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Doctors Fear Rise of Totally Drug-Resistant Tuberculosis

Update Date: Feb 12, 2013 01:18 PM EST

Tuberculosis is already a threat. The World Health Organization reports that, in 2011, 8.7 million fell ill with the second-deadliest infectious disease and 1.4 million people died. Drug-resistant tuberculosis is already a problem. However, a growing, potentially disastrous trend is on the rise: tuberculosis that is totally resistant to virtually every antibiotic that doctors have at their disposal. If the problem is not properly managed, the lack of antibiotics could give way to a global panic. Already in South Africa, multi-drug resistant tuberculosis (MDR) and extremely drug-resistant tuberculosis (XDR) have lowered South Africa's tuberculosis cure rate from 73 percent in 2008 to 53 percent just two years later.

According to U.S. News and World Report, Dr. Uvistra Naidoo contracted tuberculosis from treating patients in his clinic. At the time, he was an avid runner, so even though he felt chest pains and flu symptoms, he did not suspect that anything was wrong. When he visited family though, they took note that he had lost 30 pounds. A subsequent visit to the doctor revealed that one lung was entirely filled with fluid.

Dr. Naidoo nearly died, and his treatment regimen lasted for three years. His side effects were perhaps worse than the disease itself, he said. He developed Stevens-Johnson Syndrome, a sometimes deadly condition that causes layers of skin to separate from one another. He bled from his eyeballs regularly. While he acknowledges that his treatment was ultimately successful, he notes that the three-year period is too long for most people. Ultimately, most cases of drug-resistant tuberculosis appear because people do not complete the antibiotic regimens, prompting the bacteria to become resistant to that medication.

Totally resistant tuberculosis, which is resistant to every last antibiotic that doctors have at their disposal, has been documented by researchers from Stellenbosch University in South Africa and the University of Basel in Switzerland. Apparently most prevalent in South Africa, the disease has also been documented in India, Iran and Italy. Even MDR has been documented in New York City, where an outbreak in a hospital killed 29 of 32 infected patients, and was only contained from the general population with the help of millions of dollars. However, because doctors do not often test for the strain of the disease, it is unknown exactly how many cases exist.

In December, the Food and Drug Administration approved bedaquiline, which will be the first new class of TB drugs in over 40 years. Doctors are uncertain about how effective the drug will be against TDR, but are hopeful. Regardless, they say that one new class of drugs will be ineffective; if new drugs are not developed quickly, the bacteria will adapt to this one as well. Doctors say that we need completely new treatment regimens.

The study is published in an upcoming issue of the journal Emerging Infectious Diseases.

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