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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?
So someone probably coughed in an elevator, in a kitchen or whatever and myself and anyone else in the vicinity were exposed.
I was put on Isoniazid with vitamin B6 (because Isoniazid knocks the sh!t out of your liver) for 9 grueling months. The first month I felt like I was dying. It really played havoc with mountain biking and meant no beer for 9 months, it was glorius to be off it.
Even two years ago it was recognized that there was an epidemic of TB in the asian sub continent and many of the H1B workers to came in may not have had it full blown, but had it and were bringing it into the USA. Could very well have been one of the fine people I worked with shortly after moving to California, but by no means would the state be unique. On weekends and holidays I'm a cyclist and put in long miles with considerable effort, which means I'm pretty well in tune with how my lungs are doing. Any little change, a day more phlegmy the others makes me take notice and track whatever seems be be going on. For that I thank all the brilliant people and lobbyists who made it so much easier during the tech boom to let people into the country on a rush to fill positions in businesses (which lobbied like hell for increases in H1B and more lax health screening.)
A little background on TB, the bug is not killed by the immune system, but isolated. If it's under control that means a little cyst-like structure is built around it which hopefully contains it the rest of the hosts life. A severe respiratory infection can weakend the immune system to the point that the bug gets out and wreaks havoc, more likely at advanced age.
A feeling of having made the same mistake before: Deja Foobar
Dead.
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.
MDR TB has been on the rise for years, as have worries about its transmissibility. Read "And the Band Played On" (mostly about AIDS in the 80's) or "The Coming Plague" (about emergent diseases) for good overviews.
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First it was going to be AIDS, then it was SARS, cancer is slowly being beaten...
Maybe a nice new healthy TB strain will be the new plague to rid ourselves of some of the population.
How long has it been, at least 400-600 years since a nice big population dwindling event has occurred...
My daily commute isn't getting any shorter, oil seems to be running out... air is getting more and more polluted... time for the G-O-D to clean the house out a little...
(and if it's my time to go, I'm fine with that)
Check out the best P2P sharing website: MEDIACHEST.COM
when we let big pharmaceutical companies take control of R&D.
Most antibiotics today are BASED on peniciline. Truth is, these resistant TB strains are resistant against PENICILINE-based antibiotics.
As I saw on Discovery once... There are thousands of natural antibiotics which are extremely complex. Some can be taken from cactae in South America, some can be taken from certain species of ants.
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.
Hmph.
Bacteria (not computer, although I suppose it could apply too) evolve regularly. Some strains of staph are now resistant to most antibiotics. I had a case of MRSA (Mesocillin Resistant Staph Aureus) two summers ago after having surgery. It was most unpleasant and only an IV-induced superdrug called Vancomycin could destroy it. So, to me it's not all that surprising that TB is making a comeback. It finally figured out how to immunize itself.
This is why:
(1) If you're proscribed antibiotics, you should take them exactly as instructed; take them for the whole course, do not stop in the last couple days or when the symptoms go away;
(2) Do not attempt to "chase off" what you think might be an oncoming infection by taking a "leftover" pill or two from a previous subscription
(3) Realize that many infections are viral; do not expect or demand to be proscribed antibiotics contrary to your doctor's wishes
Doctors are now becoming very aware of bad behaviors which cause bacteria to become antibiotic-resistant, but convincing people to follow good practice is apparently harder.
My father lost his father when he was a mere 9
years old to TB. I don't understand why people
treat this as "someone elses problem" - it isn't a
SEP. It *will* bite you. You'll never have to worry about new diseases because the old ones are doing nicely...
The irony with TB is that
people think they are getting well, and stop taking
the drugs (which are making them feel ill). End result: great selection pressure to make resistant bugs).
I for one pray that we can stamp out that big disease called ignorance (hey, look at what happened in Nigeria with that dumb fuck (who cares
what religion?) and Polio). Damn. I had a friend
with scars from hell and calipers when I was a kid
and I'm a mere 45 year old. I never want to see
such things, not even in my nightmares...
To anyone who's interested in the subject, I'd reccomend them to read Mountains Beyond Mountains by Tracy Kidder, a halfway decent book on the very interesting subject of Dr Paul Farmer, who's been desling with TB epidemics in Haiti / Siberia / Etc for quite a while now. Very informative.
Not sarcastic at all - The Gates Foundation is one of the major forces fighting TB today.
History will show that the baby boom and X generations, who worry and fret about every little imagined risk, actually will have lived in the golden age of human health. This will be the period when antibiotics were effective and vaccines developed in the mid 20th century kept them safe from the viral diseases. Evolution will overcome all those safeguards.
People under 30 have a bleak future.
Even things as simple as the commom cold are highly mobile conpared to a "few" years ago. Given air travel what it is today; a small outbreak of anything highly contagious can spell absolute disaster on a global scale. It's easy to forget people have only recently become the global travelers we now are. TB and all the others are no longer isolated to the point of initial/original concentration. Adds new meaning to "just off the jet".
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.
Personally, I hold doctors highly liable for the abuse, misuse and general over-use of antibiotics. Of course the patients are pretty damned stupid too, but I have seen cases where the doctor didn't see anything but a blood test before prescribing the antibiotics.
There are so many natural ways to inspire your own immune system to build and strengthen itself and it seems to me that for capitalistic reasons alone medical professionals do not prescribe them.
I'm not a doctor or medical expert either. But I'll say this much -- from the time I decided I was done taking pills and crap for every minor problem out there and let my body do its own healing, I have been a healthier, stronger person and I can't remember the last time I was sick... I remember what it was -- the flu -- but it was great than 5 years ago and basically, I just waited it out -- fever and headaches and agony and all. I recognize the fact that extreme situations call for the use of medicines and other modern medical techniques. But I think they are way over-used and in my opinion (guess) it's so they can way over-charge people.
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.
If it's "worldwide" it should be called a pandemic threat, not simply an epidemic threat.
Tubercolosis? LOL! This is not a problem! We live in a perfectly disinfected world... COUGH!! ... no bacteria can survive COUGHHH COUGH! we have the most advanced antibiotics and medicines... COoOoooOUGH! COUuUuuuGH!!
COUGH... WTF!?... COUGH! COUGGGHHH! SCOUGHGCH... BLEURG...
*STUNF*
Is it wrong to think we shoulda withheld medical technology from people incapable of using it properly so it would still work for us?
No. It would be wrong to refuse to TREAT those people, and wrong of us not to teach them the proper way to use the tech, but not wrong to think "man, we shouldn't give that kid a gun without teaching him how to shoot."
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
Yeah, I'm a Gen-X'er, and I know how glad I was to have an effective AIDS vaccine when I was growing up.
If the doctors are at fault, it is for bowing to the demands of ignorant, demanding patients who want antibiotics for every sniffle that little Tyffany or Brett get. I have had several co-workers who just wouldn't give up the belief that they could blast the common cold by having their pediatrician shoot up Junior with penicillin.
The Mexican practice of selling antibiotics over the counter doesn't help either. They're treated as a cure-all down there, and immigrants continue the practice.
Like the poster said, you're better off living a clean and healthy lifestyle, putting up with minor ailments, and saving antibiotics for actual bacterial infections.
Stefan
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
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.
"Alright, I'm a practicing lung doctor so I've got to say a little bit."
[...]
"Using INH for a long enough duration will not cause resistence. Dead bugs can't develop resistence."
[...]
"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."
The article we're all discussing in this thread reports the incipient global TB epidemic caused by carpetbombing TB exposees with bacteriocides, which leaves the few mutants resistant to the drug to inherit their food supply: us. The principle of using a drug like INH "long enough" to kill all of the bacteria, even the more resistant mutants, depends on "long enough" being both less than the human lifetime, and humans nearly always following the long program. The biology of TB, or any other very large population fought with merely systematic techniques, allows at least a small population to survive, which can then reproduce. If large enough, that population can overcome the human immune response that resists the original infection (if the immune system hasn't been damaged too much, along with the liver damage, from the medication). Unless each bacterium is destroyed individually, systematic is all we've got, and we're dealing with statistics. The same reality applies to human behavior - highly variable across populations of millions, inevitably slopping across any thresholds. This attitude is solid biochemistry, but bad medicine. And it's the unchanging environmental factor within which TB has adapted. Without an alternative, the MDR epidemic seems inevitable, making inroads in the US more slowly, but just as inexorably as abroad.
--
make install -not war
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
I highly recomend reading Mountains Beyound Mountains: Health the World: The Quest of Dr. Paul Farmer
He essentailly discovered that DOTS doesn't work
In this excellent work, Pulitzer Prize-winner Kidder (The Soul of a New Machine) immerses himself in and beautifully explores the rich drama that exists in the life of Dr. Paul Farmer. A Massachusetts native who has been working in Haiti since 1982, Farmer founded Zanmi Lasante (Creole for Partners in Health), a nongovernmental organization that is the only health-care provider for hundreds of thousands of peasant farmers in the Plateau Central. He did this while juggling work in Haiti and study at the Harvard Medical School. (Farmer received his M.D. and a Ph.D. in anthropology simultaneously in 1990.) During his work in Haiti, Farmer pioneered a community-based treatment method for patients with tuberculosis that, Kidder explains, has had better clinical outcomes than those in U.S. inner cities. For this work, Farmer was recognized in 1993 with a MacArthur Foundation "genius grant," all of which he donated to Zanmi Lasante. Using interviews with family members and various friends and associates, Kidder provides a sympathetic account of Farmer's early life, from his idiosyncratic family to his early days in Haiti. Kidder also recounts his time with Farmer as he travels to Moscow; Lima, Peru; Boston; and other cities where Farmer relentlessly seeks funding and educates people about the hard conditions in Haiti. Throughout, Kidder captures the almost saintly effect Farmer has on those whom he treats. Copyright 2003 Reed Business Information, Inc.
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
Sorry, I don't want to drag this off-topic into another screed about the evils of extended copyright, but it is mildly relevant.
My grandfather was a well-respected medical researcher. The works that he developed his fortune and reputation have been superceded, but toward the "mature" part of his career in the 1930's he did a lot of work on tuberculosis especially with animal tests on cattle. The articles my grandfather wrote are still under copyright. He's been dead for decades, and tuberculosis has been a non-issue for most Americans for years. Now that a more vicious strain of TB is starting to emerge, I find it disturbing that this material is still illegal to share.
If you can't see what I'm talking about, look at the two-digit year rollover problem framed in the media as Y2K. All of the research into the causes, identifications, and solutions to the "millenium bug" will remain under copyright for close to 90 years under current copyright law. Imagine though that copyright was extended yet again and these works weren't public domain until AFTER the next two digit rollover in 2100.
Just as people have already started to build two-digit years into databases again, so have people given up on many practices that might minimize the spread of TB. Some people can't even identify these practices or understand why they're at issue.
I realize that the research into Y2K and bovine tuberculosis isn't "gone" that it's still around under lease, but it seems that having only the choice of paying for out-of-date information on a tangential problem or recreating the works someone else did is a waste of resources (money or time) that could be better applied toward whatever problem is causing researchers to look back on these old issues.
I'm thinking about digging into my grandfather's work papers (what's left anyway) and trying to digitize some of his data, notes, and private letters on the subject of bovine TB. Some of this data probably can't be collected today because of regulations on animal testing that didn't exist in the 1930's. I know full well that it would be irrelevant to the current threat of drug resistant tuberculosis strains, but it might let some researchers or problem-solvers keep their money and time focused where the real problem is rather than paying/recreating old research.
While I'm not against people making money from their research and creative works, the length of time that this stuff remains under protection is absurd. The money made either for my family or the publishers trailed off to nothing decades ago. The potential monteary profit of his work is far outweighed by my own interests in not becoming a victim of a drug-resistant version of this affliction. The benefit of this work today is only as part of a contextual frame or foundation for research into other communicable diseases.