Thread: More TB Cases Resist Multiple Antibiotics

http://www.10news.com

More TB Cases Resist Multiple Antibiotics
Overall TB Rate In U.S. Lower Than Ever

POSTED: 12:11 pm PST March 23, 2006

ATLANTA -- Health officials said Thursday they are seeing what appears to be a disturbing increase around the world in tuberculosis infections resistant to both the first- and second-line antibiotics used against TB.

"It's basically a death sentence. If people are failing first- and second-line drugs and we don't have in the pipeline a new drug for immediate use, that's a crisis," said Dr. Marcos Espinale, executive secretary of the World Health Organization's Stop TB Partnership.

The CDC and WHO surveyed a network of 25 tuberculosis laboratories on six continents from 2000 to 2004 and found that one in 50 TB cases around the world is resistant not only to the usual first-choice TB treatments, but also to many medications that represent the second line of defense.

The survey represents the first international data on what is being called "extensively drug-resistant" TB.

For more than a decade, health officials have worried about "multidrug-resistant" TB, which can withstand the mainline antibiotics isoniazid and rifampin. One in five TB cases falls into that category, according to the survey.

But the survey also found many cases of a more difficult form of TB -- one that does not respond to at least three of six classes of second-line drugs. That is especially worrisome, because second-line drugs are generally considered more toxic and less effective.

"These are individuals who are virtually untreatable with available drugs," said Dr. Kenneth Castro of the CDC.

The survey looked at 17,690 TB cases that were analyzed for drug susceptibility. Of those, 20 percent were multidrug-resistant and 2 percent were extensively drug-resistant.

The problem was worst in Latvia, where public health care deteriorated after the Soviet Union collapsed. Doctors believe TB develops resistance to drugs because some patients fail to complete a full course of medication.

In the United States, health officials looked at 169,654 TB cases from 1993 to 2004 that were analyzed for their drug response and found that 1.6 percent were multidrug-resistant and 0.04 percent extensively drug-resistant.

U.S. multidrug-resistant cases rose from 2003 to 2004, from 113 to 128. Though the number was small, it represented the largest single-year increase in more than 10 years. Ninety-seven of those 128 cases were in people born in other countries, mostly Mexico, the Philippines and Vietnam.

Overall, the TB rate in the United States has never been lower.

In 2005, about 14,100 cases were reported, or 4.8 cases per 100,000 people. That is a 4 percent decline in the rate from 2004. However, the TB rate in foreign-born people in the United States was 8.7 times that of U.S. natives.

"Worsening resistance around the world poses a problem in the U.S.," Castro said.

Dr. Henry Blumberg, an Emory University medical school professor, said the figures are preliminary and the problem may be bigger than the numbers indicate.

Some drugs under development might become effective treatments for these difficult forms of TB. But CDC funding for TB control and research has not kept up with inflation in the past decade, Blumberg said.

A small town in Tx. has this. Said they treated 9 members of one family at a cost of $1 Mil.

They didn't report if they were illegal or legal....but one can guess!

Ugh! These people are handling food with unclean hands all over the place. Half of them dont even wear the plastic gloves or hairnets required by most resturants. So next time you go to a fast food joint, make sure they are handling food in the proper way.

http://sfgate.com/cgi-bin/article.cgi?f ... HT1771.DTL

SAN FRANCISCO
CDC concerned about drug-resistant TB
San Francisco has highest rate of disease in country
- Erin Allday, Chronicle Staff Writer
Friday, March 24, 2006


A new strain of drug-resistant tuberculosis that is "virtually untreatable" is raising alarm among public health officials, even as the less virulent, and much more common, form of TB continues to decline in the United States.

The Centers for Disease Control and Prevention reported for the first time Thursday on the emergence of "extensively drug-resistant" tuberculosis, which does not respond to most first- or second-line drug therapies for TB.

The new strain is still rare in the United States. But public health officials in San Francisco, where the tuberculosis rate is the highest in the country, say they're seeing patients who face an increasingly resilient form of TB and don't respond to any of the drugs used to fight the disease.

"We're seeing much more extreme forms of resistance than ever before. It used to be just two of the front-line drugs, and now it's all of them," said Dr. L. Masae Kawamura, director of San Francisco's TB Control Section and chairwoman of the federal Advisory Council for the Elimination of Tuberculosis. "It often results in having to have operations where you remove the source of infection, you remove part of the lung. It's really turned back the time to pre-antibiotic era."

Tuberculosis, a bacterium that usually affects the lungs, is highly treatable in most cases, with a mortality rate of about 5 percent in the United States. Using a treatment course of four drugs, it generally takes about six months, and $3,000, to cure.

But it's critical that patients adhere to a strict drug-maintenance schedule, or they risk developing a resistance to the drugs. Patients who are identified as drug-resistant do not respond to two of the four first-line drugs. Those who suffer the extensively drug-resistant, or XDR, form do not respond to three of the six second-line drugs.

Patients with drug-resistant TB, including XDR, can take up to two years to be cured -- for a cost of up to $250,000, according to Dr. Robert Benjamin, medical director for the Alameda County TB control program. They remain contagious for a longer period, and worldwide 25 percent to 33 percent of them die.

Dr. Marcos Espinal, executive secretary of the World Health Organization's Stop TB Partnership, said Thursday that new research is needed to develop new drugs in order to treat the tougher strains. "If people are failing first- and second-line drugs, and we don't have a new drug in the pipeline for immediate use, that's a major crisis we're facing," he said.

Drug-resistant tuberculosis cases increased 13.3 percent in the United States from 2003 to 2004 -- the largest year-over-year increase since 1993. Such cases now account for 1.2 percent of total TB cases in the United States.

San Francisco gets one to four drug-resistant cases a year, Kawamura said. Almost all of the cases have been in immigrants from countries where TB is more prevalent and treatments are less rigorous.

Many public health offices in the United States, including San Francisco, have developed a strict program to monitor patients with TB, checking in with them daily to make sure they take the medication. But in other parts of the world, treatment isn't nearly as thorough. Patients are more likely to get treatment from private health-care providers who don't get government training in dealing with TB, or they use over-the-counter drugs to self-medicate.

"Drug resistance is largely a man-made problem. Poor treatment practices are by and large what lead to drug resistance," said Dr. Philip Hopewell, a UCSF professor of medicine who helped write the World Health Organization's first international standards for TB care, released this week. "If a patient arrives here (in the United States) with tuberculosis, they get treated effectively. We don't create the problem here. By and large, the drug-resistant cases we get are imported."

In fact, of the 128 cases of drug-resistant TB reported in the United States in 2004, 97 were in foreign-born patients, the CDC said.

It's critical, public health officials said Thursday, that the United States take an active role in improving both detection and treatment of tuberculosis overseas.

"Immigration is what has made America great, but with global mobility also comes mobility of diseases," Benjamin said. "If we fail to provide the technical assistance necessary to improve TB control in those countries, we will certainly bear the brunt of an incredibly dangerous and costly disease."

About a third of people worldwide are infected with tuberculosis, according to the CDC. About 9 million active cases show up, and 2 million people die of TB every year. With the spread of HIV, which weakens the immune system and leaves patients more susceptible to tuberculosis, TB is reaching pandemic levels in parts of Africa, the CDC said.

Tuberculosis as a whole was down 2.9 percent nationwide in 2005, with 14,093 cases reported for a rate of 4.8 cases per 100,000 people, according to the CDC. The number of cases dropped 3 percent, to 2,900, in California, which has about a third of the nation's TB cases.

San Francisco showed a 2.2 percent drop, to 132 cases, but still has the highest TB rate in the country, at 16.6 cases per 100,000 -- more than three times the national rate.

E-mail Erin Allday at eallday@sfchronicle.com.

Here's another article I ran across today.

http://english.epochtimes.com/news/6-3-26/39706.html

Tuberculosis Remains High Among Foreign-Born
By Georgia Heyward
Epoch Times New York Staff Mar 26, 2006


NEW YORK — Despite a record low in Tuberculosis cases for 2005 in New York City, infection remains high among foreign-born New Yorkers, reports the Department of Health and Mental Hygiene.

"We have made significant progress in the fight against Tuberculosis but more remains to be done," said Health Commissioner Dr. Thomas R. Frieden in a written statement. "Disparities persist and we need to do a better job of reaching foreign-born New Yorkers to let them know that TB is preventable and curable.

In 2005, 989 new cases were reported. A 5 percent drop in TB from the previous year is believed to be due to an effective drug treatment program, Directly Observed Therapy, in which a trained health professional oversees drug administration for TB patients. Curing TB requires treatment by several drugs for at least six months. If the drugs are discontinued before the infection is cured, one can develop an immunity to the TB drugs, making it very difficult to cure.

One of the most common infections in the world, TB is found in about one out of every three people.

Despite gains in New York City, 70 percent of new TB infections are found in foreign-born New Yorkers. Immigrants from China are the most likely to be infected with TB, including those from Taiwan, Hong Kong, and Mainland China.

"Neighborhoods in the City that have the largest immigrant populations from countries with high TB rates continue to have the highest TB rates," said Dr. Sonal Munsiff, Assistant Commissioner for the Bureau of TB Control in a written statement.

Rates are highest in Brooklyn and Queens, boroughs which also have the largest foreign-born populations.

TB is transmitted through prolonged close contact with an infected person. It is contracted by breathing in airborne bacteria from someone with active TB disease in the lungs.