Extremely virulent, drug resistant strain of TB running wild in South Africa

It was 18 months ago when doctors in South Africa who were treating HIV/AIDS patients first raised the alarm that an untreatable form of tuberculosis (TB) was circulating.

At that time Dr. Tony Moll and his colleagues at the small rural Church of Scotland hospital in Tugela Ferry were battling to deal with HIV/AIDS along with tuberculosis which is often a sequel to the deadly disease.

The TB they were seeing appeared to be an extremely virulent strain and resistant to drugs.

They suspected the outbreak was not confined to local areas and was in fact the tip of an epidemic.

Any benefit from the long awaited anti-retroviral drugs were soon decimated by the new TB strain and patients died.

TB is an airborne illness which is spread through coughing and sneezing and is especially deadly for those with weakened immune systems.

1 in 10 people in South Africa are HIV-positive and the doctors had urgently requested that health authorities investigate the scale of the outbreak and provide better resources for diagnosing the new XDR strain of TB, so those with it could be isolated from other patients.

Over the years South Africa has come under sharp criticism for it's policies and attitude regarding HIV/AIDS, the South African government has in fact finally been shamed into providing life-saving drugs to HIV-positive people.

It was only last week, when the World Health Organisation and America's Centres for Disease Control (CDC) visited South Africa and warned of the need for immediate action, that the warnings and demands from Dr. Moll and his colleagues were heeded.

The deadly XDR-TB has now been detected in at least 28 other hospitals in KwaZulu-Natal.

The hospital in Tugela Ferry, which serves about 250,000 people over an area of 650 square miles, has dealt with 63 patients known to have XDR-TB, of which 60 have died within an average of 16 days of being diagnosed, which as Dr. Moll points out equates to a 98% mortality rate.

Medical researchers suspect the strain has now entered undetected into Mozambique and Lesotho, and other parts of South Africa, due to migrant labour.

Dr. Umesh Lalloo, of the Nelson Mandela School of Medicine in Durban and head of the research team investigating the Tugela Ferry outbreak, says if the TB strain spreads, and nothing is done, it will make bird flu look like a 'picnic'.

But there is a great deal of concern that a similar battle looms as happened over AIDS, with President Thabo Mbeki, whose controversial health minister, Manto Tshabalala-Msimang, declined to attend a meeting of the WHO, CDC and South Africa's TB experts recently, to discuss how to combat the outbreak.

Dr. Tshabalala-Msimang has in the past evoked sharp criticism and even ridicule from the medical profession for advocating beetroot and garlic as an effective HIV/AIDS treatment, and has been apparently angered over the publicity surrounding the TB crisis.

The WHO says the misuse of anti-tuberculosis drugs is the most likely cause of the origins of XDR-TB which has resulted in the growing spread in South Africa of another form of the disease - MDR-TB - that does not respond to the standard drug treatments but can be contained by the prolonged use of more expensive medicines.

Regular TB drugs costs around U.S.$100 whereas MDR-TB drugs costs about U.S.$35,000 and needs 18 months of treatment, yet another burden on a health service already struggling to cope with HIV/AIDS; XDR-TB does not respond to any of the drugs currently available.

Dr. Moll alerted KwaZulu-Natal's health officials to the crisis in emails last year but received little response.

In May this year he finally sent a letter from the hospital to the provincial health minister, Peggy Nkonyeni.

The letter asked for an intense epidemiological study, for improved ventilation in the TB wards and adequate isolation of the TB patients so they didn't infect the other patients.

None of these things have happened.

The demands are the same as those the WHO and CDC now say are necessary to contain the spread of XDR-TB, along with more test laboratories and more money for drug development.

South Africa's health department now says it is working around the clock to contain the outbreak by setting up systems to monitor its spread and investigating whether two previously unavailable drugs might provide effective treatment.

It has promised to start distribution this week and on the advice of medical experts the health department has signed a deal with local pharmaceutical company Aspen to buy Capreomycin and talks are under way with a second supplier to secure Para Amino Salicylic Acid.

The two antibiotics increase the pool of treatment options available for those suffering from tuberculosis in South Africa; the drugs have been widely available in other nations for years.


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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