[End of Days] "White Plague" lurks among rich and poor

percicles · Mar 19, 2012

This is the second article I've read in the last five days talking about drug resistant viruses and bacteria. Super MRSA, TB, Gonorrhea.....

Do I order a plastic bubble now?

Drug-resistant "white plague" lurks among rich and poor

LONDON (Reuters)- On New Year's Eve 2004, after months of losing weight and suffering fevers, night sweats and shortness of breath, student Anna Watterson was taken into hospital coughing up blood.

It was strange to be diagnosed with tuberculosis (TB)- an ancient disease associated with poverty - especially since Watterson was a well-off trainee lawyer living in the affluent British capital of London. Yet it was also a relief, she says, finally to know what had been making her ill for so long.

But when Watterson's infection refused to yield to the three-pronged antibiotic attack doctors prescribed to fight it, her relief turned to dread.

After six weeks of taking pills that had no effect, Watterson was told she had multi-drug resistant TB, or MDR-TB, and faced months in an isolation ward on a regimen of injected drugs that left her nauseous, bruised and unable to go out in the sun.

"My friends were really shocked," Watterson said. "Most of them had only heard of TB from reading Victorian novels."

Tuberculosis is often seen in the wealthy West as a disease of bygone eras - evoking impoverished 18th or 19th century women and children dying slowly of a disease then commonly known as "consumption" or the "white plague".
But rapidly rising rates of drug-resistant TB in some of the wealthiest cities in the world, as well as across Africa and Asia, are again making history.

London has been dubbed the "tuberculosis capital of Europe", and a startling recent study documenting new cases of so-called "totally drug resistant" TB in India suggests the modern-day tale of this disease could get a lot worse.

"We can't afford this genie to get out of the bag. Because once it has, I don't know how we'll control TB," said Ruth McNerney, an expert on tuberculosis at the London School of Hygiene and Tropical Medicine.

INTERNATIONAL ALARM

TB is a bacterial infection that destroys patients' lung tissue, making them cough and sneeze, and spread germs through the air. Anyone with active TB can easily infect another 10 to 15 people a year.

In 2010, 8.8 million people had TB, and the Geneva-based World Health Organization (WHO) has predicted that more than 2 million people will contract multi-drug resistant TB by 2015. The worldwide TB death rate currently runs at between two and three people a minute.

Little surprise, then, that the apparently totally untreatable cases in India have raised international alarm.

The WHO has convened a special meeting on Wednesday to discuss whether the emergence of TB strains that seem to be resistant to all known medicines merits a new class definition of "totally drug-resistant TB", or TDR-TB.

If so, it would add a new level to an evolution over the years from normal TB, which is curable with six months of antibiotic treatment, to the emergence of MDR-TB, then extensively drug-resistant TB (XDR-TB).

What's so frustrating about that progression, says Lucica Ditiu of the WHO's Stop TB Partnership, is that all drug-resistant TB "is a totally man-made disease".

Like other bacteria, the TB bug Mycobacterium tuberculosis can evolve to fight its way past antibiotic medicines. The more treatment courses patients are given and fail to complete, the stronger and more widespread the resistance becomes.

"The doctors, the healthcare workers, the nurses, entire healthcare systems have produced MDR-TB. It's not a bug that has come from nature. It's not a spontaneous mutation. It came about because patients were treated badly -- either with poor quality drugs, or not enough drugs, or with insufficient observation so the patient didn't finish the treatment course," said Ditiu.

Ditiu is somewhat reassured that the WHO is meeting to look at recent extreme cases of drug-resistance, which will at least throw a spotlight on this often-forgotten disease. But she says while definitions are central to international guidelines and treatment protocols, they make little difference to sick people.

"What is much more important is the drama and tragedy of the human beings. Whether it's MDR, XDR or TDR TB, it doesn't make much difference to the patients. A lot of them will face a very, very unfortunate fate."

WHEN THE DRUGS DON'T WORK

The situation in India is a case in point.

Dr Zarir Udwadia, a tuberculosis specialist at the Hinduja National Hospital in Mumbai, published a paper in the Clinical Infectious Diseases journal late last year documenting four cases of TDR-TB. He told Reuters he has now identified 12 cases for which he has all but run out of treatment options. Three are already dead.

He has tested one powerful anti-TB drug after another on samples cultured from these patients - including first-line treatments like isoniazid, rifampicin and streptomycin, and a range of second line drugs like moxifloxacin, kanamycin and ethionamide. Each medicine failed.

"If you add it all up, they were resistant to 12 drugs in total," he said.
Like others, Udwadia blames poor medical practice.

Non-prescription and over-the-counter antibiotic use is rife in India and it may be no coincidence that the country now has one of the highest burdens on MDR-TB in the world, with more than 100,000 cases.

Udwadia's team conducted a recent study in Mumbai, home to more than 12 million people often living in harsh and overcrowded conditions, and found in one district only five out of 106 doctors in the unregulated private sector could give a correct prescription for a hypothetical patient with MDR-TB.

Most of the prescriptions were "inappropriate" and would only have made the patient worse - driving the conversion of MDR tuberculosis to XDR and then to TDR tuberculosis.

The Mumbai findings show that totally drug-resistant TB "was an accident waiting to happen," Udwadia said.

"To get to this stage, you have to have amplified resistance over years, with loads of misuse of (antibiotic) drugs. And no other country throws around second-line drugs as freely as India has been doing."

SPREAD

That might suggest countries that use antibiotics more prudently should be less vulnerable. Experts are not convinced, and history suggests otherwise.
One of the biggest difficulties in tackling TB is the ease and speed with which it spreads. When patients cough, sneeze or spit, they propel thousands of germ-carrying droplets into the air around them. With people travelling the world in confined spaces, a disease like TB can easily hitch a ride.

A good example is extensively drug resistant TB, which first hit world headlines during an outbreak in South Africa in 2006. Barely four years later in 2010, the WHO said drug-resistant tuberculosis was at "record levels" worldwide and a total of 58 countries had reported at least one case of XDR-TB.

Ditiu fears a similar pattern could emerge with TDR-TB.
"It is spreading, it's spreading as we speak right now," she said. "The situation is extremely worrying."

Anna Watterson, who took 19 months "out of normal life" for her MDR-TB to be successfully treated but still qualified as a barrister and now works in London's law courts, can't be sure where she picked up her infection.
At the time she was living in the northwest borough of Brent, an area of London with a large immigrant community and pockets of poverty. Like millions of others in the British capital, she commuted on the Tube underground train system most days.

Watterson had also travelled to India a couple of years earlier, and since TB can lie dormant for long periods, it's also possible she may have contracted it there.

"You can't be isolated from the rest of the world," she said. "We've become too complacent about TB, thinking that it's gone away. But the reality is that until it goes away in the developing world, it's not going away anywhere."

http://news.yahoo.com/drug-resistant-white-plague-lurks-among-rich-poor-113851688.html
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justtxyank · Mar 19, 2012

It has begun...

RunninRaven · Mar 19, 2012

I just watched that movie Contagion last week for the first time and reading articles like this has me pretty well terrified now. Plastic bubble, indeed.

Blurr#7 · Mar 19, 2012

justtxyank said: ↑

It has begun...

Click to expand...

Yup! Just do everything opposite of what they're doing on "The walking dead" and you'll survive.

RocketFire · Mar 19, 2012

Agree 100% with the article. We need to become more aware of TB and follow through complete treatment of TB infection and since this is very difficult to do in third world countries, we are just at the mercy of the disease.

percicles · Mar 19, 2012

RocketFire said: ↑

Agree 100% with the article. We need to become more aware of TB and follow through complete treatment of TB infection and since this is very difficult to do in third world countries, we are just at the mercy of the disease.
Click to expand...

The article states that London is European ground zero for this new strain of TB. London is hosting the Summer Olympics in less than five months.

Xerobull · Mar 19, 2012

The White Plague has been around since 1492.

Yonkers · Mar 19, 2012

I'm middle class so I'm safe.

JayZ750 · Mar 19, 2012

Totally drug resistant?? Please. They just need to come up with new drugs!

MoonDogg · Mar 19, 2012

JayZ750 said: ↑

Totally drug resistant?? Please. They just need to come up with new drugs!
Click to expand...

tmoney1101 · Mar 19, 2012

ROXRAN · Mar 19, 2012

Stock up NOW on .223 and 9mm, and some 12 gauge. serious. Ammo only goes up in value and lasts 30, 40 years as long as it's dry. DO IT!!!!

FFz · Mar 19, 2012

Or stock up now on isoniazid rifampin pyrazinamide and ethambutol

faraza84 · Mar 19, 2012

thats crazy, one of my cousins in England was diagnosed with TB just recently. Yea hes on a long term regiment but its gotta be tough to take all those meds for soo many months. People here have a hard time taking a few pills for a week so i hope the government does something to monitor dosing.

Precision340 · Mar 21, 2012

damn you, scumbag evolution!!!

emjohn · Mar 21, 2012

Sorry, India.

JeeberD · Mar 22, 2012

Oh *****...

"Students at Texas college exposed to tuberculosis"

http://www.foxnews.com/health/2012/03/22/college-students-in-texas-exposed-to-tuberculosis/

chestr · Mar 22, 2012

JayZ750 said: ↑

Totally drug resistant?? Please. They just need to come up with new drugs!
Click to expand...

Easier said than done when funding for research continues to be cut and pharmacy companies don't see enough profit in new antibiotics to deem it worthy of their time. Not to mention many doctors prescribe drugs unnecessarily to appease their patients' demands.

Here's an a pretty good article from the Economist last year about superbugs: http://www.economist.com/node/18483671

percicles · May 17, 2012

This is the second case.

New mom in South Carolina fighting flesh-eating bacteria

A new mom in South Carolina is the second person in recent weeks to contract a rare disease known as flesh-eating bacteria.

Lana Kuykendall, 36, from Piedmont had just returned home after giving birth to twins when she felt severe pain in her leg, reports WYFF-TV. Her husband, Darren, rushed her to the hospital when they noticed that an unusual spot on the back of her leg was spreading.

Lana Kuykendall has undergone four surgeries to prevent the bacteria—from a syndrome known as necrotizing fasciitis—from getting worse. The bacteria comes from a type of streptococcus, which also causes strep throat. In the infrequent cases when the bacteria makes its way to the blood, muscle, or lungs, it can be life-threatening, according to the Centers for Disease Control and Prevention.

Lana Kuykendall is in critical but stable condition. It is unclear how she contracted the bacteria.

"The sad part about it is that she hasn't gotten to see the babies for the first week of their lives," says Darren Kuykendall. "I talk to her every day. I tell her how good she's doing, and how strong she is, and that she's a fighter. She can make it." Friends and family are watching over the healthy twins.

Georgia graduate student Aimee Copeland, 24, grabbed national headlines after she contracted the infection from a zip-lining accident on May 1. She fell near the Little Tallapoosa River and the bacteria entered her body through a gash in her leg. Most of her left leg has been amputated, and she will also lose her fingers, according to a report in the Associated Press. Doctors are using a process that accelerates healing to save her palms.

Sean Helgesen says he got lucky in his battle four years ago with the bacteria in a Daily Beast article. A pulled muscle during a workout quickly escalated into excruciating pain, flu-like symptoms, and immobility in his arm. He was rushed into surgery and flesh from his armpit to his hip was removed. The procedure saved his life, and underlines the necessity for rapid, aggressive surgery after diagnosis. Drugs are also used to treat the infection, but don't always work. Helgesen did not have any external cuts or scrapes, and doctors concluded that the strep bacteria was present in his system when he pulled the muscle.

http://news.yahoo.com/blogs/lookout/mom-south-carolina-fighting-flesh-eating-bacteria-172817677.html
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weslinder · May 17, 2012

I live in Katy. Should I evacuate?

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[End of Days] "White Plague" lurks among rich and poor

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