Extensively Drug-Resistant Tuberculosis (Xdr-Tb): The Facts

By, Medical News Today, March 29, 2007

What is XDR-TB?

TB can usually be treated with a course of four standard, or first-line, anti-TB drugs. If these are misused or mismanaged, multidrugresistant TB (MDR-TB) can develop. MDR-TB takes longer to treat with second-line drugs, which are more expensive and have more side-effects. If these drugs are also misused or mismanaged, extensively drug-resistant TB (XDR-TB) can develop. Because XDR-TB is resistant to first- and second-line drugs, treatment options are seriously limited and so are the chances of cure.

What is the medical definition of MDR-TB and XDR-TB?

MDR-TB is due to bacteria that are resistant to at least isoniazid and rifampicin, the two most powerful first-line anti-TB drugs. XDR-TB is due to bacteria that are resistant to any fluoroquinolone, and at least one of three injectable second-line drugs (capreomycin, kanamycin and amikacin), in addition to isoniazid and rifampicin. This is a revised definition of XDR-TB, on which the WHO GlobalTask Force on XDR-TB agreed in October 2006.

How do people develop XDR-TB?

People who are ill with pulmonary TB (TB of the lungs, the site most commonly affected) are often infectious and can spread the disease by coughing, sneezing or simply talking, as these acts propel TB bacteria into the air. Another person breathing in these bacteria may become infected with TB but without disease; only the TB skin test becomes positive. If the bacteria overcome the body's immune system, the person becomes ill with TB. A person ill with TB develops XDR-TB when first- and second-line anti-TB drugs are misused or mismanaged during the course of treatment and become ineffective (that is, when drugs are taken in the wrong combination, are fewer than those prescribed or taken in insufficient doses or insufficient time). People with XDR-TB can be infectious and pass the drug-resistant bacteria to other people.

How easily is XDR-TB spread?

There is probably no difference between the speed of transmission of XDR-TB and those of any other forms of TB. The spread of TB bacteria depends on factors such as the number and concentration of infectious people in any one place and the time of exposure, along with the presence of people with a higher risk of being infected, such as those with HIV/AIDS.

Can XDR-TB be cured or treated?

Several countries with good TB control programmes have shown that up to 50-60% of affected people can be cured. Nevertheless, successful treatment also depends greatly on the extent of the drug resistance, the severity of the disease and whether the patient's immune system is compromised.

Can vaccination prevent XDR-TB?

The TB vaccine, called the bacille Calmette- Guérin (BCG) vaccine, prevents severe forms of TB in children, such as TB meningitis. BCG would be expected to have the same effect in preventing severe forms of TB in children, even if they were exposed to XDR-TB, but it may be less effective in preventing TB in adults. New vaccines are urgently needed, and WHO and members of the Stop TB Partnership are actively working on them.

How do I know if I have TB or XDR-TB?

Symptoms of XDR-TB are no different from those of ordinary or drug-susceptible TB:
- a cough with thick, cloudy mucus (or sputum), sometimes with blood, for more than 2 weeks;
- fever, chills and night sweats;
- fatigue and muscle weakness;
- weight loss; and
- in some cases, shortness of breath and chest pain.
If you have these symptoms, you do not necessarily have XDR-TB, but you must see a doctor for a check-up. If you are already being treated for TB and at least some of these symptoms are not improving after a few weeks of treatment, you should inform your clinician or nurse.

How quickly can XDR-TB be diagnosed?

This depends on the patient's access to health care services. If TB bacteria are found in the sputum, TB can be diagnosed in a day or two, but this finding will not be able to distinguish between drug-susceptible and drug-resistant forms. To evaluate drug susceptibility, the bacteria need to be cultivated and tested in a suitable laboratory. Such a final diagnosis for TB, and especially XDR-TB, may take 6-16 weeks. To reduce this period, new tools for rapid TB diagnosis are urgently needed.

How can a person with drug-sensitive TB avoid getting XDR-TB?

The most important thing is to continue taking all treatment exactly as prescribed. No doses should be missed and treatment should be taken right through to the end. If patients suffer from side-effects - for example, the tablets make them feel sick - they should inform their clinicians or nurses, because simple solutions are often available. If they need to travel for any reason, patients should make sure they have enough tablets with them for the duration of the trip.

What is the link between XDR-TB and HIV/AIDS?

In places where XDR-TB is most common, people living with HIV are at greater risk of becoming infected with XDR-TB, owing to their weakened immunity. If many HIV-infected people live in these places, there will be a strong link between XDR-TB and HIV. Fortunately, in most places with high HIV rates, XDR-TB is not widespread. For this reason, most people with HIV who develop TB will have drug-susceptible TB, and can be treated with standard first-line anti-TB drugs.

How common is XDR-TB?

XDR-TB is rare, although numbers of cases are not yet known. WHO estimates that there were almost half a million cases of MDR-TB worldwide in 2004, however, with the highest rates in Europe. Wherever second-line drugs to treat MDR-TB are being misused, the possibility of XDR-TB exists. Recent studies indicate that XDR-TB cases comprise 15% of MDR-TB cases in some areas of Europe and urgent research is under way to find out more.

Is it safe to travel to places where XDR-TB has been identified?

XDR-TB has been found in every region of the world. The people most at risk if they come into contact with someone with XDR-TB are those with reduced immunity to infectious diseases, such as those with HIV or other medical conditions that can compromise the immune system. Such people should avoid high-risk areas, where no infection control measures are in place. Air travel carries only very minimal risks of infection with TB of any kind. Travellers with concerns about visiting countries with XDR-TB, or other health risks, should seek advice from their doctors, national authorities or trusted travel web sites such as that of WHO
(http://www.who.int/topics/travel ). Why have I never heard of XDR-TB before?

For some years, isolated cases of very highly resistant TB around the world have been seen that would today be called XDR-TB. These cases have been reported in greater numbers only recently, as regular surveys of drug resistance have been made in more and more countries and laboratory capacities have improved. This has led to the closer examination and naming of the problem.

How do countries prevent XDR-TB?

Countries can prevent XDR-TB by ensuring that the work of their national TB control programmes, and all practitioners working with people with TB, is carried out according to the International standards for tuberculosis care . These emphasize:
- providing proper diagnosis and treatment to all TB patients, including those with drug-resistant TB;
- ensuring regular, timely supplies of all anti-TB drugs;
- properly managing anti-TB drugs and providing support to patients to maximize adherence to prescribed regimens; and
- caring for people with XDR-TB in centres with proper ventilation, and minimizing contact with other patients (particularly those with HIV), especially in the early stages before treatment has had a chance to reduce the infectiousness.
Meanwhile, countries should promote the wide dissemination of The patients' charter for tuberculosis care , which lists the rights and responsibilities of TB patients and their families.

What should I do after contact with a person known or suspected to have XDR-TB?

You should consult your doctor or a local TB clinic, and be screened for TB. This is most important if you have any symptoms of TB. In case of cough, you will be asked to provide a sample of sputum, which will be tested in the laboratory. Several other tests will be performed in the clinic, including a skin test and a chest radiograph.

Latest Information and regular updates
The latest information and regular updates on XDR-TB and related TB issues are available on the web sites of WHO headquarters (http://www.who.int/tb ), the WHO Regional Office for Europe (http://www.euro.who.int/tuberculosis ) and the Stop TB Partnership (http://www.stoptb.org ).

Tuberculosis
The facts

* Tuberculosis (TB) is contagious and spreads through the air; if not treated, each person with active TB infects, on average, 10-15 others every year.
* One in ten people infected with TB bacilli will become sick with active TB in his or her lifetime. People with HIV are at much greater risk.
* TB is a disease of poverty, affecting mostly young adults in their most productive years.
* In the WHO European Region, there were 445 000 new TB cases in 2005 and 66 000 deaths: an estimated 7 deaths every hour.
* TB is a leading killer among HIV-infected people with weakened immune systems. In 2005, 14 000 new TB cases are estimated to have occurred in HIV-positive adults.
* TB is a Region-wide pandemic. European Union (EU) countries report 23% of all new cases, and Kazakhstan, Romania, the Russian Federation, Turkey, Ukraine and Uzbekistan account for 73% of the total number of cases in the WHO European Region.
* Multidrug-resistant TB (MDR-TB) does not respond to the standard treatments, using first-line drugs. MDR-TB is present in virtually all countries recently surveyed by WHO and partners.
* Every year, 450 000 new MDR-TB cases are estimated to occur worldwide, including 70 000 in the European Region.
* Extensively drug-resistant TB (XDR-TB) occurs when resistance to second-line drugs develops. It is extremely difficult to treat and cases have been confirmed all over the world.

The response

* In 2005, the WHO Regional Director for Europe sent a letter to all Member States, warning of a TB emergency in the Region.
* WHO's Stop TB Strategy aims to reach all patients and ensure the achievement of the MDG target by 2015.
* The Stop TB Strategy is based on DOTS and emphasizes the need for a health system approach and effective primary health care to address the TB epidemic.
* DOTS has 5 elements:
(a) political commitment with increased and sustained financing;
(b) case detection through quality-assured bacteriology;
(c) standardized treatment with supervision and patient support;
(d) an effective drug supply and management system; and
(e) a monitoring and evaluation system, and impact measurement.
* DOTS coverage (the share of a country's population living in areas where health services adopted the strategy) reached 60% in 2005; 35 countries in the Region have declared 100% DOTS coverage, although DOTS services in many countries need to be expanded and strengthened.
* WHO, at headquarters and in regional and country offices:
(a) develops policies, strategies and standards;
(b) supports countries' efforts;
(c) measures progress towards TB targets and assesses national programmes' performance, financing and impact; and
(d) promotes research; and facilitates partnerships, advocacy and communication.
* Full funding of the Global Plan to Stop TB 2006-2015 will cost US$ 56 billion, including US$ 8.9 billion to be used in the WHO European Region.
* The Global Drug Facility, run by the Stop TB Partnership, has expanded access to drugs for TB patients in 11 out of the 18 priority countries in the Region.
* Through the Green Light Committee, projects managing MDR-TB can apply for access to quality-assured second-line anti-TB drugs at much reduced prices.
* The United Nations Secretary-General appointed the former President of Portugal, Jorge Sampaio, as the first United Nations Special Envoy to Stop Tuberculosis in 2006. His role is to strengthen political commitment at the highest levels to ensuring implementation of the Global Plan to Stop TB 2006-2015.
* Nelson Mandela, former President of South Africa, warned that, "we cannot fight AIDS unless we do much more to fight TB". WHO's global policy on collaborative TB/HIV activities and the activities of the WHO Regional Office for Europe ensure that these words are being put into action.
* A Stop TB Partnership for Europe was launched in October 2006 to engage key European stakeholders in promoting a more robust response to the Region's epidemic.
* The International standards for tuberculosis care describe a level of care that all practitioners should seek in managing TB patients. The patients' charter for tuberculosis care outlines patients' rights and responsibilities.

http://www.euro.who.int


Source: http://www.medicalnewstoday.com/medicalnews.php?newsid=66187&nfid=rssfeeds

South Africa: Acute Burden of Active TB in HIV-Positive Kids

By, Khopotso Bodibe, Health-e (Cape Town), March 23, 2007

Scientists are trying to protect children born to HIV positive mothers from getting TB, the most common infection suffered by people with HIV.

Children under two born to HIV positive mothers are at high risk of getting TB, but the risk doubles if the child is also HIV positive.

This is according to a study involving 1 300 children born to HIV-infected mothers based in Johannesburg, Cape Town and Durban. The sample is divided into two groups - 800 HIV negative and 500 positive kids.

"The question that we're faced with is how to actually prevent HIV-infected children as well as children that are born to HIV-infected mothers, but that are not themselves HIV-infected from developing tuberculosis," says the study's lead scientist, Professor Shabir Madhi, Director of Wits University's Respiratory and Meningeal Pathogens Research Unit (RMPRU).

The aim of the study is to investigate the possibility of preventing primary tuberculosis by giving all the babies Isoniazid (INH), one of two first-line medicines used to treat TB.

"We've got HIV-infected children and HIV-uninfected children that were born to infected mothers Fifty percent of the children in each of these groups would receive Isoniazid (INH). The other 50% would receive a placebo," says Madhi.

"We are providing them with the drug from three months of age until two years of age. During that time period, if the child manifests any sort of symptoms of TB we would investigate the child. And obviously, we would only know at the end of the study whether this intervention of ours works or not.

"At two years of age we plan to stop the intervention drug and we would continue following up for another two years in each child just to see whether the effect of the intervention actually endures after the initial two years of prophylaxis. So, in total it would be a four-year period."

Preliminary results from the study, which started recruiting in November 2004, show that there is a huge burden of TB infection in children with HIV.

"When we started the study, our estimate was that over a two-year period about 12% of HIV-infected children would actually develop tuberculosis," says Madhi.

"But our preliminary data actually suggests that the incidence (the number of children that actually develop tuberculosis in one year in HIV-infected children) is around 20%. So, we've completely under-estimated the burden of tuberculosis that actually exists in HIV-infected children."

In the uninfected children, the incidence of tuberculosis is about half of what it is in HIV-infected children.

Until now, the strategy to prevent the development of TB, including pulmonary or lung TB in children, has been to vaccinate them early after birth with the BCG vaccine.

However, says Madhi, there are some problems with the vaccine: "We know, firstly, that it's not very effective in preventing pulmonary TB in children. It's more useful in preventing extra-pulmonary TB, that's TB meningitis and TB of other areas of the body

"The next problem is that there's emerging data which actually shows that a BCG vaccine might actually be harmful to HIV-infected children."

Even so, kids in Prof Madhi's study still receive the vaccine as routine. The professor says he has a few good reasons to suspect that the research using chemo-prophylaxis with Isoniazid will prove effective.

"There's a study that's been completed in South Africa on HIV-infected adults with a CD 4 count greater than 200 that have previous evidence of infection by TB. When these adults are actually prophylaxed with INH, we find that, actually, they have a reduced risk of developing TB subsequently.

So, at least, there's adult data to support the notion that this is the sort of strategy that might work in children. Our study is slightly different in that children that we're looking at haven't had previous infection by TB We're more interested in actually preventing the primary infection from taking place as well as the subsequent disease from developing."


Source: http://allafrica.com/stories/200703230658.html

South Africa: Drug Resistant TB Poses Greatest Risk to Healthcare Workers

By, Kerry Cullinan, Health-e (Cape Town), March 23, 2007

Until recently, Mandla was a nurse at a Durban hospital. But for the past few months, he has been a patient trying to shake off multi-drug resistant (MDR) TB.

"I became sick with TB in August last year. By January, I had finished my normal TB treatment but I still wasn't cured and that is when they found I had MDR TB," says Mandla, a tall, thin man in his thirties.

"I took my treatment properly without a break and this is the first time I have had TB," adds Mandla, who said he had lost both his appetite and energy.

It is highly likely that Mandla picked up MDR TB from one of the patients he cared for.

Healthcare workers are the most at risk of getting MDR TB - and its incurable cousin, XDR TB.

"MDR and XDR TB are no more infectious than ordinary TB," says KwaZulu-Natal provincial TB manager Bruce Margo. 'These are not super-bugs that can infect people more easily.

"South Africa has a very high TB rate, and there are a lot of people with active TB coughing and sneezing in their communities. So ordinary people are most at risk of getting TB.

"But healthcare workers are most at risk of getting MDR and XDR TB as they are more likely to come into contact with them than ordinary South Africans."

Margo estimates that in KwaZulu-Natal alone, there are around 40 000 people with active, infectious TB.

"We know that we have under-estimated the cases of MDR TB, but even if we triple our figures, this would mean that there are 3 000 cases of MDR TB in KwaZulu-Natal. This poses far less of a risk than ordinary TB to ordinary people," says Margo.

However, the serious, drug-resistant cases were most likely to end up in hospitals cared for by nurses like Mandla and doctors like Dr Igbal Master, a long-term TB doctor at King George V Hospital, the Durban hospital with the greatest cases of MDR TB in the country.

"About 10% of people with normal immune systems who are exposed to the TB bacillus develop TB," says Master.

"If you are healthy, you are unlikely to get TB. I have been exposed to TB and MDR TB over many years and have not developed active TB. But there is a chance that, as I get older and my immune system weakens, MDR or XDR is waiting for me," says Master with a rueful laugh.

People with HIV are at great risk of getting TB, yet many healthworkers are reluctant to reveal their HIV status to their employers - and they thus endanger their own health by working on wards with TB patients.

Since the public outcry over XDR TB, special masks are available for health workers but only one nurse in the male TB ward at King George was wearing a mask.

Masters says that most of the doctors have stopped using the mask, which is really uncomfortable in the tropical climate and "interferes with doctor-patient relations".

Dr Shamila Maharaj, the hospital's medical manager, says that it is hard to attract doctors to work at her hospital. Nurses' salaries have been hiked to the highest grades to attract staff.

"I had a young doctor interested but then he came back and started asking many questions about his risks and compensation if he became infected," says Dr Maharaj.

"I think there should be some kind of incentive, like the inhospitable or scarce skills allowance, to attract health professionals as we are really struggling to get doctors," she said.

The many research institutes wanting to study drug-resistant TB could also help by providing sessional doctors, she adds.

At present, there are only seven doctors at King George V to oversee the 100 MDR TB patients, 30 XDR patients and 200 weekly outpatients who attend the bi-weekly clinics. These doctors are also assisting to treat patients at a new 120-bed facility opened in Durban's Clairwood area which only has one doctor at present.


Source: http://allafrica.com/stories/200703260404.html

Drug resistance and HIV-AIDS threaten anti-TB drive: WHO

By, AFP, March 22, 2007

Expanding drug resistance and HIV/AIDS threaten to reverse tangible gains made in the global fight against tuberculosis, the World Health Organisation warned Thursday.

The global tuberculosis epidemic is showing signs of slowing for the first time since the WHO declared it a global health emergency in 1993, the UN's health agency said in a report on attempts to control TB.

The overall number of cases continued to increase in line with the world's population growth, reaching 8.79 million in 2005, against 8.71 million a year earlier.

Virtually no country in the world is spared, with cases reported in 199 nations, the report said. The overwhelming majority -- 7.4 million -- are found in Asia and sub Saharan Africa.

However, the proportion of the population struck by the infectious respiratory disease stayed level and even declined in some regions, the report added.

"We are currently seeing both the fruits of global action to control TB and the lethal nature of the disease's ongoing burden," said UN Secretary General Ban Ki-moon.

"Almost 60 percent of TB cases worldwide are now detected and, out of those, the vast majority are cured," he added. "But the disease still kills 4,400 people a day."

The progress identified in the report falls far short of meeting of a UN target of halving prevalence of the disease by 2015, health officials warned.

"There are serious challenges to the progress we have made. We need to redouble our efforts," WHO Director General Margaret Chan said.

More than 2.1 million people were receiving multidrug treatment recommended by the WHO (DOTS), which is regarded as highly effective but requires steady medical follow-up and patient discipline.

The "DOTS" diagnosis and treatment programme was available in 187 countries by 2005, but access was uneven, the WHO said.

Seven of the 22 countries worst affected by TB, including five African nations, had insufficient plans to expand health staff, according to the report.

"We need to tackle this problem as part of the larger challenge of increasing access to primary health care services," Chan said.

"All people, no matter who they are or where they are, should have access to TB diagnosis and treatment as part of package of general health services that bring multiple health benefits," she added.

The "DOTS" package has formed the cornerstone of efforts to prevent drug resistance in recent years and has expanded. The report said treatment and cure targets were narrowly missed in 2005, except in 26 countries in the Pacific region and in south East Asia.

The WHO also fears that "little effort" is being made to screen HIV patients for tuberculosis especially in Africa.

HIV/AIDS patients with their weakened immune systems are highly susceptible to tuberculosis infections, and accounted for 195,000 of the 1.6 million TB deaths in 2005.

"In most cases tuberculosis is both curable and preventable, (yet) certainly in Africa is the first known cause of death of people living with HIV," Peter Piot, the head of UNAIDS, told journalists.

The report also underlined that the global scale of "extensively drug resistant" strains of tuberculosis (XDR-TB) discovered last year "is not yet known."

"It is really alarming because of the high mortality rate of people infected with these strains, which are resistant to all known anti-TB drugs. It is a serious threat to the global response," Piot said.

Health officials underlined that drug resistance thrived on inadequate investment and poor health services.

"Beyond that, because of the threat of XDR-TB, research to identify new diagnostics, drugs and medicines is more vital than ever," said Mauro Raviglione, head of the WHO's anti-TB programme.

WHO TB Strategy out of reach for many endemic countries

By, Bobby John and Tim France, March 24, 2007

On the occasion of World TB Day (Saturday March 24), it is important to recognise that resistance to TB drugs has assumed very serious proportions. New global data on TB, published this week by the World Health Organisation (WHO), highlights weaknesses in many national TB programmes, which raises the potential for widespread TB drug resistance. How did the world reach this precarious state?

A WHO expert would argue that increasing levels of TB drug resistance "reflects a failure to implement the WHO Stop TB Strategy". The strategy hopefully maps out the steps that national TB control programmes need to take.

By all accounts then, national TB programmes are not living up to expectations.

The bacterium that causes tuberculosis (TB), Mycobacterium tuberculosis, is naturally sensitive to antibiotic drugs used to treat the disease.
The accepted truth about how TB drug resistance starts is that it is mostly 'acquired' in individual patients, because of inadequate treatment with TB drugs, which are now at least 40 years old.

Poor patient drug adherence, or the use of too few drugs leads - the story goes - to various forms of drug-resistant TB. Multidrug-resistant TB (MDR-TB) is a specific type that does not respond to the two most powerful anti-TB drugs. Latest estimates are that MDR-TB makes up about
4 per cent of all new and previously treated TB globally. Apparently, the antiquated TB drugs are also failing.

Drug-resistant TB is already geographically widespread, which includes places where TB control programmes have been in place for many years.
But incredibly little is known about just how much TB drug resistance there is outside of capital cities, for example, and even in some entire countries where drug resistance may be common because of historically poor TB control.

No progress can be made if TB clinics are there but patients are not.
Today's standard test for TB relies on a technique (sputum microscopy) invented over a hundred years ago. It provides no information about drug resistance. Apparently TB diagnosis is also failing us.

There seem to be too many weak links. A further litany of vital TB programme components has also been ignored for years, in favour of a single jewel in the TB strategy's crown: directly-observed treatment short course, or DOTS.

In many places, a consistent lack of focus and investment has led to chronically weak TB diagnostic and laboratory services; infrequent and incomplete TB drug resistance surveillance; inadequate management of individual drug resistant TB cases; and paltry TB infection control measures, including in health care settings.

Predictably, many TB-endemic countries have indeed failed to meet the exacting standards of the WHO Stop TB Strategy. Given the circumstances in many countries where TB is rife, what is surprising is that they should be asked to pursue such a pipe dream.

DOTS was supposed to stem TB drug resistance. Because of sloppy and unimaginative implementation, it is evidently failing us. As the full extent of TB drug resistance comes to light, prioritising TB drug delivery above all other areas of TB diagnosis and care looks increasingly like WHO has been building a house, just without foundations. We cannot now claim to be surprised when a decade of overlooking the systemic challenges faced by countries with high incidence of TB brings the entire house down.

Promoting policy frameworks is no replacement for working together to achieve what needs to be done to address TB. The Global Plan to Stop TB, (2006-2015), launched by the Stop TB Partnership just over a year ago, is a road map for such a coordinated action. WHO urgently needs to look beyond 'their' Stop TB Strategy to help promote and coordinate the comprehensive range of actions set out in the plan and to recognise the track record of over 500 global partners who put their name behind it.

When she took office just a few months ago, the new WHO director-general, Margaret Chan, identified the organisation's many partnerships as one of her immediate priorities. "Either the partnerships have to change or we have to change or both of us have to change to be more relevant", she said. "What is important to me is, are we getting the results that matter?"

In the case of controlling TB drug resistance, the answer is an unequivocal 'no'.

-----

**About the Authors:

Dr Bobby John, is the Executive Director of the Center for Sustainable Health & Development, India, and President of Global Health Advocates
(www.ghadvocates.org)

Tim France, PhD is Technical and Policy Adviser at Health & Development Networks (www.hdnet.org), and Chair of the Stop TB Partnership Media and Events Task Force (www.stoptb.org)

Drug resistant TB: the 'forgotten disease' fights back

By, Agence Presse France, Marts 20, 2007

PARIS (AFP) - In the time it takes you to read this sentence out loud, someone somewhere in the world will have died of an illness that has been readily curable for half a century.

That relentless tally will rise to 1.6 million people over the course of a year, making tuberculosis the deadliest infectious disease on the planet after AIDS and ahead of malaria, according to the UN's World Health Organisation (WHO).

On Thursday, the WHO will release a major report on tuberculosis two days ahead of World TB Day, with a special focus on 22 "high burden countries," eight of them in Africa.

There will be some good news.

The worldwide epidemic of TB seems to have peaked; new, more effective drugs are in the pipeline; and many countries have met 10-year targets for detection and treatment.

India and China in particular, experts say, have made measurable strides in curbing infection and reducing mortality.

But progress in checking the disease's spread is severely threatened, the same health officials add, by new strains impervious to some or all of the arsenal of drugs currently available.

Another peril is the HIV/AIDS epidemic, which weakens the human immune system, creating a hospitable environment for what was once aptly called the "wasting disease" or "consumption."

The number of countries in which so-called extensively drug resistant TB -- XDR-TB for short -- has surfaced nearly doubled from 19 to 35 in only a year, including newly reported outbreaks in South Africa and ten nations in Europe.

"The level of resistance in XDR-TB seriously reduces treatment options, resulting in high rates of treatment failure and consequent mortality," Paul Nunn, coordinator of the WHO's TB/HIV and Drug Resistance programme, said recently.

If the problem is not tackled now, he warned, the world will witness "the replacement of the current global epidemic of mostly drug-susceptible TB with multi-drug resistant or XDR disease, and the need to solve a human catastrophe at vastly greater expense."

While the numbers remain paltry compared to the incidence of tuberculosis as a whole, of the 27,000 confirmed cases of XDR-TB reported in 2005, 16,000 -- 60 percent -- proved fatal.

Of the 420,000 cases of the somewhat less virulent multi-drug resistant TB (MDR-TB), almost one in four was mortal.

Overall, there are eight to nine million new cases of tuberculosis, all types combined, every year.

Current treatment for TB, developed more than four decades ago, is difficult to administer and requires six to nine months of therapy.

When patients fail to complete a treatment, the germ Mycobacterium tuberculosis that causes the disease develops a resistance to the drugs to which it has been exposed.

With an estimated two billion people carrying a latent form of the infection -- one out of every three people on the planet -- the risk of exposing vulnerable populations to highly pathogenic forms of a disease that spreads through the air, as with the common cold, has sounded alarms among health professionals.

"The fact that there are essentially untreatable forms of TB in the community is very worrisome," Richard Chaisson, a professor at John Hopkins University in Baltimore and a leading authority on XDR-TB, commented by e-mail.

"Urgent measures are needed."

Posing an additional challenge is the overlay of TB and HIV/AIDS, especially in sub-Saharan Africa.

"Africa has the highest rates in the world of HIV/AIDS infection, and those rates have fuelled the TB resurgence. People who have compromised immune systems are much more vulnerable," said Melvin Spigelman, Head of Research and Development at the New York-based TB Alliance, which leads the world in developing new drugs to fight the disease.

Nearly 200,000 people living with HIV died for TB in 2005 alone, he pointed out.

Curing patients who have both diseases is hampered by the incompatibility of drugs considered essential for each illness, giving rise to a highly dangerous condition known as IRIS, for immune-reconstitution inflammatory syndrome.

If tuberculosis seems like a 19th-century illness to many people in the West, it is partly the dated association with artists and writers taking cures in Alpine sanatoria.

The main reason, though, is that the disease was largely eradicated in industrialized nations by antibiotics after World War II.

But it has never ceased to plague the developing world. "It is the quintessential disease of the poor," said Spigelman.

"It is the poor nations in general that have the highest incidence of the disease, and even in developed countries -- the US and Britain, for example -- it is the poor who are affected," he said.

And because society's most impoverished members do not have the clout to plead their case, Spigelman added, "it has become a forgotten disease."


Source: http://news.yahoo.com/s/afp/20070321/hl_afp/healthdiseasetuberculosis_070321023941

Eastern Cape confirms two more XDR-TB cases

By, Independent Online, March 19, 2007

Two more cases of killer XDR-TB have been diagnosed in the Eastern Cape, the provincial health department said on Monday.

Spokesperson Sizwe Kupelo said the two patients were diagnosed with extreme drug resistant tuberculosis (XDR-TB) on Thursday of last week at the Jose Pearson TB Hospital in Port Elizabeth.

The two were subsequently transferred to the Fort Grey TB hospital in East London where they were isolated from ordinary TB patients.

Forty-three patients in the Eastern Cape have been diagnosed with the deadly strain of the infectious disease since its emergence in the province in November 2006. According to the department, six people have died.

Source: http://www.iol.co.za/index.php?from=rss_South%20Africa&set_id=1&click_id=13&art_id=nw20070319224404772C571161

TB Second Biggest Infectious Killer Worldwide

By, Catharine Paddock, Medical News Today, March 19, 2007

TB, the infectious lung disease, is a leading cause of death from infectious diseases worldwide, second only to HIV/AIDS.

The airborne disease that we all thought had been eliminated by the 1960s, is now killing nearly 2 million people worldwide every year. According to the World Health Organization (WHO), new infections of tuberculosis, or TB, occur at the rate of one per second.

And also of increasing concern to health professionals and organizations worldwide is the sharp rise in drug-resistant strains of TB.

Of these, extremely drug-resistant tuberculosis, XDR-TB, has emerged as a top priority - in Sub-Saharan Africa it is said to be threatening to undermine the progress in the fight against HIV/AIDS. The WHO, the Bill Gates Foundation and the European Union have launched programmes to tackle the problem.

Poorer countries are not the only ones to be hit by TB. London for example is called "the TB capital of Europe", and most large cities in Europe and North American have seen sharp rises in the disease.

But the problem is bigger in Africa and Asia because of the higher prevalence of HIV/AIDS and reduced healthcare capability, particularly shortages of TB drugs and ensuring patients finish the treatment programme which can take up to 18 months. This is how resistant strains emerge.

Other groups have also launched campaigns. In the US, philanthropist and political activist George Soros, chair of the Open Society Institute announced earlier this week a coalition with Partners in Health, Brigham and Women's Hospital, and the RESULTS Educational Fund. They have set up a fund to develop new treatments for patients with drug-resistant TB and HIV/AIDS in developing countries.

The coalition have called on governments in the wealthier nations to support initiatives to stop the global epidemic that hits poorer nations with under-resourced healthcare systems much harder. Basic control of TB is the key, they say.

Many health experts are saying that the way to stop the dual epidemic is to fight it on two fronts. Strengthen basic control of TB, and develop new treatments for the drug-resistant strains.

A potential new treatment was highlighted earlier this month when UK scientists announced that a drug used to treat common fungal infections could hold the key to treating drug-resistant TB.

Biologists at The University of Manchester showed that compounds known as azoles - the active agent in many antifungal drugs - kill the TB bacteria, and could also be effective against emerging drug-resistant strains.

Professor Andrew Munro, who led the research in Manchester's Faculty of Life Sciences, said "TB is back with a vengeance with a third of the world's population currently infected".

Professor Munro explained the resurgence of TB and the drug-resistant strains: "The bacterium survives the initial attack by the body's immune system and then lies dormant, usually in the lungs, waiting for any sign of weakness, such as a secondary infection. Its resurgence over the last 20 years has been closely associated with the AIDS epidemic, which destroys the human immune system and has allowed TB to get a grip once again."

"People in places like India or Africa would be given antibiotics but often not in sufficient quantities to kill the bug completely; this is how resistant strains develop and these regions have become huge breeding grounds for these 'super strains'," said Professor Munro.

In researching the DNA of the TB bacterium, the Manchester scientists found it had a large number of enzymes called P450s, which is unusual for a small organism like a bacteria. They discovered that existing anti-fungal treatments based on azoles already target P450s, for instance in the treatment for Candida albicans (the causative agent of thrush).

They found that azoles were good at killing TB bacterium as well, by blocking the action of its P450s that are essential for maintaining cell structure. They also bind tightly to some of the TB P450 enzymes and inactivate them.

The research is published in the Journal of Biological Chemistry.

Meanwhile the WHO has announced that 650 million dollars will be needed every year to treat over 1.5 million patients with drug-resistant TB by 2015.

Dr Paul Nunn of the WHO's Stop TB Department announced the figure to delegates at the opening session of the 14th Conference on Retroviruses and Opportunistic Infections (RCOI) in Los Angeles at the end of last month. He called drug-resistant TB "one of the most urgent issues in the developing world".

XDR-TB stands for extremely drug-resistant TB, which according to the WHO is MDR-TB (multi drug-resistant TB) plus additional resistance to certain second line drugs. More specifically, XDR-TB is resistant to the fluoroquinolones and resistant to at least one of the injectable drugs,amikacin, kanamycin and capreomycin.

The problem of XDR-TB was first defined in March 2006 by the US Centers for Disease Control and the WHO. 18,000 TB isolates were shown to contain 20 per cent of MDR-TB. These were tested for 2nd line drug resistance. Ten per cent of the MDR isolates were found to be resistant to 3 or more of the 6 second-line drugs.

In order to fight XDR-TB, developing countries need more advanced facilities, particularly on the laboratory side. Dr Nunn said, for example, there is an acute shortage of laboratories with capability to perform drug susceptibility tests (DST), particularly for second line drugs, which is technically more demanding. "South Africa, alone, has more DST capable laboratories than the rest of sub-Saharan Africa put together," he said.

According to Dr Paul Farmer, co-founder of Partners In Health and based at Harvard University and Brigham and Women's Hospital in Boston, the growth of "XDR-TB highlights a global failure to prevent and treat basic TB". He said TB can be treated with simple and inexpensive drug treatment programme, but when we don't handle that very well, TB becomes drug resistant.

According to the WHO, the best way to prevent strains of XDR-TB from developing, is to strenghten the control of basic TB. To do this it estimates 5 billion dollars will be needed in 2007 to treat more than 9 million new cases worldwide.

Saturday 24th March is World TB Day.

Source: http://www.medicalnewstoday.com/healthnews.php?newsid=65508&nfid=rssfeeds

$3m pledge to battle XDR-TB in Africa

By, Global Africa Network, March 15, 2007

MASERU, Billionaire George Soros pledged $3-million on Wednesday to fight a deadly strain of tuberculosis in Africa.

Since an outbreak of extensively drug-resistant tuberculosis (XDR-TB) was identified in South Africa last year, health experts have repeatedly issued dire warnings about the disease's spread across the continent, fuelled by the Aids pandemic. But aside from a series of worldwide meetings, little concrete action has been taken.

Soros's Open Society Institute announced a $3-million grant to the non-profit organisation Partners in Health and Brigham and Women's Hospital in Boston, Massachusetts. The donation will be used to design a model project of community-based XDR-TB treatment in Lesotho.

Once treatment guidelines are developed, experts hope the programme might be adopted in other poor countries.

Partners in Health has previously implemented community-based programmes for drug-resistant TB in countries including Peru and Rwanda. "It is possible to treat highly resistant tuberculosis," said Dr Paul Farmer, co-founder of Partners in Health, who disputed characterisations of the disease as "virtually untreatable".

Farmer emphasised the need for HIV and TB treatment to be integrated.

"It's great that Soros has stepped forward, but what we really need is massive investments from governments," said Mark Harrington, executive director of the Treatment Action Group, a United States-based health advocacy group.

"Governments have been embarrassed about the outbreak and terrified of not knowing what to do about it," he said, calling the XDR-TB problem "out of control".

Last September, the World Health Organisation (WHO) confirmed 53 XDR-TB cases in South Africa, of which 52 were fatal. Most of the patients were also HIV-positive. To date, more than 300 cases have been identified, and at least 30 more are picked up each month.

In a few weeks, WHO experts will finally begin helping South African authorities investigate the origins and spread of last year's outbreak. The WHO estimates $650-million is needed to combat the XDR-TB problem annually.

XDR-TB exists worldwide, but it is of particular concern in Africa, where patients are often co-infected with HIV/Aids, which essentially translates into a death sentence. XDR-TB is a variant of TB, an easily transmissible disease that is resistant to two of the second-line TB drugs, used as a last line of defence.

No XDR-TB cases have been found in neighbouring countries such as Lesotho, Malawi or Zimbabwe, but experts suspect weak surveillance systems there are simply not picking them up. The disease has been identified in 28 countries worldwide, including all Group of Eight countries.

The delayed response to XDR-TB, Harrington said, does not match the severity of the outbreak. "People think of TB as an old disease, and it's largely been ignored," he said. "But if they really understood how serious XDR-TB was, they would be scared out of their wits." - AP


Source: http://news.africast.com/africastv/article.php?newsID=61487

XDR-TB is 'an absolute emergency'

By, Mail & Guardian online, March 12, 2007

South Africa is struggling to contain an outbreak of extensively drug-resistant tuberculosis (XDR-TB) and the World Health Organisation (WHO) is sending a permanent staff member to help, reported the Lancet.

The medical journal said the WHO TB expert would advise the Health Department on how to deal with the outbreak of the often-fatal XDR-TB, which has spread to all nine provinces. The department has confirmed 269 cases of XDR-TB.

The director of Stop TB at WHO, Mario Raviglione, said the local, national and international response to the spread of XDR-TB was too little too late.

"This is an absolute emergency," he told the Lancet.

"It is the most urgent thing I have seen in my 15 years of working in tuberculosis: a highly resistant strain that is now killing HIV-positive people and is spreading very rapidly.

"Nobody is moving fast enough."

An appeal for $95-million made last October in Paris had met little response, he said.

The WHO is also discussing the possibility of stationing WHO staff members in each province.

Raviglione said the immediate focus should be to investigate the outbreak at the Church of Scotland Hospital at Tugela Ferry in KwaZulu-Natal.

A study published online by the Lancet last August showed that 53 patients contracted XDR-TB and 52 died at the hospital. KwaZulu-Natal authorities launched their own investigations, but these have yet to be completed.

A total of 205 XDR-TB cases have been confirmed in KwaZulu-Natal, the province with the highest HIV prevalence.

XDR-TB cases are those resistant to three or more of the six second-line TB drugs. -- Sapa


Source: http://www.mg.co.za/articlePage.aspx?articleid=301718&area=/breaking_news/breaking_news__national/

Antifungal drug kills tuberculosis bug

By, News-Medical.net, March 12, 2007

Scientists hoping to find new treatments for one of the world's most deadly infectious diseases say drugs used to treat common fungal infections may provide the answer.
Tuberculosis, or TB, is a highly contagious disease of the lungs that was thought to have been virtually eliminated by the 1960s, but is now resurgent and kills nearly two million people worldwide every year. New infections are occurring at a rate of one per second.

Of equal concern is the dramatic rise in the incidence of new strains of TB that are resistant to traditional antibiotics. As a result, the World Health Organisation, the Bill Gates Foundation and the European Union have all launched initiatives to tackle the problem.

Now, biologists at The University of Manchester have shown that chemicals called azoles - the active agent in many antifungal drugs - kill the TB bacteria, and could be effective in tackling the emerging drug-resistant strains.

"TB is back with a vengeance with a third of the world's population currently infected," said Professor Andrew Munro, who led the research in Manchester's Faculty of Life Sciences.

"The bacterium survives the initial attack by the body's immune system and then lies dormant, usually in the lungs, waiting for any sign of weakness, such as a secondary infection. Its resurgence over the last 20 years has been closely associated with the AIDS epidemic, which destroys the human immune system and has allowed TB to get a grip once again."

London is the TB capital of Europe, although most large cities here and in North America have seen rapid increases in the number of TB infections. However, the problem is most acute in Africa and Asia where HIV/AIDS is also most prolific and a shortage of traditional TB medicines and problems with patient compliance has led to the emergence of drug-resistant strains of the disease.

"There were only ever a limited number of drugs that were effective against TB anyway," said Professor Munro, who is based in the University's £38 million Manchester Interdisciplinary Biocentre.

"People in places like India or Africa would be given antibiotics but often not in sufficient quantities to kill the bug completely; this is how resistant strains develop and these regions have become huge breeding grounds for these 'super strains'."

Funded by the EU's NM4TB (new medicines for tuberculosis) project, the Manchester team set about trying to find alternative drugs that could be used to treat these multi-drug resistant varieties of TB, known as MDR-TB.

"We knew that the TB bacterium was a clever organism, able to evade the human immune system and to survive long-term, sometimes unnoticed, in the body. We also realised that these peculiar features of the TB bacterium must mean that there are 'unusual' aspects of its composition and biochemistry that set it apart from most other bacteria and that could provide new targets for antibiotic drugs.

"When we began looking at the bug and its DNA content in more detail, we noticed it had some unusual characteristics. In particular, we noted the presence of a very large number of enzymes called P450s, which are usually associated with more complex organisms.

"In humans, P450s oxygenate molecules in the body and are essential for steroid metabolism; they are also prevalent in the liver where they help us detoxify and dispose of countless chemicals and toxins that enter our system. Most bacteria have few, if any, P450s but we discovered that the TB bacterium has 20 different types."

Even more exciting for the team was the knowledge that existing anti-fungal drugs already target P450s as a way to treat, for example, systemic and more superficial infections caused by fungi such as Candida albicans (the causative agent of thrush).

"The class of drugs called azoles are able to kill off fungal infections by blocking the actions of one of its P450s that is essential for maintaining the cell structure," said Professor Munro. "We were able to show in laboratory experiments that various types of these azole drugs were also very good at killing the TB bacterium, and also that they bind very tightly to a number of the TB P450 enzymes that we have isolated - inactivating their function."

The research - published in the Journal of Biological Chemistry - offers the potential of a whole new approach to fighting the TB bug and has already attracted interest from one major pharmaceutical company.

http://www.manchester.ac.uk


Source: http://www.news-medical.net/?id=22548

TB the silent killer

By, Ishrat Firdousi,The Financial Express, March 10, 2007


In developed countries, many people think tuberculosis (TB) is a disease of the past. TB, however, is still a leading killer of young adults worldwide. Some 2 billion people-one-third of the world's population-are thought to be infected with TB bacteria, Mycobacterium tuberculosis.

TB is a chronic bacterial infection. It is spread through the air and usually infects the lungs, although other organs and parts of the body can be involved as well. Most people who are infected with M. tuberculosis harbor the bacterium without symptoms (have latent TB), but some will develop active TB disease. According to World Health Organization (WHO) estimates, each year, 8 million people worldwide develop active TB and nearly 2 million die.

One in 10 people who are infected with M. tuberculosis may develop active TB at some time in their lives. The risk of developing active disease is greatest in the first year after infection, but active disease often does not occur until many years later.

TB is primarily an airborne disease. The bacteria are spread from person to person in tiny microscopic droplets when a TB sufferer coughs, sneezes, speaks, sings, or laughs. Only people with active TB can spread the disease to others. People with TB who have been treated with the correct drugs for at least 2 weeks, however, are no longer contagious and do not spread the bacteria to others.

To identify those who may have been exposed to M. tuberculosis, health care providers typically inject a substance called tuberculin under the skin of the forearm. If a red welt forms around the injection site within 72 hours, the person may have been infected. This doesn't necessarily mean he or she has active disease.

If people have an obvious reaction to the skin test, other tests can help to show if they have active TB. In making a diagnosis, doctors rely on symptoms and other physical signs, the person's history of exposure to TB, and X-rays that may show evidence of M. tuberculosis infection.

The health care provider also will take sputum and other samples to see if the TB bacteria will grow in the lab. If bacteria are growing, this positive culture confirms the diagnosis of TB. Because M. tuberculosis grows very slowly, it can take 4 weeks to confirm the diagnosis. An additional 2 to 3 weeks usually are needed to determine which antibiotics to use to treat the disease.

Between 2 to 8 weeks after being infected with M. tuberculosis, a person's immune system responds to the TB germ by walling off infected cells. From then on the body maintains a standoff with the infection, sometimes for years. Most people undergo complete healing of their initial infection, and the bacteria eventually die off. A positive TB skin test, and old scars on a chest X-ray, may provide the only evidence of the infection.

If, however, the body's resistance is low because of aging, infections such as HIV, malnutrition, or other reasons, the bacteria may break out of hiding and cause active TB.

Early symptoms of active TB can include weight loss, fever, night sweats, and loss of appetite. Symptoms may be vague, however, and go unnoticed by the affected person. For some, the disease either goes into remission (halts) or becomes chronic and more debilitating with cough, chest pain, and bloody sputum.

Symptoms of TB involving areas other than the lungs vary, depending upon the organ or area affected. With appropriate antibiotic treatment, TB can be cured in most people. Successful treatment of TB depends on close cooperation between patient and health care provider. Treatment usually combines several different antibiotic drugs that are given for at least 6 months, sometimes for as long as 12 months.

Some people with TB do not get better with treatment because their disease is caused by a TB strain that is resistant to one or more of the standard TB drugs. If that happens, their health care providers will prescribe different drugs and increase the length of treatment.

People who do not take all the required medications can become sick again and spread TB to others. Additionally, when people do not take all the prescribed medicines or skip times when they are supposed to take them, the TB bacteria evolve to outwit the TB antibiotics. Soon those medicines no longer work against the disease. If this happens, the person now has drug-resistant TB.

Some people have disease that is resistant to two or more drugs. This is called multidrug-resistant TB or MDR-TB. This form of TB is much more difficult to cure.
Treatment for MDR-TB often requires the use of special TB drugs, all of which can produce serious side effects. People with MDR-TB may have to take several antibiotics, at least three to which the bacteria still respond, every day for up to 2 years. Even with this treatment, however, between four and six out of 10 patients with MDR-TB will die, which is the same rate seen with TB patients who are not treated.

TB is largely a preventable disease, and adequate ventilation is the most important measure to prevent its transmission in the community.

Health care providers try to identify people infected with M. tuberculosis as early as possible, before they have developed active TB. They will give infected people a medicine called isoniazid (INH) to prevent active disease. This medicine is given every day for 6 to 12 months. INH can cause hepatitis (inflammation of the liver) in a small percentage of people, especially those older than 35 years.

Hospitals and clinics take precautions to prevent the spread of TB, which include using ultraviolet light to sterilize the air, special filters, and special respirators and masks. In hospitals, people with TB are isolated in special rooms with controlled ventilation and airflow until they can no longer spread TB bacteria.

In those parts of the world where the disease is common, WHO recommends that infants receive a vaccine called BCG (Bacille Calmette Guerin) made from a live weakened bacterium related to M. tuberculosis. BCG vaccine prevents M. tuberculosis from spreading within the body, thus preventing TB from developing.

BCG has its drawbacks, however. It does not protect adults very well against TB. In addition, BCG may interfere with the TB skin test, showing a positive skin test reaction in people who have received the vaccine. In countries where BCG vaccine is used, the ability of the skin test to identify people infected with M. tuberculosis is limited. Because of these limitations, U.S. health experts do not recommend BCG for general use in this country.

WHO estimates 11.4 million people worldwide are infected with both M. tuberculosis and HIV (human immunodeficiency virus, which causes AIDS [acquired immunodeficiency disease]). The primary cause of death in those infected with body microbes is from TB, not AIDS.

One of the first signs that a person is infected with HIV may be that he or she suddenly develops TB. This form of TB often occurs in areas outside the lungs, particularly when the person is in the later stages of AIDS.

It is much more likely for people infected with M. tuberculosis and HIV to develop active TB than it is for someone that is only infected with M. tuberculosis. Fortunately, TB disease can be prevented and cured, even in people with HIV infection.

People infected with both MDR-TB and HIV appear to have a more rapid and deadly disease course than do those with MDR-TB only. If no medicines are available, as many as eight out of ten people with both infections may die, often within months of diagnosis.

Diagnosing TB in people with HIV infection is often difficult. They frequently have disease symptoms similar to those of TB and may not react to the standard TB skin test because their immune system does not work properly. X-rays, sputum tests, and physical exams may also fail to show evidence of M. tuberculosis infection with in people infected with HIV.


Source: http://www.financialexpress-bd.com/index3.asp?cnd=3/10/2007§ion_id=10&newsid=54960&spcl=no

WHO calls for greater efforts to fight TB

By, earthtimes.org, March 12, 2007

The World Health Organization (WHO) on Monday hailed the progress of governments of Western Pacific countries in fighting tuberculosis (TB), but warned that the region needed greater effort to effectively control the disease. The region has successfully met the WHO's 2005 target of detecting at least 70 per cent of TB cases and curing at least 85 per cent of infections, said Pieter van Maaren, regional adviser for the health body's TB programme.

He was speaking at a three-day WHO meeting on TB held in Malaysia's eastern city of Kuching on Borneo island.

TB control efforts in the region were intensified following the declaration of a TB crisis in 1999, and funding to affected countries was increased.

However, despite the positive trend in eradicating TB, van Maaren warned that the region was still far from achieving its 2010 goal of reducing TB deaths by half, compared to the 2000 levels.

In recent years, over 3.5 million TB cases and nearly 300,000 deaths have been recorded in the region, he was quoted as saying in a WHO statement.

"We clearly still have a lot of work to do before we can meet the goal we have set for ourselves," he said.

He cited problems such as limited access to and quality of health services, the emergence of multidrug-resistant TB, HIV-associated TB epidemics, inadequate engagement of all care providers and lack of adequate human resources as some of the problems that needed to be overcome.

Han Tieru, WHO representative in Malaysia, Brunei and Singapore, added that a rise in TB cases was due to lack of activities to address the link between the spreading of the disease and HIV.

"In settings such as in Singapore and Malaysia where TB and HIV share common risk factors, TB-HIV co-infection is of increasing concern," he said.

"We cannot control one without controlling the other. So, we must rapidly scale up TB-HIV collaborative activities through formally established mechanisms and plans."

Health representatives from eight countries, as well as TB are present for the conference, which ends Wednesday.


Source: http://www.earthtimes.org/articles/show/39091.html

Warning Over TB 'Epidemic'

By, Patrick Sawer, Evening Standard, March 10, 2007

TUBERCULOSIS cases in London increased by 11.2 per cent last year.

Figures published today show that the number of people suffering from the lung disease has risen by 31.7 per cent since 2000.

The worst-affected boroughs were Brent, with 285 cases, followed by Newham with 259, Ealing with 240 and Hounslow with 167.

Liberal Democrat MP Lynne Featherstone, who released the figures, is demanding the Government investigates and puts together a plan to combat the disease.

Ms Featherstone, the Lib-Dem spokeswoman on international development, said: "I raised this issue last year and clearly nothing has been done. How long will it take for the Government to wake up? TB is a curable disease.

This rise is, therefore, unacceptable and the apparent lack of action from the Government is unforgivable.

"It urgently needs to find out why TB cases in London are increasing and make clear how it plans to deal with this epidemic."

TB had been in steady decline in the UK until an increase in travel to and from developing countries led to a resurgence. Around 40 per cent of all UK cases are in London. TB most frequently attacks the lungs and, if left untreated, can be fatal.

Microscopic droplets of the bacteria are spread from carriers in coughs and sneezes.

Dr John Hayward of charity TB Alert said: "Increased global travel is one of the biggest factors. People are travelling to their home areas, namely Africa, India, Pakistan, Bangladesh and South America.

"Any place that has high rates of HIV will also have high rates of TB because of lowered immunity."

In Britain, poorer inner-city areas provide a breeding ground, with bad diet and health leaving many people with less resistance. But Hayward, a former director of public health for Newham, warned: "You don't have to be HIV positive, born in Somalia and live in a squat to catch TB.

"You can also be a white middleclass lawyer and catch the disease."

The most common symptom coughing formore than three weeks.

Only last week, 14 hospital patients who came into contact with a new infected employee hospital in West Sussex were warned to contact doctors.

Worthing and Southlands Hospitals NHS Trust said there was risk to the public.

(c) 2007 Evening Standard; London (UK). Provided by ProQuest Information and Learning. All rights Reserved.



Source: http://www.redorbit.com/news/health/865562/warning_over_tb_epidemic/index.html?source=r_health

Commentary: Africa TB alarm after years of neglect

By, Masimba Biriwasha, March 7, 2007

HARARE -- The recent emergence of extensively drug-resistant tuberculosis (XDR-TB) in South Africa is not only the result of poor treatment adherence by TB patients; it stems from years of neglect endured by TB programs throughout sub-Saharan Africa.

The current scale of the region's drug resistance challenge is poorly understood, and African TB programs are so dilapidated, many are at a loss as to how to respond.

"We don't understand the extent of it, and whether it's more widespread than anyone thinks," admits the head of the World Health Organization's (WHO) TB department, Dr. Mario Raviglione. "And if we don't know what has caused it, then we don't know how to stop it," he told the New York Times last week.

It has been widely acknowledged that the new deadly TB strain may have developed because of insufficient medication, or because patients missed some of their treatments. This ignores the many factors known to have major impact on treatment adherence. These include social and economic factors, as well as weaknesses in the healthcare system itself - all widespread in sub-Saharan Africa. This means that even "compliant" patients are at a high risk of TB recurrence, as well as developing and transmitting drug-resistant strains.

The tendency of recent reports to focus on patient-related factors as the "cause" of drug resistant TB conveniently overlooks the pervasive systemic factors driving TB and drug resistance in Africa.

HIV infection increases the likelihood of active TB more than 50-fold, for example, an estimated one-third of the 24.5 million people living with HIV (PLHIV) in sub-Saharan Africa, also have TB. To make matters worse, current diagnostic tests for TB often fail to detect the disease among PLHIV.

As a result of the high rate of HIV infection in the region - and an almost complete lack of TB infection control measures in health centers - the threat of the new deadly TB strain spreading is high. There are fears that should XDR-TB spread among the HIV-positive population, it could wreak havoc among millions of people throughout sub-Saharan Africa, reversing gains made in TB control and antiretroviral programs.

The capacity for TB drug resistance testing is, ironically, better in South Africa than anywhere else in the region. If XDR-TB had emerged in Zambia, or Lesotho, or Zimbabwe, for example, we might never have known. And if it has already emerged elsewhere, we still might not know, even today, because of the relative inability to detect TB drug resistance.

More than anything else, what makes the reported South African cases so alarming is that it could indicate that TB drug-resistance underlies the HIV epidemic throughout the region. The factors behind the emergence of drug-resistant TB are by no means unique to South Africa, but are also prevalent throughout neighboring countries.

Eleven of the 15 countries with the highest TB incidence globally are in the sub-Saharan Africa region. Nevertheless, TB is regarded as far less of a health priority than HIV. In recent years, annual spending on HIV programs in the region has skyrocketed, while, in the same period, anti-TB efforts have received paltry increases in resources.

Responding to the challenge of drug resistance - and TB in general - will require re-building the basics of African TB programs in a number of ways: training and retaining health workers in sufficient numbers; strengthening diagnostic and laboratory facilities; maintaining continuous drug supplies (including second-line drugs for treating drug-resistant forms of TB); introducing infection control measures to stop the spread of TB; raising awareness among affected people and communities.

As a first step to rolling back the years of neglect, understanding the extent of the drug resistance problem and its interaction with HIV is paramount. Detailed population-based studies of TB drug resistance in Africa are urgently required.

Secondly, difficult questions must also be asked about whether current TB control strategies are sufficient to address TB drug resistance and TB/HIV co-epidemics in the context of Africa.

Not until these two question marks have been lifted will investment by the international community ensure an appropriate response.


Source: http://www.metimes.com/storyview.php?StoryID=20070307-010714-9806r

Masimba Biriwasha is a member of The Key Correspondent Team, coordinated by the Health and Development Networks (HDN). The HDN's Web site is: www.TheCorrespondent.org and its email is: Correspondents@hdnet.org. This commentary was submitted to the Middle East Times.

XDR-TB may get out of control: experts

By, SABC News, March 8, 2007

Leading health experts say the extreme drug resistant tuberculosis (XDR-TB) virus affecting certain parts of KwaZulu-Natal and the Eastern Cape can get out of control if it is not immediately treated. XDR-TB has already killed more than 50 people in KwaZulu-Natal.

The deadly XDR-TB is reported to be spreading rapidly across the country. US public health experts say most South Africans who are infected with HIV are actually being killed by TB. Richard Chaisson, of the Consortium to Respond Effectively to the Aids/TB epidemic, otherwise known as CREATE, says TB has become more dangerous.

SA has some tools to fight TB
Chaisson says funding for research, and development of new tools to effectively fight this latest scourge, remains the problem. However he says South Africa has other resources to deal with it.

Archbishop Tutu is already sounding the alarm. Last week he wrote an open letter to the US congress, asking for $300 million to fight TB in Africa. The XDR-TB virus has already been detected in 28 other countries.

George Soros, a US billionaire, and other activists have started a campaign to urge governments to take necessary steps to stop this latest scourge before it gets out of control.


Source: http://www.sabcnews.com/south_africa/health/0,2172,145039,00.html

TB strain threatens "uncontrollable" epidemic

By, Laura MacInnis, Reuters, March 6, 2007

Extremely drug-resistant strains of tuberculosis could spark a "practically uncontrollable" epidemic among HIV/AIDS sufferers in areas like Africa, a World Health Organization (WHO) official said on Tuesday.

Mario Raviglione, director of the United Nations agency's Stop TB Department, said health experts needed to ensure a recently discovered strain - known as XDR-TB - did not trigger a wave of infections among those with weak immune systems.

He said better diagnostic tools and improved health care procedures - including isolation rooms for those afflicted with the highly contagious bug - were vital to stop its spread.

"If all the elements of good TB control are put in place, we have a chance of taking care of this disease," the Italian doctor said in an interview at the WHO's headquarters.

"If we let the situation ... with XDR go out of control, as it might well do, then we are in trouble. All of our gains over the last 10 years in controlling TB would be lost."

Tuberculosis, an airborne disease spread like the common cold, afflicts about 9 million people each year and kills 1.6 million. It is normally treatable with antibiotics but drug-resistant strains have emerged in past years, complicating a U.N.-backed drive to stop the spread of the disease by 2015.

More than 400,000 people were found in 2004 to have developed "multi-drug resistant" strains that could not be treated with at least two key first-line tuberculosis drugs, with most cases in China, India and Russia.

XDR-TB, a "super bug" which resists three or more classes of second-line tuberculosis drugs, has been identified in 28 countries worldwide, with cases concentrated in the United States, Latvia and South Korea.

In South Africa, the XDR strain has killed nearly 200 people since September, mainly HIV patients unable to fend it off.

Raviglione said the strain could cause widespread deaths among those with HIV/AIDS, given their susceptibility to tuberculosis and the difficulty in treating it.

"Either we intervene rapidly to stop the spread of this strain, or you could foresee in the future that this strain would replace the other one," he said. "That would make it practically uncontrollable."

New antibiotics and drugs to fight XDR-TB could take more than five years to reach the market, Raviglione said, so countries needed to boost their laboratory capacities to quickly identify which patients have drug-resistant TB strains.

"In South Africa they are capable, that is why they discovered it. But we don't know what's happening in Mozambique, in Lesotho, in Swaziland, in Zimbabwe," he said, noting it was possible the strain was more widespread in the region.

Africa accounted for most of the world's tuberculosis deaths in 2004, followed by southeast Asia, according to WHO data.

http://www.kare11.com/news/health/health_article.aspx?storyid=246323

By, Anita Manning, USA TODAY, March 6, 2007

A dangerous form of tuberculosis that resists treatment with both first-line and second-line drugs is spreading around the world, spurring an urgent search for new ways to stop the ancient scourge.

Extensively drug-resistant TB (XDR-TB) has been found in 28 countries, including, rarely, the USA, the World Health Organization says.

Multi-drug-resistant TB (MDR-TB), which is immune to the two most powerful anti-TB drugs, has been reported for years and is now in 90 countries. But it was not until March 2006 that WHO and the Centers for Disease Control and Prevention recognized XDR-TB, a form of the disease that has developed further immunity, which makes some of the second-tier drugs ineffective. It is still sometimes curable, but only with expensive drugs and intensive treatment.

Last August, an outbreak in South Africa was reported in which 52 of 53 patients with XDR-TB died. Most also had HIV. Now, XDR-TB is in every province of South Africa. At last week's Conference on Retroviruses and Opportunistic Infections in Los Angeles, Karin Weyer of the South Africa Medical Research Council estimated 600 XDR-TB cases in the country with a fatality rate of 84%. More than 80% of those infected are HIV patients.

WHO says $650 million is needed each year to control drug-resistant TB.

"We were fairly complacent with the sense that we had drugs that work, and we do," says Maria Freire, CEO of The Global Alliance for TB Drug Development, a non-profit devoted to finding new TB drugs.

But when those drugs are given inappropriately or stopped too soon, drug resistance emerges, requiring more expensive and toxic alternatives. Regular TB can be cured with a combination of drugs taken for six months. MDR-TB requires a different combination, taken for 18 months to two years. If that regimen isn't followed carefully, XDR-TB can emerge.

"It doesn't mean you're totally untreatable, it means . they're giving you everything they have," Freire says. And in some cases, "we've simply run out of ammunition. We no longer have the drugs we need to fight this."

The TB Alliance is working with pharmaceutical companies, academic researchers and institutes to find new drugs, Freire says, and there are promising candidates in the pipeline. She says the goal is to develop drug combinations that attack different parts of TB bacteria to reduce resistance; that can be taken along with the anti-retroviral therapy needed by HIV/AIDS patients; and that are effective when taken for two months or less.

"That's a huge leap," she says, "but not an impossible goal." Ultimately, she says, the hope is to be able to "treat TB as you would any normal infection, with a 10-day treatment," but that may require a decade or more of biological research.


Source: http://www.kare11.com/news/health/health_article.aspx?storyid=246323

Drugs are not enough for extreme TB - doctors

By, iol.co.za, March 6, 2007

Multi-drug-resistant tuberculosis (MDR-TB) needs a proactive networked response, particularly when it appears together with HIV infection, an international discussion on MDR-TB heard in Johannesburg on Monday.

"It is one disease where there are more questions than answers," said Dr Norbert Ndjeka from Limpopo - part of a group of South African doctors who travelled to Latvia for training in MDR-TB management.

MDR-TB is TB which does not respond to standard TB treatment, and extreme drug resistant TB (XDR-TB) is even more resistant to treatment. The combination of XDR-TB and HIV infection in South Africa has been proving deadly.

The Johannesburg meeting, organised by the international Lilly MDR-TB Partnership brought South Africans together with Lilly affiliates from Europe.

'It is one disease where there are more questions than answers'This partnership is underwritten by international pharmaceutical company Lilly to the tune of $70-million and brings together public and private partners, health professionals, business and communities to address MDR-TB around the world. It was the partnership's first global study tour.

"Drugs are not enough," said partnership project head, Dr Patrizia Carlevaro.

The partnership aims to combat the growing MDR-TB pandemic and support the World Health Organisation's goal of treating 800 000 patients by 2015.

Ndjeka said 13 medical professionals from eight provinces - excluding the Eastern Cape - attended the Latvia training, which included monitoring and management, MDR-TB and HIV co-infection, infection control and drug management.Ndjeka told the Johannesburg meeting that the training they received was "superb" and said South Africa could learn a lot from Latvia's management of MDR-TB.

'Drugs are not enough'"Their cure rate is above 66 percent... Ours is below 50 percent."

Ndjeka said Latvia had good methods of networking on patient difficulties."We do not have all the information around resistance patterns in the South African population."

He said South Africa also did not have all the drugs - XDR-TB treatment required six or seven drugs.Latvia has policies on infection control in place, runs effective isolation of XDR-TB patients, has masks and special lights to kill TB germs through radiation, and screens health care workers annually for infection.

The South African team trained in Latvia recommended to the health department that the national MDR-TB protocol be updated and encouraged research and networking on the MDR-TB problem, including HIV and TB collaboration."

As government alone we cannot make it."Involvement of all stakeholders is essential to achieve better outcomes for our national TB control programme," said Ndjeka."

The growing incidence of extreme drug resistant TB in South Africa is highlighting the urgent need for more effective measures for preventing, detecting, diagnosing and managing TB," said Dr Kgosi Letlape, chairman of the South African Medical Association (Sama).

Letlape said South Africa ranked seventh in the world in reported TB cases and was among the 22 high-burden countries targeted as part of the WHO's Stop TB campaign.

He said Sama aimed to help develop the capacity of health professionals to deal with TB. He said TB and HIV care should be integrated and commented that HIV-positive patients were generally better informed than those with TB, which impacted on their treatment.

"You have got much higher compliance among HIV patients than among TB patients."Sama is developing an online training course for physicians on MDR-TB which will include the WHO guidelines on combating the disease.

The course aims to provide doctors with the skills to diagnose, prevent, detect and manage TB, including promoting education and self-care, promoting therapy compliance and controlling associated disorders.

Letlape said 2554 health professionals had been trained in TB management since 2003, and Sama hoped to increase this to 5000 in 2007.General secretary for the Democratic Nurses' Association of South Africa (Denosa), Thembeka Gwagwa, said Denosa aimed to empower nurses to deal with TB.

As part of this, Denosa trained a core group of 20 nurses from seven provinces in TB management, who in turn trained another 500 nationally.

Northern Cape nurses reported that during the last quarter of 2006, after their 186 nurses were trained, the TB cure rate increased from 18.7 percent to 20.1 percent, while the treatment interruption rate dropped from 21.3 percent to 14.8 percent.Eastern Cape trained 60 nurses, and reported that the TB treatment compliance improved by 30 percent.

Mpumalanga and KwaZulu-Natal nurses reported a "sharp decrease" in the treatment interruption rate after training.

Gwagwa pointed out that some provinces had no budget for training, which "doesn't augur well".

She said poverty was a huge challenge in battling MDR-TB, as it stopped patients from getting to clinics and meant they took medication on empty stomachs."

MDR-TB is a man-made problem," said nurse and educator Kathy Dennill, who heads the nursing leadership programme at the Foundation for Professional Development (FPD)."

It stems from bad management. And we need to look at that management."Dennill's foundation runs training for nurses.FPD's Dr Anton Stoltz said the links between HIV and TB were crucial."It is very important that we know how people with TB present with HIV."

In support of the battle against MDR-TB, Lilly has passed on the skills and technology needed to manufacture TB drugs."We have given away our trademark," said Carlevaro.

"Twenty years ago people were saying MDR-TB is a lost cause. Now we say it's cost-effective to treat."

In South Africa, Lilly has passed on technology, skills and capital funding to pharmaceutical company Aspen Pharmacare, to enable it to produce low-cost drugs to fight MDR-TB, including XDR-TB.

Aspen currently manufactures the oral TB drug cycloserine and within about 15 months will be able to manufacture capreomycin, thanks to Lilly's assistance, said Aspen executive director Stavros Nicolaou.

He said Aspen was developing the capacity to manufacture a dried injectable powder in a vial which required only water to be added to it, a method which kept the medicine stable.

This would be used for capreomycin.He urged support for the battle against both TB and HIV - "a potentially devastating cocktail".Nicolaou said that thanks to Lilly's help, Aspen could sell the MDR-TB drugs "largely on a cost-recovery basis" instead of a profit-making basis. - Sapa


Source: http://www.int.iol.co.za/index.php?from=rss_News&set_id=1&click_id=79&art_id=nw20070305225920738C736233

HIV/AIDS, tuberculosis and malaria in Kenya could destabilize the country

By, news-medical.net, March 4, 2007

The prevalence of HIV/AIDS, tuberculosis and malaria in Kenya could destabilize the country's social and economic sectors, according to the recently released Kenya National Human Development Report 2006, Kenya's Nation reports.

"The limited amount of resources spent on HIV/AIDS, malaria and TB intervention programs constrain the quality and range of social services -- including education, health care, law and order, water and sanitation -- which are often seen as basic rights and essentials for human development," the report says.

It adds that the three diseases "erode society's capabilities to realizing anticipated development since these diseases divert resources towards emergency health care provision, away from training and growth opportunities."

According to the report, as more children contract the diseases or lose their parents to them, there will be fewer students to enroll in schools.

The report also says that HIV prevalence is higher in more impoverished regions of the country, highlighting the "likely effect of HIV/AIDS on human capabilities and human development in the most affected regions."

According to the report, 75% of all police deaths in 1999 were because of AIDS-related complications, which increases the potential for crime as police capacity to address crime is reduced.

Malaria, which accounts for roughly 5% of deaths nationwide and 30% of outpatient hospital visits, also has a "sporadic and yet devastating" effect on Kenya's highland areas, the report says.

In addition, there were roughly 200,000 cases of active TB in Kenya in 2005, but only 50% of cases were covered by the TB control program, raising concern that the number of TB cases could be higher, according to the report (Mwaniki, Nation, 2/28).

Source: http://www.news-medical.net/?id=22366

Drug-resistant TB spreading around the world

By, Anita Manning, USA TODAY, March 5, 2007

A dangerous form of tuberculosis that resists treatment with both first-line and second-line drugs is spreading around the world, spurring an urgent search for new ways to stop the ancient scourge.

Extensively drug-resistant TB (XDR-TB) has been found in 28 countries, including, rarely, the USA, the World Health Organization says.

Multi-drug-resistant TB (MDR-TB), which is immune to the two most powerful anti-TB drugs, has been reported for years and is now in 90 countries. But it was not until March 2006 that WHO and the Centers for Disease Control and Prevention recognized XDR-TB, a form of the disease that has developed further immunity, which makes some of the second-tier drugs ineffective. It is still sometimes curable, but only with expensive drugs and intensive treatment.

Last August, an outbreak in South Africa was reported in which 52 of 53 patients with XDR-TB died. Most also had HIV. Now, XDR-TB is in every province of South Africa. At last week's Conference on Retroviruses and Opportunistic Infections in Los Angeles, Karin Weyer of the South Africa Medical Research Council estimated 600 XDR-TB cases in the country with a fatality rate of 84%. More than 80% of those infected are HIV patients.

WHO says $650 million is needed each year to control drug-resistant TB.

"We were fairly complacent with the sense that we had drugs that work, and we do," says Maria Freire, CEO of The Global Alliance for TB Drug Development, a non-profit devoted to finding new TB drugs.

But when those drugs are given inappropriately or stopped too soon, drug resistance emerges, requiring more expensive and toxic alternatives. Regular TB can be cured with a combination of drugs taken for six months. MDR-TB requires a different combination, taken for 18 months to two years. If that regimen isn't followed carefully, XDR-TB can emerge.

"It doesn't mean you're totally untreatable, it means … they're giving you everything they have," Freire says. And in some cases, "we've simply run out of ammunition. We no longer have the drugs we need to fight this."

The TB Alliance is working with pharmaceutical companies, academic researchers and institutes to find new drugs, Freire says, and there are promising candidates in the pipeline. She says the goal is to develop drug combinations that attack different parts of TB bacteria to reduce resistance; that can be taken along with the anti-retroviral therapy needed by HIV/AIDS patients; and that are effective when taken for two months or less.

"That's a huge leap," she says, "but not an impossible goal." Ultimately, she says, the hope is to be able to "treat TB as you would any normal infection, with a 10-day treatment," but that may require a decade or more of biological research.


Source: http://www.usatoday.com/news/health/2007-03-04-tb-strain_N.htm?csp=34

Photovoice raises TB awareness in Thailand

By, Masimba Biriwasha, HDN Key Correspondent, March 1, 2007

A community project in northern Thailand named ‘TB Photovoice Thailand’ is using photos and stories to tackle often hidden issues surrounding TB and HIV infection, diagnosis, treatment and coping strategies. The project is proving that a picture can indeed speak a thousand words, but even more than that, it can help influence social change.

Thailand is ranked 18th among countries with high tuberculosis (TB) incidence according to the World Health Organization's (WHO) TB 2006 report, and also has approximately 570,000 people living with HIV. It is estimated an average of 30 percent of people living with HIV are co-infected with TB. HIV infection increases the demands on TB programmes through the need for better diagnostic tools, monitoring and treatment. A combination of HIV-related tuberculosis (TB), and an inadequate provision of treatment and community awareness among a myriad of migrant groups, is currently reversing previous gains in TB control.

Clinical diagnosis of TB is more difficult in co-infected patients, and similar symptoms can be caused by various types of infections. In addition, there is increasing evidence of multi-drug resistant TB (MDR-TB) in the country.

In the TB Photovoice project, people with experiences of TB take photos of their daily lives, and write personal essays based on the pictures, with an ultimate goal of influencing the way society perceives the disease.

According to Caroline Wang, creator of the photo-voice methodology, it is a process through which people can identify, represent and enhance their community through a specific photographic technique.

"This project aims to raise awareness on TB and HIV in Thailand. Through pictures people can tell their stories, share some of their problems, and give recommendations as individuals affected by TB and HIV," said Kaetwa Sangsuk, TB Photovoice Thailand's coordinator.

Poverty and a vast diversity in languages and cultures pose a significant challenge to reaching immigrant groups with much-needed TB/HIV education and treatment. It is clear that to be effective, TB/HIV services in Thailand require active engagement with local communities, especially already marginalized migrant groups.

Equipped with essential local knowledge and experience, TB/HIV control programmes can exponentially increase their effectiveness. Local communities need to be involved in the planning, implementation and evaluation of TB control programmes.

"Informed local participation is the most direct way to address obstructive misconception and to facilitate educational outreach," states the U.N. Millennium Project report titled "Investing in strategies to reverse the global incidence in TB."

Using pictures to communicate about TB and HIV, particularly in low literacy contexts, can significantly improve community awareness as well as influence the government’s response to providing medication and services.

Participants in the TB Photovoice Thailand project came from a TB/HIV support group in Chiang Dao and Muang district in Chiang Mai province, in the north of Thailand.

Chiang Dao – a border district with Myanmar – has a population of 74,000, and nearly half of those are immigrants. The majority of the migrants are poor and work in the agricultural sector. The district has one of the highest TB prevalence rates in Chiang Mai province, which already has one of the highest provincial case-loads in the country.

Participants receive training on how to take photographs, and are then given cameras to enable them to take pictures that document their experiences of TB.

Through taking and writing about the pictures, participants undergo a process that helps them to reflect about difficult issues associated with TB and its implications to their health and community.

"All my pictures are about my experience with TB. They show the various stages of TB, including treatment and recovery," said Narai Daenchai, 29, a participant in the TB Photovoice project.

In 2005, Daenchai was diagnosed as TB-infected. Like many of the project's participants, Daenchai was already living with HIV but he knew little about the connection between HIV and TB.

He fell sick and lost a lot of weight. He even locked himself away in his room to keep away from attention until he finally sought treatment. Throughout that period, his mother was his pillar of support. She fed him and prayed for him. Today, Denchai thanks his mother for staying by his side during his illness.

"I was in treatment for almost nine months; now everything is almost back to normal except that I cannot do too much work because my lungs are still weak," said Daenchai.

Last year, he joined TB Photovoice through the Chiang Dao Hospital's People Living with HIV and AIDS support group.

"Taking pictures has enabled me to express myself and also to become a messenger within my community," said Daenchai. "I get all the information that I can about TB, and the pass it on to people. I tell people that it is possible to treat TB."

In an attempt to reach out to the community, the photographs taken by participants are also displayed at the Chiang Dao Hospital to help attendants gain knowledge about the disease.

Coming together at monthly sessions, participants get to share experiences and feelings through the pictures and offer each other emotional support.

Having someone in the community who has had personal experience with TB, and can prove that it is treatable is a critical component in helping communities to respond to the problem of TB.

"The TB Photovoice project has enabled me to communicate to members in my village about TB/HIV and how to prevent problems. Also, knowing that there are other people with the problem has helped me to cope," said Saengmuang Muangchongsang, 40, also a participant in the project. "I use the photographs and stories to talk to people that may be affected by TB."

Participants also use pictures and their personal stories to advocate for TB/HIV treatment in their communities.

At Chiang Dao Hospital, the participants maintain a bulletin board which shows their pictures, stories and information about TB infection and treatment.

"The project is very good because by providing health communication within our communities, it fills a gap left by government," said Nuttawardee Areenu, a nurse in the TB/HIV unit of Chiang Dao Hospital.

"There are many migrant groups in Chiang Dao, who speak different languages, which make health communication very difficult."

TB Photovoice was founded in November 2004 by Romel Lacson shortly after his wife Claudia and their unborn child succumbed to TB meningitis.

The goal of the project is to provide local people around the world with a voice to articulate best practices and obstacles toward TB eradication, and to assist local communities disseminate this knowledge, and promote media awareness of the toll that TB exacts upon millions of lives.

HIV Fueling Deaths From XDR-TB In South Africa, Researchers Say

By, Medical News Today, March 1, 2007

About 85% of HIV-positive South Africans coinfected with extensively drug-resistant tuberculosis, TB that is resistant to the two most potent first-line treatments and some of the available second-line drugs, have died -- a situation that presents one of the most pressing issues in global HIV and TB control -- researchers said on Sunday at the 14th Conference on Retroviruses and Opportunistic Infections in Los Angeles, the Los Angeles Times reports (Chong, Los Angeles Times, 2/26). According to Karin Weyer of South Africa's Medical Research Council, cases of XDR-TB have been found in 40 hospitals in South Africa, as well as in every province in the country. Weyer and her colleagues have found about 600 cases of XDR-TB in the country, the San Francisco Chronicle reports (Russell, San Francisco Chronicle, 2/26). XDR-TB has appeared in about 10% of people who had been diagnosed with multi-drug resistant TB in South Africa, according to Weyer (Los Angeles Times, 2/26). According to the Chronicle, XDR-TB does not seem to spread easily, but it does pose a threat to people and health care workers who are HIV-positive (San Francisco Chronicle, 2/26). Since September 2006, about 183 people, most of whom were HIV-positive, have died from XDR-TB in the country. XDR-TB could exacerbate the HIV/AIDS epidemic in South Africa, where about five million out of a population of 45 million people are HIV-positive and as many as 1,000 people die of AIDS-related complications daily (Kaiser Daily HIV/AIDS Report, 2/20). According to World Health Organization estimates, the number of countries with XDR-TB cases had increased from 17 in March 2006 to 28 currently. The most-affected countries include South Africa, South Korea and parts of Eastern Europe, according to CDC. XDR-TB "creates a huge challenge in terms of infection control, especially in settings where high numbers of HIV-positive individuals are converging," such as hospitals, Weyer said. Paul Nunn, coordinator of WHO's TB drug-resistance unit, at the conference said that the 85% mortality rate is "completely egregious" (Los Angeles Times, 2/26). It is important to increase awareness about XDR-TB worldwide "but without causing undue alarm," Nunn said. He added that the international community needs to spend $650 million annually on efforts to control various strains of MDR-TB, of which XDR-TB is one (San Francisco Chronicle, 2/26). Kevin Fenton, director of CDC's National Center for HIV, STD and TB Prevention, said that the XDR-TB cases in South Africa are a "wake-up call" for bolstering TB surveillance and prevention efforts. "We increasingly live in a small world," Fenton said, adding, "With foreign travel and migration to the U.S., we have to be very much aware of emerging threats of XDR-TB" (Los Angeles Times, 2/26).


Source: http://www.medicalnewstoday.com/medicalnews.php?newsid=63903&nfid=rssfeeds