Totally Drug-Resistant TB Emerges In India

ananyo writes "Physicians in India have identified a form of incurable tuberculosis there, raising further concerns over increasing drug resistance to the disease (abstract). Although reports call this latest form a 'new entity,' researchers suggest that it is instead another development in a long-standing problem. The discovery makes India the third country in which a completely drug-resistant form of the disease has emerged, following cases documented in Italy in 2007 and Iran in 2009."

Comments

Not *totally* drug resistant

[ArcherB]

We just haven't found a drug to fight it. And before people get on the anti-antibiotics bandwagon, if we didn't use antibiotics, then the simplest infection would be "Totally Drug-Resistant".

Now if you want to speak of the "overuse" or preventative use of antibiotics, then go ahead.

Re:Not *totally* drug resistant

[i kan reed]

There's no such thing as an anti-antibiotics bandwagon. Does not exist.

If you search for the phrase "ban antibiotics" you will ONLY find results for people opposed to agricultural antibiotic use on healthy animals. That's it.

There are enough stupid movements to hate without having to invent new ones.

Re:Not *totally* drug resistant

[wolfsdaughter]

The problem isn't using antibiotics to fight bacterial infections.

The problem is incorrectly using antibiotics, much of which comes from IGNORANCE and POVERTY
1) Ignorance: lack of education on how antibiotics work, and a frightening number of people stop taking the antibiotics as soon as they start feeling better - VERY BAD IDEA!

2) Poverty: medicines are expensive, and so people who are tight on money will "share" drugs, with other people to save on costs. This goes hand in hand with ignorance about how the drugs work.

The answer to this (and many other problems) is universal education and healthcare.

Re:Not *totally* drug resistant

[Anonymous Coward]

Pssh, your anti-anti-anti ban movement isn't fooling anyone.

Re:Not *totally* drug resistant

[David Greene]

You misunderstand the problem. Antibiotics are not the problem. The overuse of antibiotics is the problem. I hear about this every single week from my wife, who is a provider. She constantly gets pressured by patients to prescribe antibiotics when they are clearly not necessary or justified. We have to change the culture of medical care here in the U.S.

Re:Not *totally* drug resistant

[Luckyo]

This is a silly claim. There are antibiotics that can kill most of the resistant bacteria. We know many of them. Problem is, they also kill the host when host is human, typically by destroying kidneys or liver.

It's not that we don't have the tools to kill these "super germs". We do. We just don't have the tools that kill the germs without killing the humans. Essentially we're paving the path for bacteria that adapt to antibiotics as a threat to their existence by remaining/becoming vulnerable to antibiotics that destroy various internal organs, and becoming resistant to those that do not.

Re:Not *totally* drug resistant

[Anonymous Coward]

They are *not* candy, some doctors prescribe them like they are and some patents demand them like they should be....

All antibiotics by their very nature disrupt the balance of the non aggressive bacteria which your body tolerates to produce extra essential vitamins in the gut and to cloud out the explicitly pathogenic varieties in the skin and elsewhere. This means that they come with a risk of skin rashes, minor stomach upsets gas and other such issues, particularly heavy use may cause more serious issues on occasion. Because of these issues you should only take antibiotics for real infections or serious wounds not colds or coughs, unless you have particular risk factors.

Despite these issues refusing them when you have a serious problem is madness, they are a powerful tool and a boon to our average lifespan and health that has not yet been equalled by any other single class of technology, wanting to cut unnecessary use to improve effectiveness and reduce risk is not the same as wanting to stop using them.

Re:Not *totally* drug resistant

[LWATCDR]

True enough.
Actually there are a couple of means to attack this strain.
1. We should sequence those strains and see if we can identify any weakness to exploit.
2. Discover how their resistance works. For example strains that are resistant to say penicillin tend to make an enzyme that breaks down penicillin. So possibly one could make a drug that binds that enzyme and combine it with the antibiotic or change the antibiotic that the enzyme has no effect or even have the drug activated by the enzyme.
3. Bacteriophages are an interesting but really under researched treatment in the West. The old USSR did a lot of research in to them and frankly we should start as well.

Of course what is really scary are the folks that are no in "raw" milk. They are making claims that it can cure everything from cancer to Autism all the while providing an excellent vector for TB.

Re:Not *totally* drug resistant

[localman57]

And how do you plan to crucify the patients who do not take the full course of antibiotics they are prescribed?

I assume he plans to use nails. Is that how pretty much everybody does it?

Re:Not *totally* drug resistant

[SydShamino]

I was attacked in mid-December by a cat, which bit my left hand harder than I knew cats could - twice. (It was an indoor feral cat we care for, and we were moving, and I had to get him in a cage. And yes, eventually we both calmed down and got him moved.)

Initially my hand swelled to twice its normal size, and then the wounds started to fester. This was within a day. Fortunately I went to the doctor the morning after it occurred, and by the time the wounds were filling with pus I was already ramping up 10 days of antibiotics. The infection was gone within three days (but of course I dutifully took the entire 10 day regimen). My hand still hurt a little but it's usable.

In retrospect, I've been thinking that just 100 years ago I very well could have either lost my hand or died. Now my biggest concern was a few weeks of pain and inability to use my hand, and maybe one or two small scars.

I am very grateful for the discovery and medical application of antibiotics, and I very much support restrictions with antibiotics to cases where they are mandatory. Doctors and patients abuse painkillers, so we restrict access to them and control their use closely so as to prevent the patients from hurting themselves. Doctors and patients abuse antibiotics, so why don't we restrict access to them and control their use closely so as to prevent patients from hurting all of humanity?

Re:Not *totally* drug resistant

[ChumpusRex2003]

Some of it is. TB requires prolonged treatment. 3 months is regarded as the absolute minimum treatment duration. 6 months is suitable for most cases. 12-24 months is needed for severe cases, or for cases affecting certain organs (brain or spine). Anti-TB antibiotics also have severe side effects - liver damage, nerve damage, permanent eye damage, they severely disrupt the biochemistry of other drugs (potentially causing them to become ineffective, or overactive), etc.

In poorer countries, patients/doctors may not be able to afford a full course of drugs, and may therefore cut it short. Uneducated patients may also stop the treatment when they start to feel better, and not carry the course through to the end (and in poorer countries, there may not be a system for doctors/law enformcenet to trace them and bring them back for treatment).

Additionally, tests for TB have are very time-consuming and expensive. It can take 8 weeks to get a drug-sensitivity test, and that's if the test comes back positive anyway (one of the problems with TB, is that it is very good at hiding, and the bugs are very difficult to grow). Where funding is constrained, diagnosis is simply by looking for the bugs in a sputum specimen with a microscope - which tells you nothing about the sensitivities. There is a signficant cost of incubating the specimens on special growth media for 8 weeks, and a low success rate. Because of this, doctors in these countries may not be able to diagnose drug resistance, except when drugs fail to halt the disease after 6 months.

The avoidance of resistance in anti-biotic treatment is best achieved by mixing multiple drugs of different types. Conventionally TB is treated with a cocktail of 3 or 4 drugs. If, however, you use those 3 drugs, ih a population that is infected with a bug that is resistant to 2 of them, then resistance to the single functioning agent, can develop very rapidly.

Things are changing with advanced test kits and DNA amplification technology, which are able to detect the genes that confer resistance, and give a result, with high accuracy and high reliability within 24 hours. The problem is the significant cost of this testing technique.

 

This would be a bad time for a "Madagascar" joke.

[Iamthecheese]

The only silver lining is that it's not even more deadly. At least we can learn about the effectiveness of quarantine methods in the modern era before something even more deadly shows up. Also each evolution that allows a bacteria to become resistant to a drug weakens the bacteria in all other cases.

Watch out Indonesia

[Toe, The]

Isn't the real story that it's in three countries, and that they are geographically disparate?

Or... does the disease only affect countries that start with the letter I?

Re:Watch out Indonesia

[Samantha Wright]

Nah, it happens all over the place, including in countries that start with "Russia". The antibiotic-resistant TB there is just not quite as bad. Unfortunately, it lives in the prison system.

Re:Watch out Indonesia

[ATestR]

STANDARD != FREE. Where I live, TB vaccinations are required for kids entering school. This is STANDARD. FREE is when you get somebody else to pay for it. Admittedly most of us have insurance to pay for it. Those without generally get the vaccinations for free anyway.

Re:Watch out Indonesia

[ColdWetDog]

It is becoming common problem in EU too. Maybe not totally resistant TB, but very hard to cure. What amazes me, is that in North America the TB vaccine is not standard (read my leaps: FREE), and the result is that when (not if) some american catches TB, he will be helpless.

There is no good tuberculosis vaccine. There is the BCG vaccine which confers some measure of immunity, but it's not very impressive. The problem with BCG is that is screws up SCREENING for TB via the PPD (skin prick test). Once you've had a BCG vaccination, you are going to test positive for TB in that screen, so you have to go to expensive and slightly dangerous X rays to determine active disease and you're pretty much hosed at determining 'latent' disease (where someone has been exposed, has the bug stuck deep inside their lungs but the critter hasn't multiplied - yet - in a couple of percentage points of people with latent TB it will go active at some point in their life so they often get treated before it progresses).

In countries where TB is epidemic, it often makes sense to use BCG. In the US and Western Europe, probably not but it's a complicated argument.

We really need 1) better vaccines and 2) better ways of detecting early infections. It's not for want of trying, it's just a nasty little bug.

Re:Watch out Indonesia

[hedwards]

Yes, because it ultimately means that you're no more humane than the prisoners are. When you start deciding that some people do and do not deserve to be treated humanely you open up the door for all sorts of inhuman behavior. Sure it's not a guarantee that one will turn into a genocidal mad man, but accepting the premise that some people don't deserve to be treated humanely makes it a significantly shorter trip.

Re:Watch out Indonesia

[fuzzyfuzzyfungus]

Prisons also have staff, visitors, and(depending on the local jurisdiction's distinction between prison and jail, if any), suspects awaiting trial but not convicted of anything.

Re:Watch out Indonesia

[Bob-taro]

I think the humane thing to do with this thread is let it die and get back on topic.

Re:Watch out Indonesia

[level_headed_midwest]

The BCG vaccine screws up using the skin test; your body has "seen" the TB antigen in the BCG vaccine and will react to the TB antigen in the skin test. It does NOT screw up the antibody test (Quantiferon), so people who received the BCG vaccine should get the antibody test instead of the skin test. Also, there is a direct test for M. tuberculosis bacteria- it's called a sputum culture. However you won't be able to grow any unless the patient has active TB as latent TB by definition has a negative culture. The skin test and Quantiferon test for latent TB, in the hopes that you catch latent TB, treat it, and kill it before it becomes active (and actively contagious) TB.

Re:Watch out Indonesia

[Applekid]

Wrong answer to my post. People who talk like you end up giving more value to the criminals than to victims.I expect such from someone like you though to write a response like you did, and you fell for it.

I would KILL, perhaps even in a painful and gruesome manner, someone raping my wife or daughters, which is NOT humane to them, but is humane to my wife or daughters. You are confusing not being humane with being inhuman. There is a distinct difference.

This is precisely why, in civilized societies, there is dispassionate legal system. There's a line between punishment of justice and vengeance of bloodlust that can only be crossed in a might-makes-right anarchy.

I find your choice of handle to be rather curiously, if the quote reflects your true feelings.

Re:Cough...

[Anonymous Coward]

that small cough doesn't sound so good. Take all these antibiotics

That explains that weird call to customer support

[elrous0]

I was wondering why "Bob" kept coughing.

Re:This would be a bad time for a "Madagascar" jok

[Samantha Wright]

I could ramble aimlessly about this general topic for a while, but instead to farm karma more efficiently I think I'll make an obscure, off topic point that I think is interesting by analogy: this directing of evolution also occurs at an environmental scale. Life may find ways to survive in the presence of all the chemicals we dump into the ecosystem, but it will be more vulnerable to other stressors as a result, including those through which it would normally survive. In combination with the on-going loss of diversity caused by more direct damage to the environment, life as we know it is pretty cornered.

It's a little as if we're extremely incompetent first-year med students trying to eliminate a patient's symptoms (i.e. the planet's inherent imperfection for supporting modern life) and we're on the verge of unintentionally killing off the infection that's actually responsible. (Admittedly, this is a lousy analogy, but it's important to realise that it's happening.)

Re:This would be a bad time for a "Madagascar" jok

[shadowrat]

Also each evolution that allows a bacteria to become resistant to a drug weakens the bacteria in all other cases.

I had not understood this to be true. I keep hearing that strains of bacteria become resistant to all antibiotics. not just a queue of 3, then the next strain is resistant to a 4th antibiotic, but no longer resistant to the first. Evolution does seem to favor specialization, but traits are only lost if they hinder. I don't know exactly what the mechanism of resistance is, but i don't know that each kind of antibiotic requires some new organ to exist resulting in lumpy slow bacteria.

Distribution of Drug-Resistant TB

[Samantha Wright]

For those interested in exactly how prevalent this sort of thing is, be aware that drug resistant TB is in almost every country in the world; it's just really bad in those particular three countries. This journal article from 2006 has maps showing the incidence rates per country.

Re:This will be unpopular....

[Dogtanian]

I can't work out whether this is meant to be a joke or not, or whether the people who modded it up as "Funny" misinterpreted it as a joke, or whether they thought it wasn't a joke, but modded it up as "Funny" anyway to show how laughable they thought it was.... :-/

Additional Note: 1 patient ran away

[Saishuuheiki]

It was also mentioned on NPR that one of the patients with the drug-immune TB in India actually checked themselves out of the hospital and they can't find them.

Here's to you our new "Patient Zero"