Poor treatment, XDR TB linked
2008-08-25 14:25
Washington - Poor treatment may be
fuelling the rise of an especially hard to treat form of
tuberculosis called extensively drug resistant or XDR TB,
doctors reported on Sunday.
But they said their project, based at a remote Siberian
prison, showed they could successfully treat nearly half the
patients with XDR TB.
It also suggested that better treatment
of patients with other forms of multiple-drug-resistant TB
would help prevent the infection from worsening into the XDR
form.
"While early studies suggested that XDR TB is untreatable,
our report indicates that while it may be difficult, it is
possible to treat these patients through the use of aggressive
regimens," Dr Salmaan Keshavjee of Brigham and Women's
Hospital and Harvard Medical School said in a statement.
"A cure rate of 48.3% is promising in a disease that
has been touted as untreatable."
Keshavjee is part of the Partners in Health programme that
has been treating prisoners and civilians in Tomsk, Siberia,
who are infected with tuberculosis.
They reported on 608 patients with multi-drug resistant
tuberculosis who were treated between September 2000 and
November 2004.
Four percent or 29 of patients were diagnosed
with XDR TB.
They said 48.3% of patients with XDR TB and 66.7% of the other patients were cured.
Earlier this month
another team reported similar results in patients with MDR and
XDR TB in Peru.
Third of world's population infected
Most of the patients with XDR TB had been treated,
incompletely, for MDR TB, the doctors found.
Nearly a third of the world's population is infected with
the bacterium that causes tuberculosis, although active TB only
develops in a fraction of those cases.
MDR TB can resist treatment with the antibiotics normally
used to treat TB.
The World Health Organisation estimates
490 000 new cases of MDR TB arise worldwide every year.
XDR TB resists the second-line drugs and must be treated
for many months or even years with a cocktail of antibiotics
and, often, surgery to remove the most badly infected lung
tissue.
The WHO identified XDR TB as a global threat in 2006 and it
has so far been confirmed in more than 45 countries.
In Africa
it is often fuelled by the Aids virus but the researchers said
few of the Russian patients were infected with HIV.
"Through aggressive management of XDR TB cases, including
by ensuring that patients are correctly diagnosed as early as
possible and put on appropriate treatment for the correct
length of time, it may be possible to slow the rise of XDR TB
deaths around the world and reduce further transmission of the
most drug-resistant strains of TB," said Keshavjee.