XDR TB: Extreme Drug Resistant TB

The adjective extreme has been extremely overused
in recent years.  For example, I recently saw a sign in a gas
station that advertised an Extreme Meal Deal: a hot dog, chips, and
soda for $2.49.  

But href="http://www.iol.co.za/index.php?set_id=14&click_id=125&art_id=vn20060910094616232C393327">Extreme
Drug Resistant tuberculosis is no hyperbole:

Dr Tony Moll of the Church of Scotland hospital at
Tugela Ferry was the first to alert the world to the emerging human
tragedy when it was found that HIV positive people who had appeared
initially to "do well" on antiretroviral treatment, were dying of a
virulent form of TB - and "frighteningly fast".

"We have seen HIV move in and create havoc in our community. We tremble
in our boots at XDR TB," Moll said.

"Worldwide there are 347 cases of XDR TB, we picked up 53 cases in our
small hospital alone, 51 percent had no prior TB, 28 percent had prior
treatment, 14 percent were newly infected with drug resistant strains.
We have lost two health care workers to XDR TB," he said.

"52 of the 53 died within 16 days of sputum collection, many died
before sputum results came out. We have two to five new patients with
XDR TB each month."

The href="http://www.who.int/mediacentre/news/notes/2006/np23/en/index.html"
rel="tag">World Health Organization is getting
concerned about this:

5 SEPTEMBER 2006 | GENEVA -- The World Health
Organization (WHO) has expressed concern over the emergence of virulent
drug-resistant strains of tuberculosis (TB) and is calling for measures
to be strengthened and implemented to prevent the global spread of the
deadly TB strains. This follows research showing the extent of XDR-TB,
a newly identified TB threat which leaves patients (including many
people living with HIV) virtually untreatable using currently available
anti-TB drugs...

...MDR-TB (Multidrug Resistant TB) describes strains of tuberculosis
that are resistant to at least the two main first-line TB drugs -
isoniazid and rifampicin. XDR-TB, or Extensive Drug Resistant TB (also
referred to as Extreme Drug Resistance) is MDR-TB that is also
resistant to three or more of the six classes of second-line drugs.

The description of XDR-TB was first used earlier in 2006, following a
joint survey by WHO and the US Centers for Disease Control and
Prevention (CDC).

Resistance to anti-TB drugs in populations is a phenomenon that occurs
primarily due to poorly managed TB care. Problems include incorrect
drug prescribing practices by providers, poor quality drugs or erratic
supply of drugs, and also patient non-adherence...

Tara has more on the subject href="http://scienceblogs.com/aetiology/2006/09/new_tb_strain.php">here.
 Revere points out that href="http://scienceblogs.com/effectmeasure/2006/09/the_sad_decline_of_cdc.php">CDC
funding for tuberculosis has been cut by 16%.
 Things like this make me wonder about our national security

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I suspect we already have these strains here in my place, too, Joseph. Not much on the HIV-TB angle, but more on a solo infection with the XDR strains. Those in the pharma industry should spruce up their R&D to keep up with the dizzying pace of drug-resistant mutation going on with the TB bacilli. They should come up with a new anti-TB arsenal, pronto!