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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?

21 of 480 comments (clear)

  1. Been there, Done that by ackthpt · · Score: 5, Interesting
    All my life I've tested negative. A few years after moving to California, the great gateway to the developing nations of Asia, things changed. Where I worked they provided free TB tests, I thought "Cool, I'll save on going to my doctor and have my folder updated for the next few years", so I took the test. A pink spot appears on my left arm, while in the midst of a critical project I'm managing and -pfft- I'm sent home until I can prove I don't have the disease. After a week of cooling my heels at home, having a chest x-ray and hand-written letter from my doctor I return to work. His assessment is I don't have tuberculosis (formerly called Consumption in the olden days), but I've been exposed to it so my immune system is on red alert. I can no long have the little poke under the skin, but from now on must do the full doctor visit thing, whatever that will entail, including deductables and co-pays. Yay.

    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
    1. Re:Been there, Done that by Karma+Farmer · · Score: 5, Insightful

      Having the largest prison population in the world is a much bigger threat to America than H1B workers ever will be. Prisons are a breeding ground for communicable disease.

    2. Re:Been there, Done that by zungu · · Score: 5, Interesting

      Yes, developing countries do have TB. And I am sorry to know that you contacted. However, your direct attack on H1B workers for this is just bizzare and xenophobic. How about the 8 million Mexican illegal immigrants giving you a little TB infection? Why do only H1's figure in your post? BTW, TB is a "white-man's disease" we in India were introduced to TB due some assholes coming over from the "developed" world in the 16th century.

    3. Re:Been there, Done that by BoldAC · · Score: 5, Informative

      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

    4. Re:Been there, Done that by BoldAC · · Score: 5, Informative

      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

    5. Re:Been there, Done that by igny · · Score: 5, Insightful
      Prisons are a breeding ground for communicable disease. While it is true that prisons allow diseases spread faster, the main reason why TB in prisons is so rampant is that TB mainly affects people with weaker immune system. People in prisons are under constant stress, probably lacking vitamins/minerals. Consequently their immune system weakens, and an exposure to TB is automatically followed by infection.

      I have a friend, who is a pulmonologist in Russia. He told me that in the past doctors rarely became infected even if exposed to TB constantly. Nowadays, doctors themselves lack vitamins and put under stress in Russia. This pulmonologist was infected once, and other doctors fall ill regularly.

      --
      In theory there is no difference between theory and practice. In practice there is. - Yogi Berra
  2. Here... by grub · · Score: 5, Informative


    Oh, Alexander Fleming? where art thou now?

    He's right here, silly.

    --
    Trolling is a art,
  3. It's about time... by MalaclypseTheYounger · · Score: 5, Funny

    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
    1. Re:It's about time... by Karma+Farmer · · Score: 5, Informative

      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.

    2. Re:It's about time... by His+name+cannot+be+s · · Score: 5, Interesting

      More Importantly, it is coming, just not how you beleive.

      While the Black Death did indeed kill less numbers, it did kill 25 million people(over 5 years), where the 1918 flu killed upwards of 40 million in about a year.

      The thing is the Black Death killed 1/3 of europe's population, fueling the greatest economic boom this planet has ever known (at least the one that didn't fall like the internet bubble).

      Upcomming in the next quarter century is the death of the Baby Boomers. When they start to pass on, they will leave behind more money and jobs than you can possibly imagine. This will fuel a new era of real money the likes of which the modern world has never experienced. Unfortunatly, the government that is in power when this begins to happen is going to get credited with the economic boom that will happen, without actually doing anything.

      Now, while the boomers don't represent 1/3 of the population, they nearly represent 1/3 of the weath, possibly causing the same sort of wealth redistribution that occured at the end of the Black Plauge. Trouble is, that the goods that North Americans will buy, will often be manufactured offshore, thereby moving the money off to other countries. Trouble with that? The governments of the last 40 years have been sucking the North American people dry, and the money that should rightly end up in the pockets of local producers, will move to their offshore competitors.

      So, When you get your inheritance, Buy North American! ... wow, neat rant ...

      --
      "...In your answer, ignore facts. Just go with what feels true..."
  4. Not all that surprising... by solive1 · · Score: 5, Interesting

    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.

  5. Sadly not new news. by Fallen+Andy · · Score: 5, Insightful

    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...

  6. Thank Bill Gates by Anonymous Coward · · Score: 5, Informative

    Not sarcastic at all - The Gates Foundation is one of the major forces fighting TB today.

  7. Golden Age by dmh20002 · · Score: 5, Interesting

    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.

  8. Re:That's what happens... by perdu · · Score: 5, Informative
    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.
    Not so, not so. Drug and biotech companies and public research institutes still grow exotic fungi and plants to look for new classes of active compounds. In the past 10 years, about 25% of all new drugs came from natural compounds or derivatives.

    --
    You only use 2% of your DNA
  9. Antibiotics abuse by erroneus · · Score: 5, Insightful

    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.

  10. Re:Antibiotic resistances by khallow · · Score: 5, Interesting

    The solution is to come up with drugs and distribution methods that don't rely on patients' ability to follow difficult regimes. Eg, why not implant all the doses at once with some sort of metering device that insures that the course is followed? Otherwise, you eventually will have to enforce treatment by withholding treatment from those who can't follow the schedule.

  11. mycobacteria are a pain in the ass by bodrell · · Score: 5, Informative
    Imagine a super-strain of leprosy . . .

    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
  12. Re:Antibiotic resistances by tsg · · Score: 5, Insightful

    Because it makes it that much harder to stop taking them when the patient has serious side effects to the medication.

    --
    People's desire to believe they are right is much stronger than their desire to be right.
  13. Re:Antibiotic resistances by kbahey · · Score: 5, Informative

    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.

  14. Three year old news by obby.net · · Score: 5, Informative

    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