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Sat, Jan. 18

Recent XDR-TB case worries group
Proper treatment key to stopping drug-resistant TB, Public Health director says

KINGMAN - The necessity for taking medications prescribed to treat tuberculosis can't be over-emphasized in the wake of the trans-Atlantic health scare created by traveler Andrew Speaker, who visited several countries while infected with extensively drug-resistant TB.

RESULTS, a nonprofit grassroots advocacy organization committed to creating the political will to end hunger and the worst aspects of poverty, is the latest group to raise concerns about XDR TB. It calls the Speaker case "only a symptom of a much greater problem" in a news release.

"While attention focuses on who may have been placed at risk of infection in this much publicized case, bigger questions remain to be answered: Why has XDR-TB emerged in the first place?" the release states.

"What impact is it having on efforts to reverse the AIDS pandemic? What steps must be taken to keep XDR-TB from spiraling out of control and becoming a major health catastrophe?"

Information on the Centers for Disease Control Web site states regular and XDR-TB are spread in the same manner. A person with the infection in his or her lungs coughs, sneezes, speaks or sings in proximity to someone else. The germs can float about for several hours before being inhaled by a healthy individual and starting a new cycle of infection.

Isoniazid and rifampin, the two best front-line drugs for treating regular TB, have little effect on XDR-TB. It also is resistant to second-line medications in the fluoroquinolones family and at least one of three injectable drugs (i.e. amikacin, kanamycin, capreomycin).

"XDR-TB is the result of inappropriate treatment," said Christy Bronston, director of nursing for the Mohave County Department of Public Health. "That may be due to the medication being stopped voluntarily by the patient or not having access to the right medications.

"When you have large numbers of bacteria they are effectively treated with a 4-drug regimen. When all four are not taken the bacteria become resistant to those medications taken, so it's important to take all medications prescribed by a physician."

Mohave County annually has both suspected and confirmed cases of tuberculosis. The health department works with TB patients and monitors intake of medications to prevent regular TB from turning into XDR-TB, Bronston said.

TB or not TB

General symptoms of TB include weakness, nausea, weight loss, fever and night sweats. Once TB gets into the lungs, additional symptoms are coughing, chest pain and coughing up blood.

If TB bacteria are found in a victim's phlegm, the TB diagnosis can be made within 48 hours, the CDC Web site states. However, that finding will not distinguish between regular TB and XDR-TB.

To determine drug susceptibility, the bacteria must be grown and testing in a laboratory. A final TB diagnosis and one for XDR-TB may take 6-16 weeks.

XDR-TB reported in 37 countries

The RESULTS news release states that since the CDC first classified XDR-TB in March 2005, the World Health Organization has registered cases in 37 countries, including the United States, Canada and Mexico.

"Using the best available data, WHO estimates there were 27,000 cases of XDR-TB worldwide in 2005 and 16,000 deaths," the release states. "All but a few developing countries - where tuberculosis is most common - have little or no capacity to test for it."

People with compromised immune systems, especially those with HIV/AIDS, are the most susceptible to TB.

XDR-TB has the potential to become a real problem and serious health concern in America, Bronston said.

Battling the extensively drug-resistant form will be expensive.

Strategy to fight disease needed

An Associated Press story Thursday out of London states more than 130,000 lives could be saved if a worldwide two-year strategy is implemented to fight XDR-TB.

XDR-TB presently is a health problem in Asia, Africa and Eastern Europe.

WHO estimates that $2.15 billion is needed in the next two years to help poor countries tackle issues that include disease surveillance, diagnosis and treatment, the AP story states. So far, WHO has about $640 million.

Treating regular TB costs as little as $16 for six months per patient. However, the cost may run up to $15,000 to treat one case of XDR-TB over several years and without guarantee of a cure, the story stated.

"We can try to control the damage that we see today from drug-resistant TB," said Dr. Eric Goemaere, head of Medecins Sans Frontieres in South Africa. "But we are only seeing the tip of the iceberg."

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