eaten and, in turn, from the prey they consumed (and then passes it on to us, because mercury won't decay in nature). I don't really know, but I suppose antibiotics breaks down after some time and not too long. When it's fed repeatedly over years and in all kinds of doses, that's when it begins to build a resistancy in your immunizing system.

For the rest I agree this is a very unsettling development. The appearance of strains of TB and other classic killer diseases (such as typhoid fever, cholera or even plague) which would be resistant to the treatment we mostly use is a horror scenario, and fighting them should be a top priority of clinical med studies and field medicine.
« Last Edit: January 16, 2012, 08:57:49 PM by gaggedLouise »

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Re: India Reports Completely Drug-Resistant TB
« Reply #18 on: January 16, 2012, 08:57:50 PM »
Tuberculosis is most likely to be spread from an animal to a human during butchery, before any freezing or cooking takes place.  It's one of the few diseases that an M.E. can contract from a human corpse (meningitis is another one that I can recall off the top of my head.)

Offline gaggedLouise

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Re: India Reports Completely Drug-Resistant TB
« Reply #19 on: January 16, 2012, 09:09:45 PM »
Thanks for pointing to that risk Oniya, it's one I wouldn't really have thought of in this context. But how about the aggregation of slews of antibiotics from butchered animals (let's say cows, pigs and poultry) to humans?

For the risk really to be there, the particular kind of antibiotics has to be effective both against a disease in the animal species in question and against a strain of bacteria - the same one, or closely related? - that would affect humans too in a severe way, right? And do those pesky antibiotics really survive the cooling and heating that goes into treatment of food and cooking these days?
« Last Edit: January 16, 2012, 09:14:24 PM by gaggedLouise »

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Re: India Reports Completely Drug-Resistant TB
« Reply #20 on: January 16, 2012, 09:39:03 PM »
I'm thinking that what might be happening is that a slaughterhouse worker (or workers) gets exposed to the drug resistant TB at work - assuming that the TB in question is a strain of M. bovis, and not merely one of its close relatives.  Then it spreads to their family members, people that they cough on, etc.  Once you have an antibiotic-resistant strain, it doesn't matter if the newly-infected person has failed to take their meds properly, or has a system saturated with antibiotics courtesy of their diet (or if the antibiotics have, in fact, denatured during cooking, which is my suspicion).  All that matters is that the bacteria has had a chance to evolve a resistance to the meds somewhere.

Many antibiotics are effective against multiple bacteria lines.  Many, if not most of the antibiotics have been tested on animal diseases as well as human diseases - first in the Petri dish, then in living animals, before being tested in humans.

Offline Pumpkin Seeds

Re: India Reports Completely Drug-Resistant TB
« Reply #21 on: January 16, 2012, 11:21:56 PM »
I'm guessing what Trieste was indicating was people's refusal to complete the TB treatment.  Keep in mind that the disease is considered serious enough to be considered a public threat.  If you are diagnosed with TB, a person will drive to your home and ensure that every pill is taken.  This is one of the few diseases where the government does step in and force medication.

Online Callie Del Noire

Re: India Reports Completely Drug-Resistant TB
« Reply #22 on: January 16, 2012, 11:35:48 PM »
I'm guessing what Trieste was indicating was people's refusal to complete the TB treatment.  Keep in mind that the disease is considered serious enough to be considered a public threat.  If you are diagnosed with TB, a person will drive to your home and ensure that every pill is taken.  This is one of the few diseases where the government does step in and force medication.

We had three guys in our command in Spain come down with TB while I was there. They didn't enjoy it at all. Being put to quarters and having everyone sent back in for testing (again) after they showed up with it was the beginning of their fun.

Offline Trieste

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Re: India Reports Completely Drug-Resistant TB
« Reply #23 on: January 17, 2012, 09:00:18 AM »
I'm guessing what Trieste was indicating was people's refusal to complete the TB treatment.  Keep in mind that the disease is considered serious enough to be considered a public threat.  If you are diagnosed with TB, a person will drive to your home and ensure that every pill is taken.  This is one of the few diseases where the government does step in and force medication.

I understand that the intent and concern are probably there but I have doubts about enforcement.

Offline gaggedLouise

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Re: India Reports Completely Drug-Resistant TB
« Reply #24 on: January 17, 2012, 10:26:48 AM »
Just as an aside, I believe TB in humans varies a lot in virulence and the force with which it breaks its bearer down. I remember reading somewhere in Hemingway, as he's speaking of an acquaintance, saying approximately: "he had contracted tuberculosis, not the kind that's glamorous but the kind you'll die from.". TB was undeniably seen as a romantic or gothically fashionable disease in the 19th and early 20th centuries, especially in women, but it's plain that many people lived with it for several decades, without being confined to a sanatorium (though they had to keep a medical regime at home), and that some even recovered completely, long before antibiotics or even pneumothorax ("blowing out" an infected lobe in a lung and sealing it off) were around.
« Last Edit: January 17, 2012, 11:12:20 AM by gaggedLouise »