Tuberculosis Treatment and Prevention

Monday, March 24, 2008

http://www.timesonline.co.uk/tol/news/uk/health/article3599420.ece

By, Melanie Reid, Timesonline, March 22, 2008

Health officials are screening the close contacts of a man who has become Britain’s first case of a virtually untreatable form of drug-resistant tuberculosis.

The man, believed to be a Somali asylum-seeker in his thirties, has a rare strain, Extremely Drug Resistant TB (XDR-TB), which has a high mortality rate.

The World Health Organisation (WHO) says that XDR-TB accounts for possibly only 2 per cent of the 9 million cases of tuberculosis in the world, but that it poses a grave public health threat, especially in populations with high rates of HIV and where there are few healthcare resources.

Health chiefs said yesterday that close contacts of the patient, who is in isolation at Gartnavel General Hospital, Glasgow, were being screened. He has been in the hospital since January.

Dr Oliver Blatchford, consultant in public health medicine in Glasgow, said yesterday: “It is no more infectious than ordinary TB but it does require different treatment. The contacts of this case are being screened in the same way as ordinary TB contacts. They will be monitored closely to ensure that any further cases are identified early and treated quickly.”

A health board spokesman added that the man had been admitted to hospital at the end of January but was unable to give any personal details or provide information about his condition.

It is understood that the man arrived at Heathrow last November and when screened for infectious diseases was found to have TB scarring on his lungs.

The condition was not active, however, and the man told doctors he had recently had a six-month course of treatment for TB. After an immigration interview, he was allowed to go to Scotland, where the disease became reactivated.

XDR-TB poses a far greater challenge to doctors than MDR-TB (Multidrug Resistant TB), which is resistant to at least the two main first-line tuberculosis drugs, isoniazid and rifampicin. XDR-TB is a form of MDR-TB that is also resistant to three or more of the six classes of second-line drugs. Doctors can only try to contain the disease with a cocktail of second-line drugs. In some cases, part of the lung can be cut out.

This is the first case reported in Britain since the revised definition of XDR-TB was published by the World Health Oorganisation in 2006. Recent findings from a survey of data from 2000-04 found that XDR-TB had been identified in all regions of the world but was most frequent in the former Soviet Union and Asia.

Professor Peter David, the secretary of TB Alert in Britain, said that drugs could contain the disease but not cure it. Treatment takes 12-18 months and is estimated to cost more than £100,000 per patient.

Global killer

— Skeletal remains show that prehistoric human beings had the disease in 4000BC, and tubercular decay has been found in mummies from 3000-2400BC

— Two billion people, one third of the world’s population, are infected with the bacterium that causes TB

— Every 15 seconds someone dies from TB. Two million people die from it each year

— Eighty per cent of TB cases are concentrated in 22 “high-burden” developing countries, but no corner of the world is safe. The WHO declared TB a global emergency in 1992

Source: Times database : http://www.timesonline.co.uk/tol/news/uk/health/article3599420.ece

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