New, deadlier form of TB hits India

January 7, 2012 2:45 PM

Tuberculosis, which kills around 1,000 people a day in India, has acquired a deadlier edge. Forty years ago, the world thought it had conquered TB.

The WHO on multi-drug resistant TB.
Drug resistant TB could bring back sanatoria. But new avenues of drug development are on the way.

posted by the man of twists and turns (34 comments total)

Emergence of new forms of totally drug-resistant tuberculosis bacilli: super extensively drug-resistant tuberculosis or totally drug-resistant strains in Iran via PubMed
posted by the man of twists and turns at 2:47 PM on January 7

GODDAMMIT.
posted by schroedinger at 3:00 PM on January 7 [3 favorites]

Your Iran link is this FPP

Btw, I've heard its a runaway problem in South Africa as well
posted by infini at 3:01 PM on January 7

Tuberculosis is incurable, weak or no unions, rapacious bankers and businessmen. beginning of the 20th century or the 21rst? Any bets on how many years until the next world war?
posted by dibblda at 3:03 PM on January 7 [15 favorites]

Photographer James Nachtway has a project on XDR-TB.
posted by docgonzo at 3:04 PM on January 7 [2 favorites]

Ok, that South Africa link was old news republished in last year, here's the latest report with video.
posted by infini at 3:08 PM on January 7

The Correct link from above
posted by the man of twists and turns at 3:08 PM on January 7

One thousand a day dying of TB in India in 2012? Is this perhaps an argument for wiping out diseases like TB and polio everywhere while we're at it, not just calling it a day once it's ceased to be a problem in the first world countries?
posted by orange swan at 3:09 PM on January 7 [7 favorites]

Any bets on how many years until the next world war?

I predict that only those with military budgets will go to war, if indeed there is one. I imagine the rest of the world dealing with problems like these to focus on infrastructure and their economies.
posted by infini at 3:10 PM on January 7

Damn, that's some depressing reading.
posted by arcticseal at 3:16 PM on January 7

One thousand a day dying of TB in India in 2012? Is this perhaps an argument for wiping out diseases like TB and polio everywhere while we're at it, not just calling it a day once it's ceased to be a problem in the first world countries?

This is a pretty bullshit characterisation of anti-polio efforts around the world.
posted by rodgerd at 3:16 PM on January 7 [19 favorites]

In case you're wondering about the main Times of India article a lakh is one hundred thousand.
posted by the man of twists and turns at 3:18 PM on January 7 [2 favorites]

infini: "Any bets on how many years until the next world war?

I predict that only those with military budgets will go to war, if indeed there is one. I imagine the rest of the world dealing with problems like these to focus on infrastructure and their economies."

India is by far the world's biggest arms importer, sixth largest military budget as percentage of GDP. Pakistan is #2 importer, but still at roughly half India's imports.
posted by vanar sena at 3:23 PM on January 7

I predict that only those with military budgets will go to war, if indeed there is one. I imagine the rest of the world dealing with problems like these to focus on infrastructure and their economies.

Most countries are good at not dealing with problems like these. TB has been endemic on Canadian reserves for quite some time.
posted by justsomebodythatyouusedtoknow at 3:26 PM on January 7 [1 favorite]

Drug resistant TB could bring back sanatoria.
This particular link is just stupid and inflammatory. Considering the author's previous article was a shill to flush your butt with Gwynneth Paltrow, I have difficulty taking it seriously.

On a more serious note,

TB may not be curable, but it is manageable. While it can be stopped in the body, the evidence you had it will always be there. You can also contract it again. On thing is for certain - for the current infection, successful treatment absolutely demands that the patient follow through completely. No shortcuts. Not doing so is almost worse than not starting the treatment in the first place.

It is a long treatment process where after a short period of time, you feel better and even are not contagious to others, but the problem is still there. There are not many ways around just sticking with the treatment regimen through to the end.

Centers for Disease Control and Prevention TB page
posted by lampshade at 3:27 PM on January 7 [2 favorites]

"Ms. McCarthy, could I interest you in an exclusive yoga retreat? Strictly in support of your...efforts, of course."
posted by Inspector.Gadget at 3:28 PM on January 7 [2 favorites]

If you're ever in Barnes & Noble, take a minute to examine the mural of the famous authors. I find it's usually in or around the cafe. Pictured is Franz Kafka… SMOKING A FUCKING CIGARETTE.

He suffered for years from pulmonary tuberculosis which spread to his larynx, and they painted him smoking? Incredibly poor taste.
posted by Houyhnhnm at 3:40 PM on January 7 [1 favorite]

"the patient [must] follow through completely."

One of the major problems with TB (and HIV) treatment efforts among vulnerable populations is the stance that treatment fails because individual patients are not adequately compliant. It is ridiculous to deem TV "manageable" and place the onus of treatment on the patient within settings where, for example, medications may cost a substantial fraction of daily wages, medical centres may be long distances from homes or worksplaces, treatment information is not delivered in native languages and/or individuals are subsequently incarcerated.

"... Barriers to adherence are often as much system related as patient related. Poor adherence to tuberculosis therapy in New York in the 1980s was often blamed on the patients, but adherence improved and tuberculosis case rates declined when the health care system was adapted to meet the needs of the indigent." Bangsberg et al., JAMA 1997.
posted by docgonzo at 3:47 PM on January 7 [7 favorites]

for the current infection, successful treatment absolutely demands that the patient follow through completely. No shortcuts. Not doing so is almost worse than not starting the treatment in the first place.

and we all know how well people do with this sort of thing (antibiotics are an example). "Well, i feel better, so i must be, now i'll stop taking these horrible and expensive drugs." Rinse, repeat. :P

I predict that only those with military budgets will go to war, if indeed there is one. I imagine the rest of the world dealing with problems like these to focus on infrastructure and their economies.

If there is one thing humans love, it's war. They will do that over any other thing, especially if it distracts them from issues that are harder to fight. Heck, blame the issue on another group, and there you go, they are even more eager.
posted by usagizero at 3:48 PM on January 7

"India sees around 3- 4 lakh deaths for all forms of TB each year..."

Imagine an additional Lincoln, Nebraska of dead. Every year... and all of the secondary affects of those deaths.

Considering that both major political parties present in the United States are quickly trying to dismantle ANY semblance of a functioning nation state beyond the Military-Industrial Complex, I have little hope that we will tend to this any better when the infection rates start spiraling beyond control....
posted by PROD_TPSL at 3:59 PM on January 7 [3 favorites]

Recently in Dallas, someone infected hundreds of people VIA a local school. It's fallen off the news radar already, but I remember hearing stats that it could potentially impact thousands of people in one of the nations largest travel hubs right before holiday travel. It's not just a 3rd world problem.
posted by dejah420 at 4:42 PM on January 7

rodgerd: "One thousand a day dying of TB in India in 2012? Is this perhaps an argument for wiping out diseases like TB and polio everywhere while we're at it, not just calling it a day once it's ceased to be a problem in the first world countries?

This is a pretty bullshit characterisation of anti-polio efforts around the world."

Now if only we could get rid of the fucking CIA using Polio Vaccination as some sort of way to attack its enemies...

There's a reason that people like Qadaffi ended up persecuting nurses trying to help people in his country.

Tuskegee isn't just the past...

It's harming the health of the world when these military/"national security" assholes continue to engage in using these programs to fuck with people they don't approve of in the name of "national security"... In the end it hurts the people who DO need these methods (and taints the name of "science" by idiots who then leech onto anti-vax ideology) and in the process WEAKENS national security by furthering a mindset that opposes legitimate vaccination for health purposes due to fear of these sorts of things. Which is *great* when it's your enemy, but that shit is just chickens WAITING to come home to roost you shits.
posted by symbioid at 5:23 PM on January 7 [6 favorites]

The rise of drug-resistant TB in prisons (and other places) was being tracked 20 years ago on an epidemiology newsgroup I used to read when the Internet was still young. Warnings were issued but they remained unheard. Not many people care about prison populations.
posted by juifenasie at 6:10 PM on January 7 [2 favorites]

Forty years ago, the world thought it had conquered TB

Paul Farmer once said (and I'm paraphrasing here, because I don't remember exactly), that the nadir of TB the US was experiencing by the 80s led the general populace to believe TB was done and gone for, that it was not longer a problem for industrialized countries. In poor communities, particularly poor urban communities, it never went away. The rest of the world, however, just moved on, and their neglect was paid back in the form of new deadly strains of TB.
posted by Panjandrum at 6:42 PM on January 7 [2 favorites]

What's scary is that you never know when or where you may come into contact with it. I live in middle Tennessee, was last out of the country when I went to the Bahamas in 1998, and would not be classified as high risk by anyone. I have psoriatic arthritis in my hands, so am being prescribed Enbrel, which is an immune system suppressant, therefore requiring a TB skin test prior to beginning treatment.

On reading the results of a TB skin test, there are 2 sets of criteria to use to determine a positive result. By one set, I was negative. By the other, more stringent set for "high risk" patients, I was positive. Since Enbrel is an immune system suppressant, I fell into the latter group. 9 months of a cheap ($4/month) antibiotic that beats the hell out of my liver. Got 2 orders from the doc with the prescription: no booze, and take every. single. pill. for the next nine months.

What sucks is, the doc, an infectious disease specialist at Vanderbilt, said if it wasn't for the Enbrel, she probably wouldn't have ordered treatment at all because i was otherwise such a low-risk case.
posted by rhythim at 6:54 PM on January 7 [1 favorite]

This is ugly. Non resistant TB in the US/UK rates a four drug regieme for two months, followed by a six month two drug course. MDR demands two years.

The thing that scares me, though, is thant they're breaking out linzolid as a last ditch. This stuff is nasty, and we are fucked if something else becomes resistant to it, because then we will have two totally resistant bugs out there.
posted by eriko at 7:02 PM on January 7

It's also scary that less money is being allocated to WHO and the CDC because of very stupid budget cutting.
posted by BillW at 7:21 PM on January 7 [2 favorites]

TB may not be curable, but it is manageable.

First it has to be recognized to be managed. We have a HUGE, vulnerable, and totally invisible, population here in the United States that has little or no access to health care and is an explosion waiting to happen. This is where it's brewing. These people aren't the poor, these are the 'regular folks'--ones among us who have lost the lottery on savings shrinking faster then they can put more in, disappearing jobs, or who were one major medical bill or another layoff from being out of their homes.

We have the Occupiers congregating, and while I admire them greatly, the living conditions are ideal for spreading something like this. They get sick, then go back home, and so it spreads.

Right now, the mindset is that it's still a third world problem. As dejah420 said, it's here, it's ours, and we need to own it and realize that if it starts getting away from us because of our shitty public health policies, we're screwed.
posted by BlueHorse at 7:56 PM on January 7

So how much work is being done to sort out the problems with the BCG vaccine? A quick glance through Google didn't find much useful information, but it was a very cursory search.
posted by dilettante at 8:05 PM on January 7

First it has to be recognized to be managed.

We have the Occupiers congregating, and while I admire them greatly, the living conditions are ideal for spreading something like this. They get sick, then go back home, and so it spreads.

TB dangers and its ability to spread like wildfire are widely recognized . The problem is that people are not listening. You are right, the mindset it is that it is not a problem while the potential for it to explode is as high as it ever was.

While I am with you on the loss of health care and the impact that it is having on raising the probability of infection, your examples may not the best.

Oddly, the Occupy encampments are probably a bit safer than it may appear. TB is most effectively spread in tight spaces where there is not a lot of air movement. As an open air encampment, it would stand to reason the Occupiers are not as much at risk simply because of the nature of um, being out in nature. Also, the homeless, while a high risk group, are most susceptible in shelters, not tent cities. A bigger problem with encampments of any type is poop and what to do with it.

The worst part of identifying likely TB transmission areas, is there is no single place that is safe. Certainly there are high risk areas, but that is no guarantee of not contracting it from a person in a low risk area. Example: you work a white collar job in say, a law firm. During a renovation of the office, you get relocated to a small room with inadequate ventilation for an extended period. You are cooped up in there on a daily basis for a few weeks with a seemingly low risk person who, unbeknownst to you, volunteers at a homeless shelter a few times a week. Welcome to the high risk club.

The work environment put you at risk due to your co-worker’s activities, lack of airflow and close proximity. That low risk office environment ceased being one due to factors that usually would have never been combined. But there you have it. You, a low risk person, has been elevated into a high risk one through no actions, fault or intent of your own. And working for a law firm you had a great health plan to boot.

The best defense is to get tested regularly even if you think you are not in a high risk group. Even a trip to the hospital is no guarantee as the PDF below indicates.

Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 (PDF)
posted by lampshade at 10:10 PM on January 7 [2 favorites]

Associated: apopo.org. From their website: "Our trained HeroRATs can quickly and accurately sniff out TB in human sputum samples. In Tanzania, APOPO offers second-line screening by our rats to our partner hospitals, which has increased new case detection rates by over 40 percent. Our rats can evaluate 40 sputum samples in just seven minutes, equal to what a skilled lab technician will do in a full day's work."

It's an awesome agency (and some of their rats are trained mine-sniffers, too) doing amazing work with almost nothing.
posted by ElaineMc at 12:03 AM on January 8 [2 favorites]

Tuberculosis is incurable, weak or no unions, rapacious bankers and businessmen. beginning of the 20th century or the 21rst? Any bets on how many years until the next world war?

Fuck it. I'm bringing back spats.
posted by atrazine at 12:11 AM on January 8 [1 favorite]

Cute? Check.

Able to detect deadly communicable pathogens? Check.

I think I just found my new best friend.
posted by PROD_TPSL at 1:02 AM on January 8

Nature: Totally drug-resistant TB hits India
posted by the man of twists and turns at 2:11 PM on January 13