First case of highly drug-resistant TB found in US

[AlphaCentauri]

Source: Forbes

It started with a cough, an autumn hack that refused to go away.
Then came the fevers. They bathed and chilled the skinny frame of Oswaldo Juarez, a 19-year-old Peruvian visiting to study English. His lungs clattered, his chest tightened and he ached with every gasp. During a wheezing fit at 4 a.m., Juarez felt a warm knot rise from his throat. He ran to the bathroom sink and spewed a mouthful of blood.

I'm dying, he told himself, "because when you cough blood, it's something really bad."

It was really bad, and not just for him.

Doctors say Juarez's incessant hack was a sign of what they have both dreaded and expected for years - this country's first case of a contagious, aggressive, especially drug-resistant form of tuberculosis. The Associated Press learned of his case, which until now has not been made public, as part of a six-month look at the soaring global challenge of drug resistance.

Juarez's strain - so-called extremely drug-resistant (XXDR) TB - has never before been seen in the U.S., according to Dr. David Ashkin, one of the nation's leading experts on tuberculosis. XXDR tuberculosis is so rare that only a handful of other people in the world are thought to have had it.



Read more: http://www.forbes.com/feeds/ap/2009/12/27/health-as-med-when-drugs-stop-working-killer-tb_7239444.html

[JCMach1]

1. Ummm, this scary...

[dipsydoodle]

2. Showed up in the UK March 2008

Hospital confirms first UK case of extreme drug-resistant tuberculosis :

Doctors have diagnosed the first ever UK case of a virtually untreatable strain of tuberculosis, marking a further step in the disease's fightback against the antibiotics that once kept it in check. A man in his 30s is in isolation at a hospital in Glasgow and is being treated with a cocktail of antibiotics in an effort to control the extreme drug-resistant tuberculosis (XDR-TB), the Guardian has learnt.

A spokeswoman at Gartnavel general hospital confirmed the case and said health officers were tracing people who may have come into close contact with the man.

This is the first time a patient has been diagnosed and treated for XDR-TB in the UK. The World Health Organisation has warned of the danger that XDR-TB poses because of the ease with which the airborne disease can travel in an era of mass migration and global travel.

Tuberculosis is spread only through close and prolonged contact with other people, such as in a family or among children in a school, so there is no suggestion that a single case could spark an epidemic. The arrival of XDR-TB in the UK is, however, a warning of the need for greater vigilance against the disease.

[eilen]

10. You don't need to be in close contact, just in the same room to catch TB

http://library.thinkquest.org/C0126375/how_tb_spreads.htm

TB spreads when people with the disease cough tiny droplets containing TB bacteria into the air, and other people breathe them in.

In overcrowded, poorly ventilated areas the germs are more easily spread from the TB sufferer to another person. People living in overcrowded conditions are more prone to being infected.
The TB bacilli are so small that they are invisible to the human eye. The germs are in the person's sputum (spit). They can only be seen under a microscope.

When one person is sick with TB, and not properly treated, that person will likely infect ten to fifteen others every year. Obviously, the more people who are coughing up TB germs at any given time, the more people will become infected. The best way to break this cycle of infection and disease is to cure infectious TB patients the first time around.

The germs can also be spread by dust that has been contaminated by the spitting from an infectious person.


During winter time it is much easier to catch as there is little ventilation and homes/businesses/schools are shut up to cut down on heating costs. We isolate TB patients and they would live at the hospital for a few weeks while taking antibiotics. We have to be fit tested with special masks (and gowns) to wear inside the room and the room has negative pressure so the air cannot come out when we open the door. The TB patient cannot leave by law as it is a public health issue. Once the 21 days are done on the antibiotics they are discharged with more ax and must report to the TB clinic for follow up. This is a very serious disease.

[northernlights]

13. this is XXDR, not XDR

even more resistant than XDR, and he is one of only 2 diagnosed cases in the world...so far.

Um, Tb is spread much more easily than you realize. If you read down the article, most infected people spread tb to 10-15 people before dying. In the hospital, suspected tb patients are isolated in rooms with negative vacuum pressure and all staff wears special tb masks anywhere near them.

It may not spread as easily as a cold, but it spreads easily enough.

[Better Today]

18. I "hear" what you're saying about its being easily spread, however

since March of 2008 only two people have had this super resistant strain? That tells me it isn't very easily spread. How is it that none of the people in any of the places these two went were infected with it if it is so easily spread.

Damn I just hate it when science and logical observations don't match up. I'm not saying you're wrong, just that it doesn't seem to really add up given the facts to date.

[northernlights]

21. only 2 people have been *diagnosed*

Not the same as only 2 people have had this strain. Mutations start with a single case, often not diagnosed because it is so new that nobody knows what to look for. So there is no telling whether those 2 people are the only people, whether the same mutation developed independently in 2 different people, or whether it's from the same source and has spread but not yet been identified.

If you read the article, it notes that most cases of tb are incorrectly diagnosed even as tb, never mind as a particular strain. The 2 people who were diagnosed with it were from 3rd world countries -- they probably lack the technological capability of diagnosing the particular strain.

Diagnosis at this level requires dna technology and identification of the new strain by one or more particular alleles on particular genes. In the overall scheme of things, very few hospitals have access to that level of technology.

[Better Today]

31. Well yes, and no, I'm sure once found they tracked anyone close to those

two to see if any of them had symptoms or illnesses. I'm going to guess that they didn't find anyone else afflicted, which tells me it isn't so contagious as they claim it is. Surely those two individuals didn't live in a vacuum during the entire incubation time and contagious stages before each realized they were ill, and then the time to realize their illness wasn't a 24 hour bug or standard illness, right?

I think it is quite odd that only 2 people have been diagnosed even with your well thought out consideration.

[northernlights]

33. I don't find it the slightest bit odd

There is no way of knowing how many people in Peru died without diagnosis of that particular strain. Likewise with whoever had the other case.

And that is just 1 particular strain. There have been other cases of XXDR since it was defined.

Again, tb is not as contagious as a cold or the flu. But it is contagious and before anti-biotics was a major cause of death.

[Better Today]

35. mountains out of mole hills at this point is all I'm saying.

Your points, though well thought out, do not sway me.

[northernlights]

36. I have no need to sway you

just to correct misinformation for other readers.

Imho, there is reason for concern over the increasing antibiotic resistance among bacteria, especially with contagious and/or particularly aggressive pathogens.

[Divine Discontent]

3. this seems like something from The Stand

[Myrina]

7. I have been waiting ...

... since I read the book in the early 90's for "Super Flu" to actually happen.

[Name removed]

4. Deleted message

Message removed by moderator. Click here to review the message board rules.

[the other one]

17. Women too!

Women who spit in the street almost never find a husband.

[iwillalwayswonderwhy]

5. With the widespread and casual use of antibiotics as a preventative

Among factory-farmed animals in overcrowded and unsanitary conditions, we are likely, in the very near future, to see many antibiotic-resistant strains of various diseases.

Enjoy that cheeseburger, folks.

[katkat]

6. yet another reason to be a vegetarian for the planet. n/t

[Myrina]

8. ... not to mention people coating themselves in sanitizers ...

... the body's natural resistance is going to go bye-bye and these viruses will have an easy-in.

[avaistheone1]

20. Sanitizers are good except for the ones with antibotics in them.

Also it is a good idea to avoid the hand soaps and dish soaps with antibotics in them.

[mrs_p]

9. while i don't necessarily agree with AB use in food animals

there really is no scientific evidence for the idea that IT is the reason for increased drug resistance.

[elleng]

12. THE REASON? of course not.

But certainly ONE of many reasons.

[iwillalwayswonderwhy]

14. It must be harmless if so many factory farms do it, right?

After all, we humans, if we get around folks who are sick with something contagious, we can just run to CVS and pick up some antibiotics over the counter to take preventatively, no wait, we can't. Why can't we again?

[katkat]

15. yup there is

Plenty of scientists foaming at the mouth about widespread "preventative" antibiotic use in "food animals." (I hate even typing that phrase, it's like "expendable humans" or something.)

http://www.hsus.org/farm/resources/research/pubhealth/human_health_antibiotics.html

"A joint scientific analysis co-sponsored by the World Health Organization, the Food and Agriculture Organization of the United Nations, and the World Organisation for Animal Health concluded: "here is clear evidence of adverse human health consequences …infections that would not have otherwise occurred, increased frequency of treatment failures (in some cases death) and increased severity of infections."

This conclusion was derived from multiple lines of evidence including epidemiological studies tracing drug-resistant human infections to specific farm animal production facilities; temporal associations demonstrating antibiotic use in farm animal populations preceding the emergence of the same resistance in humans; and microbial studies showing that antibiotic-resistant bacteria from farm animals not only infect humans, but may transfer that resistance to other bacteria that colonize the human gut.<28> The strongest evidence may be data from Europe's experience, which showed that after antibiotics were banned for growth promotion in animal agriculture, there was a subsequent decrease in the levels of antibiotic-resistant bacteria in farm animals, on meat, and within the general human population.<29>

According to the head of the CDC's food poisoning surveillance program, "he reason we're seeing an increase in antibiotic resistance in foodborne diseases is because of antibiotic use on the farm."

[mrs_p]

24. this is a biased site

and, as a scientist, i cringe at policy being made on emotions and conjecture -- not hardcore evidence. that is all i am saying. we need more studies before i will buy this hook, line, and sinker....

[northernlights]

25. my microbiology professor has bought the line

that it is a major reason (not the only reason, but a major reason). He's a PhD from Rutgers, although his specialty is molecular biology, not infectious diseases. I think it's listed as a major reason in Brock's Microbiology as well, but sold the book (big mistake. now i'm going to buy it again) so can't look it up.

[WriteDown]

37. HSUS? Seriously?

The same org that wants no reptiles to enter the hobby? I would take anything they say with a huge mound of salt.

[nonsequitur]

29. Much blame lies with the docs that give an antibiotics for anything from a cold to leg cramps.

[WriteDown]

38. I remember the good old days like back in the 1800's when there was no disease

Of course, things were much simpler then. Then they had to ruin everything by inventing antibiotics and discovering things like cancer!

[Odin2005]

11. Oh shit!

[zelta gaisma]

16. my thoughts EXACTLY!!! and I mean literally

[grahamhgreen]

19. It's not the first case. We shot a BBC documentary on this over 10 years ago... MORE FEAR!

[JonQ]

22. They said first case in the US

not first ever.

[grahamhgreen]

23. We shot in Denver at a special unit set up for this kind of TB

They had at least one American I remember speaking with.

It was interesting because the doctor in charge of the unit expected that he would catch the disease someday - talk about dedication!

Of course, that didn't make the crew any more comfortable.

So I know there were people in the US over 10 years ago - I met them and spoke with them and their doctors; WHERE they contracted the disease, I do not remember.

The Jewish Hospital, as i recall.

[northernlights]

26. XXDR? or XDR...or MDR (multi-drug resistant)?

XXDR is a new level of antibiotic resistance above XDR. According to the article, only a handful of cases in the world in recent years.

And based on the article linked below, XDR wasn't even defined until 2006.

"extensively drug-resistant tuberculosis (XDR-TB) was first formally defined in early 2006 and described a form of tuberculosis with resistance to the first-line anti-tuberculosis drugs, isoniazid and rifampicin, and three of the six classes of drugs that constitute second-line tuberculosis therapy. This definition was revised in late 2006 to describe cases that involve resistance to isoniazid and rifampicin, as well as any drug from the flouroquinolone class, and any of the three injectable drugs used to treat tuberculosis; capreomycin, kanamycin and amikacin....

Doctors have developed a further diagnostic term to describe tuberculosis with an even greater degree of drug resistance. Extensively drug-resistant tuberculosis, or XXDR-TB, defines any case of tuberculosis with resistance to all first- and second-drugs with anti-tuberculosis activity."



http://www.aidsmap.com/en/news/CBA086E0-D64C-43A4-B9A5-D21C57B35E8D.asp

[grahamhgreen]

27. I don't recall, I'm not sure they had those classifications

I'm sure the doco is out there somewhere.

There is a very real danger of either becoming an epidemic. Very contageous.

I was a little nervous for a few weeks after shooting!

Another reason for single payer, IMHO.

[JonQ]

28. Could be the article got their facts wrong

I was just elaborating on what they had said, not verifying it.

[mntleo2]

30. Yoohoo! You Officials! Merely check every shelter ...

...because this form of TB is rampant among the homeless, ask any public health nurse.

Leave it to a bunch of elitist idiots to assume that since the homeless are invisible and do not exist, they haven't suffered this illness for years and been passing it on ... and it isn't as if people haven't been sounding the alarms for at least 5 years or more. Including doctors, nurses, social workers, workers with the homeless, you name it. HELLOOOOOO!


No it was just, "Quick! Look ... over there! Swine Flu! RUUUUUUUUUUUUUUUUUUUUNNNNNNNNNNNNNNNNN!"


(sigh) The first one ...give me a break ...

Cat In Seattle

[valerief]

34. Oh, but the elites are busy CREATING more homeless people.

It's not just an avocation with them. It's their life's mission.

[shraby]

32. It might be the first one, but I'll take bets that it won't be

the last one. Things like this start with one, but every one that catches it will give it to X number of people who in turn will give it to X number of people, ad infinitum until they come up with something that will cure it.