To this I say....No, No, No and....maybe. As in all things infectious and contagious, there's a long history and story behind it. There are no easy stories.
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| Total Resistant Mycobacterium tuberculosis |
So here's the truth:
TDR-TB: There's an early-warning list serve that we all subscribe to. It allows those of us who deal with infections a "heads up" about what's going on in the rest of the world. It's called Pro-Med. This is not the first time we've seen TDR-TB. It's been around since 2009. At least, that's when it was discovered. There there 12 cases at that time both in Mumbai and Iran. Before that, in 2003 there were two women in Italy in 2003. Both were sick for a loooonnng time before they died....of TB infection.
You can read about their story here: briefly recounted in 2007 in the journal EuroSurveillance, published by the European Centre for Disease Prevention and Control (ECDC).
Both women were middle-aged at most (the journal says only “younger than 50″), born in Italy, from middle class families, and otherwise healthy, with no diseases that would put them at greater risk of TB infection. (Among other things, that means no HIV.) They were both treated at the E. Morelli Hospital, a giant TB sanatorium in the town of Sondalo, north of Milan near the Swiss border. They were both diagnosed by local doctors and treated with repeated rounds of the normal TB drugs — three rounds each — before someone recognized that something unusual was happening - Hello....the drugs were NOT working. They were separately admitted to the Morelli hospital with what the paper calls “a very severe clinical picture (extended bilateral cavities),” which means the TB infection had eaten away the tissue of their lungs, leaving empty dead zones. (If you’d like to see what that looks like, here are some pathology images, not from these women.)
The first woman actually caught "regular" multi-drug resistant TB from her mother and gave it to her 14-year-old daughter (who is not the second case in the paper — more on her below). She was treated in three different hospitals, with 17 different antibiotics, for 422 days, or 14 months — and took TB drugs for 94 months before her untreatable disease killed her.
The second woman — whether she was related to the first, or lived near her, is not made clear — was in one other hospital before being admitted to the TB specialty institution in Sondalo. Her inpatient treatment took 625 days and also involved 17 different drugs. After she was discharged, she was on a drug regimen for 60 months before untreatable TB killed her also.
There are some lessons to pick out from these stories.
The first is that TDR-TB has occurred randomly before - FROM POOR MANAGEMENT OF THE DISEASE. Note, both these women died in 2003, but at that point, one had been under treatment for 5 years and the other for 8 years.
The second is that, as the Indian account emphasized that these TDR cases are artifacts, created by poorly chosen and insufficient drug treatment. The EuroSurveillance paper says that the drug susceptibility tests showed resistance to new drugs was acquired over time. Case 1 was initially mismanaged, and then admitted at the reference hospital being already resistant to the majority of the available drugs. Case 2 management and adherence to the regimen prescribed was sub-optimal before admission to the reference hospital.
What's this mean?
1. Not all physicians are adequately trained to treat TB. Only qualified Infectious Disease doctors should be treating TB. While most TB can be treated effectively (if caught in time) only those with a lot of experience and knowledge should be treating these patients. (My opinion - but others agree with me)
2. This cluster of new cases in India and Iran are just the newest reported/discovered. Get this...they are all from the same hospital. There are undoubtedly are more out there. Once again, these patients were treated ineffectively. All these TB bacteria are COMPLETELY resistant to every drug known to man. 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.
3. The really 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 World Health Organization. At the best of times and conditions, 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. This means that many patients don't complete their antibiotic course. Meaning that the bacteria that remain are resistant to these drugs. It's simple evolution.
4. In the USA we have a wonderful Public Health System that starts at the county level, is supported by the State Health Department and subsequently the CDC. In Pierce County, we have people that observe +TB patients actually take their drugs to make sure that they don't develop resistant TB. A problem on the horizon is the threat to this system by budget cuts. First to the State Health Departments and then to the county health department, front-line, boots on the ground people that keep us safe preventing the spread of infection in the community. This is your tax dollars hard at work keeping you safe. Really, it works! We should not dismantle the Public Health System.
Write or call your state legislatures now. Don't cut the budgets of your health departments! These cuts WILL come back to bite us.
(rant for the day)
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