thepeel
Joined: 08 Aug 2004
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 Posted: Mon May 21, 2007 1:43 am Post subject: Superbug poses dire threat to Africa |
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STEPHANIE NOLEN
From Monday's Globe and Mail
May 21, 2007 at 4:54 AM EDT
DURBAN, SOUTH AFRICA � Tony Moll knew there was a problem, a grave problem. To tell him so, he had a ward full of patients who were sicker by the day.
But the gentle doctor, a veteran of 20 years of practice in a rural town in the low hills of KwaZulu-Natal province, never considered that he was looking at a problem that some public-health experts say may be the worst threat to humanity in the past half-century.
When the lab called to tell him just what was wrong with those patients, the news left him "in shivers." The Church of Scotland Hospital in Tugela Ferry, an old mission station of low, graceful stone buildings where Dr. Moll is the chief physician, now has the macabre title of "home of XDR TB" - extensively drug-resistant tuberculosis.
The TB bacillus, a bug that has been pesky but totally treatable since the advent of antibiotics in the 1940s, has suddenly morphed into something virtually incurable. And the disease is spread not with a complex exchange of bodily fluids, like AIDS or Ebola, but simply by laughing, talking, coughing or breathing.
Feeding off a vulnerable population and a health system staggering under the challenge of the AIDS epidemic, XDR may already have spread from South Africa, creating the danger of an uncontrollable epidemic on the continent.
After Dr. Moll got the call from the lab, he started keeping track of patients with XDR. In a matter of days, it killed 52 out of 53 people who had it, most within two weeks of arriving at the hospital.
Almost all of them were diagnosed posthumously, because the TB killed them before the lab ever got the diagnostics finished.
"We're losing ground again, facing another untreatable condition," said Dr. Moll, a veteran of the fight with AIDS. "It's put us in a hopeless situation."
Origin of an outbreak
The journey to Dr. Moll's terrifying discovery began in early 2005, when he noticed something peculiar. The staff at his hospital had become accustomed to the marvellous "Lazarus effect" of anti-retroviral treatment for AIDS: seeing desperately sick people quickly start gaining weight and return home or go back to work. But now, in his ward, he had two men in their 30s on ARVs whose HIV infections were suppressed to undetectable levels. Yet their TB, which would normally have cleared up in a matter of weeks, kept getting worse.
He suspected multidrug-resistant TB, or MDR, believed at the time to be as bad as the disease could get. So he collected sputum from 45 patients and sent it off to a lab in Durban for cell culturing. (The only way to tell if a TB strain is drug-resistant is to grow cultures from a patient sample, zap it with the different drugs and see which, if any, fail to kill it.) The process takes six to eight weeks. "In that time, we more or less forgot about it," Dr. Moll said. One of his two young men died.
But the phone call from the lab, when it eventually came, slammed the issue to the top of their agenda: Of the 45 samples, 10 were indeed drug-resistant. But they weren't resistant to just one or two of the drugs used against TB. They were resistant to all six medications available for use in Tugela Ferry. In other words, there was nothing to cure that TB at all.
"That was so scary," Dr. Moll said. His first thought, he confessed, was personal - for himself and his staff. "Because you're talking about airborne transmission, and this means if a patient has got it, you as a doctor or a nurse working with that patient are breathing it in ... you are breathing in XDR as part of your job." Four health workers were among the 52 people who had died. |
http://www.theglobeandmail.com |
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