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Tuberculosis May Become A Global Threat Again
Iphtashu Fitz writes "The journal Nature Medicine is due to release a report today on how highly drug-resistant strains of tuberculosis are on the verge of becoming a global epidimic. Strains of TB that are highly resistant to antibiotics are becoming increasingly prevalent in places like Russia, eastern Europe, and China, and only small changes are required to make these strains start spreading quickly. Treatment for multiple-drug-resistant strains of TB requires a carefully monitored cocktail of drugs taken for months on end, a regimin that many, especially in poorer countries are unlikely to follow to completion. The strategy used by the World Health Organization to combat TB, the "directly observed treatment, short course" or DOTS, involves using trained health workers to watch patients take their long courses of drugs, since even a little carelessness could result in TB mutating into a more drug resistant form within the patient." Oh, Alexander Fleming ? where art thou now?
Oh, Alexander Fleming? where art thou now?
He's right here, silly.
Trolling is a art,
America has the lowest rate of TB infection because we manage the disease differently than the rest of the world.
The rest of the world gives the ineffective TB vaccine, while the US doesn't. The TB vaccine is known not to work, and it ruins the best test we have to screen for infection - the ppd (TB skin test).
In America, we treat everyone that converts their skin test and we don't administer the TB vaccine. Our public health officials deserve a big pat on the back for this decision.
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Not sarcastic at all - The Gates Foundation is one of the major forces fighting TB today.
How long has it been, at least 400-600 years since a nice big population dwindling event has occurred...
The 1918 Flu Pandemic probably killed more people worldwide than The Black Death. The Black Death killed a larger percentage, though.
TB has never been and never will be resistant to Penicillin. Your grasp of antibiotics is slightly less than your grasp of spelling.
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Antibiotic resistance was noted in hospitals in the 50's and 60's, spurring the few physicians who observed it to advise restrictions on antibiotic prescriptions. Few, however, heeded this advice and decades later, antibiotics are still prescribed readily throughout the world -- even without a doctor's prescription or supervision in a number of countries. Of course there is significant noise now about the continued development of resistant bacteria, but it still has little effect in places where such drugs are easy to come by and cheap.
As an interesting aside, bacteria aren't the only pathogens that can develop resistance to devices we use to kill them. Early protease inhibitor use in AIDS patients resulted in strains of AIDS that were resistant to that treatment.
In China, where big pharm isn't in control (remember, this is the land of the bear gall bladder as medicine guys) today's news is reporting that over half urban dwellers are sick ! And that the hardest hit there are middle managers, whose life expectancy is down to 58 years old for well below the national average of 72. Yet the article's stll defending "traditional chinese medicine". Bears of the world, watch out!
You only use 2% of your DNA
Well, over a period of centuries (6th, 14th, and 17th), The Black Death killed about 137 million people... The 1918 flu did kill about 25 million in one year, which is pretty significant.
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No, this is what happens when people get viral infections and demand antibiotics from their doctors, which are 100% useless against viruses. Those carrying TB and overdoing antibiotics can give the virus an opportunity to evolve defenses against penicillin.
Tip to help the world avoid this: Ask your doctor what his professional opinion is about the source of your illness. If he/she believes that it's viral, ask what kind of OTC medications (NyQuil, Benadryl, whatever) will work best to deal with the symptoms. It may not slow things much, but at least you'll know that you weren't the cause for the strain that kills us all.
You can never go home again... but I guess you can shop there.
Tuberculosis is caused by mycobacterium tuberculosis, and like its name, it is indeed a bacteria. However, we have not found any antibiotics succesfully in treating or killing completely the mtb. Infections of tb lie latent forever within your body. As per regard to perscribing antibiotics to viral infections (like the cold), they are nothing more than a placebo. Secondary symptoms can be placed under control by medicines (cold medicine, aspirin) that suppress immune responses, something that antibiotics do not perform. This is really a case of people thinking they know more than they do coupled with a severe confusion with reality.
Hmm. There is a way to kill (or otherwise slow down) viral threats: Interferon.
The protein interferon, produced by animal cells when they are invaded by viruses, is released into the bloodstream or intercellular fluid to induce healthy cells to manufacture an enzyme that counters the infection. Interferon is therefore considered a potential medical resource as a BIOPHARMACEUTICAL.
For many years the supply of human interferon for research was limited by costly extraction techniques. In 1980, however, the protein became available in greater quantities through GENETIC ENGINEERING.
Scientists also determined that the body makes three distinct types of interferon, each perhaps with several members. These classes were first called leukocyte, fibroplast, and immune interferon after their supposed production sites, but it is now known that each particular class is not, after all, made by a single cell type.
The classes are therefore now called, respectively, alpha, beta, and gamma interferon. Interferons were also first thought to be extremely species-specific, but it is now known that individual interferons may have different ranges of activity in other species.Alpha interferon has been approved for therapeutic use against hairy-cell LEUKEMIA and Hepatitis C. It has also been found effective against chronic hepatitis B, a major cause of liver cancer and cirrhosis, as well as for treatment of genital warts and some rarer cancers of blood and bone marrow. Nasal sprays containing alpha interferon provide some protection against colds caused by rhinoviruses.
(http://hepatitis-c.de/whatinf.htm)
Antibiotics do jack against viral threats. They are designed (for the most part) to disrupt the bacteria's cell walls (bleed them to death). Since human cells (animal type) do not have cell walls, your body is fine. Viruses do not have cell walls, hence they are ineffective.
I am John Hurt.
But natural antibiotics just can't be patented (think of it as the OSS medicine), and companies don't give a sh*t about them.
What utter bollocks. Aspirin (acetylsalicylic acid) was derived from a compound present in the bark of the willow tree (Salyx). It was patented on March 6, 1889.
Tubal-Cain smokes the white owl.
When I moved here from the UK, where everybody gets vaccinated against TB, I had to have a chest x-ray done to prove i didn't have TB because immunity from vaccination gives the same result on the skin test.
Alright, I'm a practicing lung doctor so I've got to say a little bit.
:)
Change in the skin TB status (or PPD) suggests a recent infection with TB. Placing someone of INH for 6 to 9 months greatly decreases the risk of someone developing active TB in the future.
The amount of exposure and the potential risks for reactivation of the TB are all evaluated before INH is prescribed.
INH can cause liver problems... and avoiding alcohol is a must.
To answer the parent's other question--
Using INH for a long enough duration will not cause resistence. Dead bugs can't develop resistence.
Yes, it can survive forever.
We see people that were exposed 20-30 years ago and have reactivation when placed on steroids or chemotherapy.
In the grand scheme of things, TB may be getting worse worldwide, but here in the states it seems well controlled. We have a huge immigrant population, and I have seen on a couple cases of active TB over the last 5 years.
I come to read slashdot in between patients to get away from medicine... please quit running these medical stories. They remind me that I'm not a real geek.
AC
Just a little background info, blatantly ripped off of this website: http://encyclopedia.thefreedictionary.com/mycobact erium
Sorry for the crappy formatting.
Mycobacterium is the only genus in the family Mycobacteriaceae of bacteria. This genus includes many pathogens known to cause serious diseases in mammals, including tuberculosis
Tuberculosis, also called TB, phthisis, consumption, and nicknamed the white plague, is the most common infectious disease in the world today. It is caused by a bacterium, usually the Mycobacterium tuberculosis but any member of the so called Tuberculosis complex will do. If left untreated, more than 50% will die in a few years time. It causes about 2-3 million deaths per year out of 9-10 million cases and is especially prevalent in undeveloped, tropical countries.
and leprosy
Hansen's disease, also known as leprosy, is an infectious disease caused by infection by Mycobacterium leprae. The modern name of the disease comes from the discoverer of Mycobacterium leprae, G. A. Hansen. Sufferers from Hansen's disease have generally been called lepers, although this term is falling into disuse both from the diminishing number of leprosy patients and from pressure to avoid the demeaning connotations of the term.
Most mycobacteria are classified into two categories, the fast-growing kind and the slow-growing kind, and most mycobacteria share some common characteristics:
* They are widespread organisms, typically living in water (including tap water treated with chlorine) and food sources.
* They can colonize their hosts without the hosts showing any adverse signs. For example, millions of people around the world are infected with M. tuberculosis
Mycobacterium tuberculosis is the bacteria that causes most cases of tuberculosis. Its genome has been sequenced.
It is a Gram-positive aerobic mycobacterium that divides every 16-20 hours. This is extremely slow compared to other bacteria which tend to have division times measured in minutes (for example, E. coli can divide roughly every 20 minutes). It is a small rod-like bacillus which can withstand weak disinfectants and can survive in a dry state for weeks but can only grow within a host organism.
but will never know it because they will not develop symptoms.
* Mycobacterial infections are notoriously difficult to treat. The organisms are hardy and can survive long exposure to antibiotics, which naturally leads to antibiotic resistance Antibiotic resistance is the ability of a microorganism to withstand the effects of an antibiotic. Antibiotic resistance develops through mutation or plasmid exchange between bacteria of the same species. If a bacterium carries several resistance genes, it is called multiresistant or, informally, a superbug.
Most mycobacteria are susceptible to the antibiotics clarithromycin and rifamycin, but antibiotic-resistant strains are known to exist.
* Mycobacteria tend to be fastidious (difficult to culture), sometimes taking over two years to develop in culture.
Species * M. tuberculosis, which causes tuberculosis Tuberculosis, also called TB, phthisis, consumption, and nicknamed the white plague, is the most common infectious disease in the world today. It is caused by a bacterium, usually the Mycobacterium tuberculosis but any member of the so called Tuberculosis complex will do. If left untreated, more than 50% will die in a few years time. It causes about 2-3 million deaths per year out of 9-10 million cases and is especially prevalent in undeveloped, tropical countries.
* M. leprae
Mycobacterium leprae, also known as Hansen's bacillus, is the bacterium that causes leprosy (now called Hansen's disease). It is an intracellular, pleomorphic, but usually rod shaped, acid fast, gram positive, aerobic only remotel
Si la vida me da palo, yo la voy a soportar Si la vida me da palo, yo la voy a espabilar
Mostly false...
Prisions are a huge breeding ground for TB. One of my partners just saw somebody that had baseball-sized masses growing from several sites on his body. He wasn't referred to a doctor for several months. Biopsy of these lesions showed tons of TB.
Medical care in the prisions is very sub-standard.
It is true that if you do not take your TB drugs as prescribed, you will be put into prision. Yes, America will force you to take your TB drugs... to keep you from infecting others.
However, most prisioners are in and out of jail too often to really get adequate screening for infectious diseases.
AC
Why only replace market forces, that seems to be only half the problem? Why not work on replacing the institution of pharmaceutical companies (which are driven by profits) with other kinds of institutions, which might be driven by different goals?
I also think that the greater the risk, the greater the reward. On the other hand, if you subsidize the risk (as we already do with government funded research), then you should be able to reduce the reward.
One idea that I've gotten into for how to organize an economy better is Participatory Economicss, or ParEcon for short. You can read more about it here... www.parecon.org It's an economic vision created by Michael Albert and Robin Hahnel. Albert just received the highest award that you can receive in Italy for his work on this vision, which has been going on for about 20 years, and has been written about in numerous books. He also received a glowing letter from Gorbachev. It's been discssed and reviewed widely in Europe. Step to the other side of the pond, in the US, the land of the free, and you won't hear a peep, not even a book review, despite the fact that Albert and Hahnel are both Americans. This gives us insight into how our media works.
Excellent advice.
However, it does not work this way in every part of the world. In third world countries, antibiotics are not as regulated as they are in G8 countries.
Pharmacists there dispense antibiotics freely without prescription, since many poor people go to the pharmacist for a cure, without having to pay the doctor's fee. This may not be purely legal, but everyone does it.
This causes more and more strains to be resistant to antibiotics, and many of the new ones become ineffective quickly.
This is why we see some almost eradicated diseases (e.g. TB in this case) revitalize and become more virulent.
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Yes, this is true...
:)
and it's a pain in the ass for us physicians. The vaccine only works for 10-20 years... so how do we test you guys over here in the states to see if you still have immunity?
We can't test your arm everytime and watch you have a horrible reaction. Plus, we don't routinely immunize people here so we can use the PPD for screening. (Plus, we screwed up the immunizations over here a long time ago and actually GAVE a bunch of people TB.... so there is a natural reaction in this country not to do immunizations. Even though the immunizations are now really, really safe.)
So you guys screw it up for the rest of us!
The story about the nicaraguan deaf children, and this tuberculosis story were both covered thouroughly in the PBS documentary series Evolution. Portions of the relevant segments are available online on the PBS website:
Deaf Children Video
Tuberculosis Video
As the medical establisment goes in the USA, if there's a chance you have TB, they treat you as if you did have it. This was effectively: take the treatment and you can go back to work, don't take it and take your chances unemployed. See the light?
That's not right, and its probably untrue. If you were threatened with your job - even if you really did have TB - then your employer comitted an actionable offense. If they really, really, really did that you own them. Especially if it was in writing.
An employer cannot legally terminate you because you have TB. Just as they cannot legally fire you if you are pregnant, have a broken leg, have HIV/AIDS, etc.
Not to mention our bodies are floating with antibiotics at pretty much anytime(ever eat meat, or especially fast food?). Teaching good habits won't change everything, we've still got to eat healthier and encourage industry to raise food-animals without the use of antibiotics except when necessary.
Taking the pills like you're supposed to won't help, when you've had many different kinds of antibiotics in your system when you first got sick. And with other antibiotics just starting being used in food-animal industries, we've got a bigger problem on our hands.
It's like in Texas, they want to cut back on emissions, but they keep trying to reduce the pollution standards on large companies. The pollution increases, the consumer has to pay more and jump through more hoops, and everybody loses.
I'm not anti-corporate at all, there are lots of good ones out there, but look at some of the specific ones and see.
Trouble is, you'd have to somehow come up with 100m^2 of membrane that possesses the right permeability to O2 and CO2, is not thrombogenic, and prevents bacterial/fungal growth... AND can fit in your chest.
/3rd year medical student
Recent studies suggest that effectiveness is much better than 10 - 20 years.
Check the Journal of the AMA May 05 2004.
A condition of employment was to not have TB. HIV/AIDS, pregnancy or a broken limb do not spread by a cough, to my knowledge. Maybe I'd be entitled to some form of workman's comp, but I couldn't perform my job at my location. (Which really was pretty silly when you come down to it, because 100 infected people could pass through the door every day, coughing their heads off, but an employee, nooooo...)
A feeling of having made the same mistake before: Deja Foobar
Tuberculosis (TB) is an infectious disease caused by bacteria
HAND
Writers imply. Readers infer.
Get real. Homeopathy can't cure anything. It's just a placebo effect.
The dose that you use is so dillute (more than a part in a trillon) that you merly got more chance to win at the loto than taking a molecule of the supposed active ingredient (like snake venom, common poison, etc).
And if you do beleive that water got memory, then with all the polution and bacterias and viruses that came in contact with the water you drink, I don't think that someone in the world would be alive to read this.
You may understand why doctors may default to such harsh treatment when in doubt. It's a damned tough bug. It can infect nearly any system in the body (even the brain, in rare cases), though it's most commonly found in the lungs. It'll sit dormant for an entire lifetime, popping up when the immune system is weak and/or when damage to the infected system released the cysts, activating the infection.
There are 3 primary kinds of TB: Mycobacterium tuberculosis (the kind people mostly get), M. bovis (cattle variant), and M. avis (bird variant).
I've read up on TB a bit (I also own the Merck Vet. Manual), because we own a cow. Cattle, a common vector for TB, are simply culled when bovine TB is detected. I assume that if effective treatment were possible, it would be similar to the long, expensive kind used on people and it's simply not profitable to cure a cow.
What these sources really don't address (or address clearly to the layman) is whether or not the bovine and avian variants are a threat to people, and if they're treated the same way. Maybe an M.D. can clarify for me. :)
Method of processing duck feet
Please do a quick Google for antibiotic families and modes of action. You will find pages like this and this.
Penicillin and derivitaves are still prescribed, but virtually every bug in the world (+ dog) is resistent to them.
One evening of watching the Discovery channel does not a B.S. in Microbiology confer.
The "natural" antibiotics to which you refer are still being found by the dozens. The problems are not (primarily) with patents. You have to:
You have to find an organism that has some antibiotic activity. Not as easy as you might thing. Searches go on CONSTANTLY, and the major drug companies grab soil samples from everywhere they can to test for organisms in the soil that exhibit unknown antibiotic properties.
You've spent several years and have found a likely candidate. Now you have to test the snot out of it. How does it do what it does? Is it a cell wall synthesis inhibitor? Does it go after 23S ribosomes? How about side effects? After all, bleach is one of the best antibiotics in the world. It's used for disinfection in BSL3 and BSL 4 microbiology labs. However, it wouldn't do you much good if you were to drink it, either. Drug interactions? If it kills someone that is taking a common drug (or worse, an uncommon drug), you're still in trouble.
Now, you have to start the FDA certification process. Do you think the FDA reimburses you for the millions you've spent to this point if things go bad? Nope. Do you think they're even going to reimburse you for the millions you're going to spend in clinical trials? Not likely. Remember Martha Stewart and IMClone? The bottom fell out of ImClone because they'd sunk a good chunk of their cash into a drug that was not going to be approved (granted, IIRC it was a cancer drug and not an antibiotic, but the principle applies).
Yes, pharmaceutical companies are businesses. They are for-profit. But it is not so much corporate greed that causes some of the outrageous drug prices as it is them having to pay for the research costs involved with the 99 drugs that didn't make it to market with the money made from the one drug that did.
Please do some research before making statements like the ones you've made.
Karma: Chameleon - mostly influenced by bad '80s New Wave music
The chronically homeless are also susceptible to TB from basically nonexistent health care and occasionally living in close quarters in shelters. Add to that their bodies are frequently weakened by alcohol abuse, poor shelter and poor hygiene and you have a vector for TB frequenting public transportation, emergency rooms, shelters, police, etc.
Requiring them to take medicine isn't even a viable option since many suffer from mental illness and they also tend to move around a lot with no way to contact them.
It is by the juice of the coffee bean that thoughts acquire speed, the teeth acquire stains. The stains become a warning
You're confusing your numbers here. The numbers you quote for flu are US only, the numbers for the other diseases are world wide. So in 1918 500,000 people died in the US alone. World wide estimates vary widely, anywhere from 25-100 million. 20,000 people die in the US from flu every year making it the #1 killer for infectious diseases. The interesting thing about the 1918 pandemic was that young, healthy people died from it at greater rates then older people. In the US you were 3 times as likely to die from it if you were between 20 and 35 then if you were over 60. Today, with the ease of world travel, a similar strain could have equally devastating results.
One of the very best things I've read on the topic of antibiotic-resistant bacteria:
Bruce Sterling: Bitter Resistance
- jon
Ganymede, a GPL'ed metadirectory for UNIX
Bacteriophage appears to be an alternative to antibiotics for fighting bacteria. An article (you have to pay to access it) in Discover Magazine by Peter Radetsky about bacteriophage was published in November, 1996. It was mentioned by a man named Caisey Harlingten in a Horizon documentary on the BBC, and seems to have been an important publication that set things into motion. What isn't mentioned in the transcript is that right at the end of the documentary, text appears that says the deal between the American company called Georgia Research, Inc. set up by Harlingten and the Eliava Institute fell apart.
Wired wrote a follow up article on the story. One of the disputes involved another man, Alexander Sulakvelidze, opposing the seemingly pointless aim to genetically engineering phages, which Harlingten wanted to do. This possibly has something to do with the fact that genetically engineered products are protected by patents and can be regulated by intellectual property laws, whereas natural phages are not. This is what Harlingten is up to now. He is trying to apply phage therapy to multi-drug resistant Tuberculosis . And this is what Sulakvelidze is up to now, applying phage therapy to livestock.
Evergreen State College and the Rowland Institute at Harvard have pages about bacteriophage. Phage therapy may have some side effects, however. Some types of phage carry genes that can actually make bacteria pathogenic (briefly mentioned at end of page). This has been observed in E. Coli as a response to antibiotics.
This "mix" is (or should be!) mandatory for any form of TBC, not only multi-resistive.
These antibiotics are extremely hard on your liver and also damage your eyesight. One of them colors your urine in pink/red. One additional drawback is that, at the end of the 6-month regimen, your system defenses will be at an all-time low, and it will take several years before you can be back to what you were before the therapy.
IF you default on this therapy, however (if you stop the start taking the medicine again, or you don't take all the pills in the mix etc.) you are going to develop a resistive or multi-resistive strain of TBC. If you develop the multi-resistive strain, you're in GREAT trouble, and are a huge hazard for the people you spend time with (which is, presumibly, the ones that are most dear to you). There are very few antibiotics which are effective with such strains, and are both expensive and hugely damaging to the liver (that's why they are not used with normal strains). Even with them, your chances of survival are not great.
So, if you do happen to get TBC, don't fuck around wth it, be pedantic and take all the medication every day, without ever skipping a dose.
Sigged!
We've got artificial hearts, artificial limbs and we're working on artificial eyes. What's it going to take to make artificial lungs? I'm talking from a technical standpoint here, not socially or legislatively.
BBC had some news a while back. Don't know the status of it now. Artificial lung breakthrough
-- If god wanted me to have a sig, he'd have given me a sense of humor.
This is what is creating the resistant strains. There is a reason that you need a prescription to get antibiotics, Doctors aren't supposed to hand them out like candy to whoever asks.
http://en.wikipedia.org/wiki/Mycobacterium
The primary problem with resistant strains of TB arise from the mismanagement of the treatments and or from its innate ability to remain latient for long periods of time. (I am an RN who has delt with many cases of TB probably more than most US Doctors individually ever see in a lifetime)
The State of Alabama saw the resurgence of TB about 1990 as a result of the AIDS epidemic and the mismanagement of it by New York City. The NYC people had turned people loose with drugs and did not monitor their behavior or results. TB tends to ride on HIV due to the immunity failure. It was clamped down on in Alabama and eventually the NYC people saw fit to correct their ways.
Essentially the whole problem arises from the modern unwillingness to quarrentine or enforce health rules. HIV has presented due to its politically insane management a gaping hole in the management of all too many diseases and TB is just one. It was for example said that Quarrantine of HIV was not reasonable. It is actually essential for several reasons not usually found in many diseases.
HIV Should be Quarrantined for these reasons.
Brain infections cause many HIV People to suffer Dementia and insanity (self protection and community protection) This is about 50% or more in the epidemic.
Immunity failures make it dangerous for HIV infected persons to be about in the community as they catch easily diseases the rest of us do not suffer from but have on our bodies.(Patient safety)
HIV is very difficult to spread (Extremely) and by suppressing access to spread it by a modest quarrantine it would be stopped from spreading.
The Secondary infection risk of HIV makes the HIV infected persons a danger to the community generally such as TB infections
This cannot be over stated in importance that HIV is a basic problem that a simple Home bound monitored Quarrantine would save millions of lives world wide. Cuba proved this and cold cocked HIV in their country. The cost of this would be less than the drugs we are handing out now!
TB does have a latiency that it will appear to be successfully treated in people and will reemerge as they get old and weak. This is similar to the HIV lowered immunity issue. It is doubtful that any person is ever successfully treated for TB rather they are simply put into a temporary remission. This means many people as they get old have it reappear from treatments as old as the 1930's. HIV lowered immunity increases the problems with other diseases like TB.
The good news is that there is a simple measure that everyone can do that vastly reduces all of these problems and it really should be considered as a national security level important thing. WASH YOUR HANDS! It is the only known effective method for handling very nearly all infectious agents. IT WORKS!
For the Nerd types, REPLACE YOUR KEYBOARDS about every 6 months and clean them often.
Never Politically Correct ~ I prefer the facts If you don't like what I say, get a life, or comment yourself.
Si la vida me da palo, yo la voy a soportar Si la vida me da palo, yo la voy a espabilar
Major media are carrying the story that the UN is blaming much of the spread of drug resistant TB on the prevalence of AIDS/HIV-infection. This is due to the susceptibility of those populations to become infected and spread the disease to others.
Seastead this.
M. avium usually doesn't pose a threat to people with intact immune systems, but it is a common AIDS-defining infection. There are also other Mycobacterium that are only usually found in AIDS like M. kansasii and M. scrofalaceum, but they pretty much paint the same picture.