New, killer TB crossing borders

2006-09-07 23:00

Johannesburg - A killer strain of extremely drug-resistant tuberculosis has been found in at least 28 hospitals across South Africa and almost certainly has spilled across borders, a specialist said on Thursday.

The virtually untreatable super bug could jeopardise efforts to deal with the Aids pandemic, said experts.

And, the doctor who discovered the new strain in KwaZulu-Natal noted it was so virulent that patients died even before doctors received the results of their tests.

Experts note that TB diagnostics haven't changed in 100 years and TB medication in 50 years.

They blame the fact that it's largely a disease of the poor - often spread by overcrowding when an infected person sneezes or coughs and the airborne bacteria infect someone else.

Last year, the Global Alliance for TB Drug Development, a non-profit organisation, began tests on a new treatment that would halve the time of treatment to two or three months.

Nine million new cases a year

This lowers the risks of developing resistant strains and expanding the number of patients receiving treatment.

At present, about nine million new active cases of TB develop each year and about two million people die.

About 200 million more people will fall ill with TB by 2020 and 35 million will die, according to the alliance's projections.

In South Africa, no one knows how many people are infected with the particularly virulent strain announced last week, Professor Willem Sturm told the conference.

This highlighted the dilemma facing already overburdened health workers.

Victims in South Africa were "all over the place...

"You can almost be sure there will be infection in Mozambique and even farther (abroad) because people travel, and quite some distance," said Sturm.

Killed 52 of 53 patients

The two-day meeting included experts from the United States Centres for Disease Control and Prevention and from 14 southern and central African nations.

The new extremely drug-resistant TB strain was discovered by rural doctor Tony Moll in eastern KwaZulu-Natal province, where it killed 52 of 53 HIV-positive patients within 16 days during a study carried out from January 2005 to March 2006.

Sturm, a microbiologist at KwaZulu-Natal University's Nelson Mandela School of Medicine, said he had gathered reports from hospitals around the country this past week.

They showed at least 28 hospitals had at least one patient with the new strain, but indicated others could be dying from it without ever being tested.

Patients died suddenly

The super bug is particularly dangerous for countries with high HIV rates that fuel a TB epidemic which, in turn, endangers uninfected people.

Moll became suspicious that he had a super bug on his hands when patients responded well to antiretroviral treatment, then suddenly died.

"What's the point in investing hugely in ARV programs if patients die a few weeks later from extreme drug-resistant tuberculosis?" said Dr. Paul Nunn, head of the United Nations World Health Organisation's TB resistance programme, on the sidelines of the conference.

The South African government estimates more than 5.5 million of the country's 44 million people are HIV-positive - second only to India - and more than 900 people die each day.

Must complete treatment

At any given time, about 330 000 South Africans have TB and 6 000 have a multiple drug-resistant variant. Half the population is believed to have latent TB.

Drug-resistance grows when people do not complete a gruelling six-month regimen of medication that cures the disease. <0p>That's difficult in a country where most people are poor and where taking the medication on an empty stomach makes one ill.

It also is difficult when one might have to walk half a day to the nearest health centre, which might be out of medication, and where there is high illiteracy.

Multiple drug-resistant TB does not respond to a "first line" of drugs that in South Africa cost about R400 to cure a patient, compared to R24 000 to cure multiple drug-resistant TB.

Extremely drug-resistant strains do not respond to a "second line" of drugs.

The health department said this week it was exploring the feasibility of importing two even-more-expensive drugs that might help.

- AP