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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.
Linux - Because Mommy taught me to Share.
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.
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.
You only use 2% of your DNA
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.
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
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.
2bits.com, Inc: Drupal, WordPress, and LAMP performance tuning.
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.
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
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
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!
http://en.wikipedia.org/wiki/Mycobacterium