Meet the first patient cured of XDR-TB

2012-05-12 16:42

It took a local doctor more than fours years to rid an angry and

scared woman of this potentially deadly disease.

Four years ago, police officers literally dragged Dimakatso Montshiwagae from her home and forced her to return to a local hospital to continue treatment for extensively drug-resistant tuberculosis (XDR-TB).

It was the second time she had fled Tshepong Hospital in Jouberton, North West.

Montshiwagae was frustrated, angry and scared. Treatment for the potentially deadly disease takes time and, ideally, patients must be hospitalised and in effect quarantined for up to two years, or even longer.

But one dedicated doctor and a change of attitude from her young patient have made all the difference. Today, she is completely cured.

In fact, she is the first person in South Africa to have been cured of XDR-TB – no mean feat in one of the world’s TB hot spots.

The 22-year-old from Christiana in North West belongs to a small and lucky group. And thanks to her doctor, Marisa van Rensburg, the group can look forward to a new lease on life. The medication used to cure her
is now part of the treatment regimen for XDR-TB patients across South Africa.

The first case of XDR-TB was recorded in KwaZulu-Natal five years ago. In 2010, there were 741 recorded cases of the disease in South Africa, with a 40% annual fatality rate.

It took doctors more than fours years to completely cure Montshiwagae.

During that period, doctors tried almost all the available and highly recommended anti-TB drugs and antibiotics on the market.

Then Van Rensburg attended a TB conference, where a colleague told her about an antibiotic called moxifloxacin. At the time, moxifloxacin was not available in the public healthcare sector.

The North West province’s TB control manager applied to the national health department to obtain the drug for “compassionate use”.

Said Van Rensburg: “Moxifloxacin was a blessing for Montshiwagae. Two months after taking it together with other anti-TB drugs that she had been taking for 14 months – including pyrazinamide, terizidone and capreomycin – she converted to a negative.”

This meant that her sputum no longer tested positive for XDR-TB. She was cured.

As part of the treatment regimen though, she had to carry on taking the drug for another year and had to undergo regular tests for two years.

“If only we had known about the effect of this antibiotic earlier, she probably would have recovered much quicker,” said Van Rensburg.

Montshiwagae was first diagnosed with ordinary TB in 2005. She defaulted on treatment and developed multidrug-resistant tuberculosis (MDR-TB).

In October 2006, she was admitted to Tshepong Hospital to be treated for MDR-TB. After six months, she had not responded to treatment. Then tests revealed that she had developed XDR-TB. She started treatment for this in April 2007.

Staring down an even longer treatment period than she had expected, Montshiwagae rebelled. In December 2007, she fled the hospital. Her doctors begged her to return, explaining that she was endangering people around her. The police were called in to intervene.

Montshiwagae this week described how officers dragged her out of her home.

She said: “I didn’t care what my doctor was saying about me being infectious. All I wanted was to have my freedom and my life back.”

She returned to hospital, but the following month she escaped again. This time, she said, she was driven by the fear of death.

“I had heard about how people with XDR are kept in this hospital until they die and I was scared that the same would happen to me.”

She again returned to the hospital and this time, she stuck to her treatment.

Montshiwagae advised other patients with TB to stay in hospital and finish their treatment, no matter how tough it gets.

“Escaping will not help you, but will put your family and friends in danger of being infected as well.”

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