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Drug-Resistant Tuberculosis Cases on the Rise

LONDON – Once thought of as a disease of another generation, tuberculosis is making a raging comeback and not just in third world countries. In fact, London has been given the dubious title of “tuberculosis capital of Europe”.

The disease, sometimes called “consumption” or the “white plague”, was the scourge of the 18th and 19th centuries, leaving millions to die a slow yet unrelenting death. Now, drug-resistant TB is showing itself in an alarming rate in the some of the wealthiest cities in the world, as well as across Africa and Asia. Tuberculosis is a bacterial infection that destroys lung tissue, making sufferers cough and sneeze, and spread germs through the air. Anyone with active TB can easily infect another 15 people a year.

Ruth McNerney, an expert on tuberculosis at the London School of Hygiene and Tropical Medicine, warns, “We can’t afford this genie to get out of the bag. Because once it has, I don’t know how we’ll control TB.”

Statistics back up McNerney’s assertion. 8.8 million people had TB in 2010 and the World Health Organization predicts more than 2 million people will contract multi-drug resistant TB by 2015. The worldwide tuberculosis death rate is between two and three people a minute.

Matters are even worse in India were an untreatable strain of the disease has caused alarm in medical communities around the world. Normal TB is generally curable with an extended round of antibiotics. Many TB patients in India are not responding to the usually successful treatment.

Lucica Ditiu of the WHO says this version of TB “is a totally man-made disease.” Mycobacterium tuberculosis, like other bacteria, has the ability to evolve and fight its way past antibiotic medicines. Making matters worse, the more treatment courses patients are given and fail to complete, the stronger and more widespread the resistance becomes.

“The doctors, the healthcare workers, the nurses, entire healthcare systems have produced MDR-TB. It’s not a bug that has come from nature. It’s not a spontaneous mutation. It came about because patients were treated badly — either with poor quality drugs, or not enough drugs, or with insufficient observation so the patient didn’t finish the treatment course,” said Ditiu.

Dr Zarir Udwadia, a tuberculosis specialist at the Hinduja National Hospital in Mumbai, published a paper in the Clinical Infectious Diseases Journal late last year documenting four cases of MDR-TB. Reuters reports he has now identified 12 cases for which he has all but run out of treatment options. Three have already died.

“If you add it all up, they were resistant to 12 drugs in total,” he said. Udwadia blames poor medical practice. Non-prescription and over-the-counter antibiotic use is common in India and making it no coincidence the country now has 100,000 cases of MDR-TB, the highest in the world.

Udwadia added, “To get to this stage, you have to have amplified resistance over years, with loads of misuse of (antibiotic) drugs. And no other country throws around second-line drugs as freely as India has been doing.”

People in western nations tend to consider themselves safe because they enjoy stricter drug laws. Experts are not convinced, and history suggests otherwise. Tuberculosis spreads with an ease unlike many other diseases. When patients cough, sneeze, or spit, they propel thousands of germ-carrying droplets into the air around them. With people traveling the world in confined spaces, a disease like TB can move rapidly from one side of the planet to the other.

A good example is extensively drug resistant TB, which first hit world headlines during an outbreak in South Africa in 2006. Only four years later in 2010, drug-resistant tuberculosis was at “record levels” worldwide with a total of 58 countries reporting at least one case of MDR-TB.

It took Anna Watterson, a Londoner infected with MDR-TB, 19 months and several rounds of treatment before conquering the infection. “You can’t be isolated from the rest of the world,” she said. “We’ve become too complacent about TB, thinking that it’s gone away. But the reality is that until it goes away in the developing world, it’s not going away anywhere.”

Though medical science will likely stifle the latest evolution of this disease, there can be little doubt new and even more resistant strains will appear.

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