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Online Discussion: Tracking new emerging diseases and the next pandemic

MDR TB

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: February 06 2007 at 2:08am

More India News http://www.newkerala.com/news4.php?action=fullnews&id=90872

Tuberculosis patients cry for attention in Madhya Pradesh

Pahargarh (Madhya Pradesh), Feb 7: Several villagers of Pahargarh in the Morena District of Madhya Pradesh continue to suffer from tuberculosis (TB) due to alleged neglect by state health authorities.

The patients, mostly from poor families of tribal community, said they neither have the money nor a choice to go ahead with treatment for the disease.

"It is very difficult to work with the disease. When we go to get medicines, they fleece us saying that we do not have the medicines. We now don't have any money left with us. So we will die," said Geeta, a patient suffering from tuberculosis.

The medical officer of the public health services in the area, without accepting any lapses on their part, stated he was doing whatever best he can do.

"We have promoted our work though hoarding. We have television programmes about it. Our duty is to do a survey of the patients and bring them to here to test their sputa and those found positive are provided free treatment to them under

Directly Observed Treatment, Short-course (DOTS)," said Shiv Kumar Saimil, medical officer.

Pahargarh, with a population of about 3000, has more than 400 patients suffering from tuberculosis. The figure is on the rise with each passing year.

Although the government has launched various anti-TB measures, including a programme named DOTs under which the workers are supposed to visit the TB-prone villages and treat the patients free of cost, nothing is evident in Pahargarh and many other areas in Morena District.

India's 15 million TB patients account for nearly one third of the world's cases.

According to heath observers, nearly 500,000 die of TB and the disease costs India more than 300 million dollar a year of which more than 100 million dollar is incurred in the form of debt by patients and their families.

Experts say if controls are not strengthened, an estimated 1 billion people will be infected by 2020 and 36 million people worldwide could die.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote tony m Quote  Post ReplyReply Direct Link To This Post Posted: February 06 2007 at 6:11am
A tragic situation. Just about all of the drugs used for tuberculosis and the mycobacteria, including 2nd line agents are now well off-patent and it is beyond reason why the generic pharmaceutical houses persist in price-fixing their already grossly inflated prices.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: February 08 2007 at 4:38am
Birds eye view tricky to post
 
 
  Hi Tony M  that was heartbreaking . More than tragic ,  plain  old neglect for humanity.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote LCfromFL Quote  Post ReplyReply Direct Link To This Post Posted: February 08 2007 at 4:52am
Here's one - very close to home (for me anyway):

"Health Officials Confirm Stanton Student Has TB
Nearly 200 People Tested After TB Case Confirmed At High School"


excerpts:

"JACKSONVILLE, Fla. -- Health officials confirmed on Wednesday that one student at Stanton College Preparatory School has contracted tuberculosis....

...Doctors found that of the 180 tested, 16 had been exposed to the disease...."

Full story here:

http://www.news4jax.com/news/10957636/detail.html
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Post Options Post Options   Thanks (0) Thanks(0)   Quote tony m Quote  Post ReplyReply Direct Link To This Post Posted: February 08 2007 at 9:59am

Food for thought. The article below came out by a team at the Pasteur Institure just this last December, 2006. It seems like besides the cell-wall-deficient forms of TB and MDR TB that that Indian study pointed out makes TB so hard to kill, and the fact that it is one of the few pathogens that likes to house in the body's macrophages, there is now proof of another reason for why you can't totally eradicate the disease, or at least chemotherapeutically......... it hides in the bodies fat.

This is also of interest with regards to Candle's post:
Odds of TB are double for Type 2 diabetics......................................................

It is a well known fact that this type (type 2, by far the most prevalent) of diabetes is associated with age and that weight gain is a strong risk factor. Anyeay, here's the story:


Source: Public Library of Science
Date: December 24, 2006
Full text found on: http://www.plosone.org/article/fetchArticle.action?articleURI=info:doi/10.1371/journal.pone.0000043

Tuberculosis Bacillus Hides From Immune System In Host's Fat Cells

Science Daily — A team from the Institut Pasteur has recently shown that the tuberculosis bacillus hides from the immune system in its host's fat cells. This formidable pathogen is protected against even the most powerful antibiotics in these cells, in which it may remain dormant for years. This discovery, published in PLoS ONE, sheds new light on possible strategies for fighting tuberculosis. Attempts to eradicate the bacillus entirely from infected individuals should take these newly identified reservoir cells into account.

Mycobacterium tuberculosis, the bacillus responsible for tuberculosis can hide, in a dormant state, in adipose cells throughout the body. The bacterium is protected in this cellular environment, to which the natural immune defences have little access, and is inaccessible to isoniazid, one of the main antibiotics used to treat tuberculosis worldwide. These results were obtained by Olivier Neyrolles* and his colleagues from the Mycobacterial Genetics Unit directed by Brigitte Gicquel at the Institut Pasteur, in collaboration with Paul Fornès, a pathologist from Hôpital Européen Georges Pompidou. They raise questions of considerable importance in the fight against tuberculosis.

Tuberculosis kills almost two million people worldwide every year and is considered by the World Health Organisation to represent a global health emergency. However, the bacillus is much more prevalent in the world's population than the statistics would lead us to believe, because only 5 to 10% of those infected actually develop tuberculosis. The bacillus may be present in a significant proportion of the population, remaining in a "dormant" state in the body, sometimes for years, and may be "reactivated" at any time. The risk of rea ctivation is particularly high in immunocompromised individuals, such as those infected with AIDS: the HIV virus and the tuberculosis bacillus make a formidable team, with each infectious agent facilitating the progression of the other.

Neyrolles' team first demonstrated, in cell and tissue cultures, that adipose cells served as a reservoir for Mycobacterium tuberculosis, and that this protected the bacillus against isoniazid. They then investigated whether the pathogen was present in adipose cells in humans. They did this by testing for traces of the genetic structure of the bacillus in samples from people considered not to be infected. Analyses were carried out on samples from deceased subjects from Mexico, where tuberculosis is endemic, and from Parisian districts reporting very few cases of tuberculosis.

The bacterium was detected in the adipose tissue of about a quarter of these people, all of whom were unaware they were infected, in both Mexico and France. These results suggest that the bacillus responsible for tuberculosis can remain protected in the adipose tissue of the body in the absence of any sign of disease.

This work has important implications for the prevention of this disease. It helps to explain how, many years after first testing positive for tuberculosis, people with no trace of the microbe in the lungs may develop some form of tuberculosis attacking the lungs, bones or genitals. It also suggests that isoniazid treatment, prescribed to the close friends and family of patients as a preventative measure, may in some cases not provide sufficient protection against the disease. This is particularly important for immunocompromised patients and for people with AIDS, for whom a secondary infection with tuberculosis bacillus may have very serious consequences.

This work highlights the importance of the search for new targeted therapeutic weapons, such as new antibiotics, which must be able to reach the dormant bacillus that has been hiding in adipose cells without our knowing it.

Citation: Neyrolles O, Hernández-Pando R, Pietri-Rouxel F, Fornès P, Tailleux L, et al. (2006) Is Adipose Tissue a Place for Mycobacterium tuberculosis Persistence? PLoS ONE 1(1): e43. doi:10.1371/journal.pone.0000043 (http://dx.doi.org/10.1371/journal.pone.0000043)

Note: This story has been adapted from a news release issued by Public Library of Science.

       

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 More on the kids , school , high school and prep and TB .
 
Archive Number 20070209.0509
Published Date 09-FEB-2007
Subject PRO/EDR> Tuberculosis, students - USA (FL)
TUBERCULOSIS, STUDENTS - USA (FLORIDA)
**************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 8 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: News4Jax [edited]
<http://www.news4jax.com/news/10965577/detail.html>


For the 2nd day in a row, a Jacksonville student has been diagnosed 
with tuberculosis. On Thu 8 Feb 2007, a student at an Eastside 
school, RL Brown Elementary School, was diagnosed with TB.

School officials sent letters home to parents about the case. 
According to officials, the student is an 11-year-old who has been 
treated and released from the hospital. School officials said next 
week they plan to test 25 classmates and others who have come into 
contact with the 11-year-old.

The health department said it's not clear if the latest case is 
connected to the TB case confirmed the day before at Stanton College 
Preparatory School. A student there also has active TB, which was 
confirmed less than a year after an outbreak at a daycare center 
located directly across the street from the high school. Stanton 
College Preparatory School is less than a one-tenth of a mile from 
Stanton Pre-School, the daycare center that closed shortly after a TB 
outbreak there in April 2006 left 4 young children sick. The 2 
schools are not affiliated.

The health department tested 180 students and faculty at the Stanton 
College Preparatory as a precaution, and found that 16 of them had 
come in contact with the disease. Testing on the 16 students and 
adults exposed to TB continued on Thu 8 Feb 2007.

"We've evaluated a number of them today, and we're continuing that 
evaluation. The ones I've seen today have been started on therapy," 
said Dr. Jeff Lauer of the Duval County Health Department.

The health department said it is taking the proximity of both schools 
into consideration as they look into the high school's TB case. 
Doctors with the health department said Duval County is the 5th 
highest in the state for active TB cases, and that there are 
currently 86 active cases of the disease in the county.

--
ProMED-mail
<promed@promedmail.org>

[Except for issues relating to drug-resistant tuberculosis, ProMED 
has not posted extensively on _Mycobacterium tuberculosis_ disease. 
The proximity of the cases mentioned here, however, is interesting 
and suggests the possibility of common exposure, which can be 
determined microbiologically by DNA fingerprinting the isolates from 
the recent cases and from the daycare center from 2006.

Time-wise, the interval from exposure with conversion of the TB skin 
test to positive and the development of active tuberculosis can be 
years to decades.  Statistically, only about 10 percent of those 
exposed significantly enough to develop tuberculin skin test 
reactivity will develop active infection in their lifetime. It is 
important to note, however, that about half of these will manifest 
within the first 2 years.

It is also important to be aware that treatment of individuals who 
have recently become reactive to the tuberculin skin test can 
decrease the risk of the development of active TB by about a factor 
of 10.  Treatment is classically administered with a single drug, 
isoniazid. Treatment of the active disease, however, involves the use 
of 4 agents. The success of either of these depends on adherence to 
the treatment and the preexisting resistance profile of the infecting organism.

The classical acid-fast staining characteristics of the tubercle 
bacillus can be seen at: 
<http://www.textbookofbacteriology.net/acid-fastbacilli.jpeg>.

A map showing the location of Jacksonville, Florida in the 
northeastern corner of the state can be found 
at:  <http://pics2.city-data.com/city/maps/fr13.gif>. - Mod.LL]

[see also:
2005
----
Tuberculosis, nosocomial - USA (NY)   2003 20051223.3672
Tuberculosis, school - Sweden (Stockholm)   20051028.3140
Tuberculosis, hospital exposures - USA (MA)   20050616.1702
Tuberculosis, nursery school - Spain (Catalonia)   20050523.1416
Tuberculosis, supermarket exposure - Netherlands (Zeist)(03)   20050225.0602
Tuberculosis, supermarket exposure - Netherlands (Zeist)   20050207.0411]
..............................ll/mj/mpp
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They don't screen Healthcare workers?
...........................................................................
 
 
 
 
Date: Fri, 23 Dec 2005

From: ProMED-mail <promed@promedmail.org>
Source: New York Times [edited]
<http://*********/2005/12/23/nyregion/23tb.html>


A New York City maternity ward nurse who had infectious tuberculosis
exposed as many as 1500 patients to the disease over 2 months in
2003, and most likely infected at least 4 infants, according to a
joint investigation by the city's health department and the CDC.

More than 1000 of the patients the nurse came in contact with could
not be found, the CDC said.  It is not clear whether any of them
contracted the disease, but city health officials say they have all
the patients' names and are watching TB registries to see if they
appear. The CDC says it believes that transmission was limited.

So far, the only patients known to have been infected are the 4
infants, who were treated and are now healthy, city health officials
said. So is the nurse, whose identity was not revealed.

While the agency declined to name the hospital, health officials
confirmed that it was the Bronx-Lebanon Hospital Center.

Dr. Kenneth G. Castro, director of the Division of Tuberculosis
Elimination at the CDC, said New York was fortunate to have a health
department with an active tuberculosis control program, because if
the infection of the 4 infants had not been detected, the number of
those who caught the disease could have grown exponentially. Still,
the case underscores the difficulty of providing appropriate
follow-up care for patients exposed to TB in hospitals and other
health-care settings.
 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: February 13 2007 at 5:45am
 http://www.sabcnews.com/south_africa/health/0,2172,143693,00.html

Eastern Cape health is giving XDR-TB drugs 

February 13, 2007, 14:45

New drugs to fight extreme drug-resistant tuberculosis (XDR-TB) have been administered in the Eastern Cape since November, the health department said. They were being supplied at Jose Pearson Tuberculosis Hospital in Port Elizabeth, said Sizwe Kupelo, a department spokesperson.

Kupelo denied reports that the hospital was not using Capreomycin and Para Amino Salicylic Acid because no one knew how to administer them. The other drugs being used in the fight against the diseases are: Amikacin, Kanamycin, Ofloxacin, and Dapsone.

The department also denied reports of at least 18 deaths in the province from XDR-TB. It claimed there had been only five confirmed deaths since November and said 28 cases had been confirmed at the Jose Pearson Tuberculosis Hospital. - Sapa

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 As time goes by ...
 
TB STRIKES SEVERAL RESORT PUB REGULARS

10:40 - 13 February 2007

Health officials have discovered four cases of tuberculosis in drinkers at a Weston-super-Mare pub almost 18 months after an initial scare.
Three regulars at the Elm Tree, on the corner of Orchard Street and Meadow Street, were at the centre of an outbreak of tuberculosis (TB) in September 2005.
The Health Protection Agency has now found four further cases linked to the Elm Tree outbreak after it attempted to trace other drinkers who may have caught the disease.

The agency is working with the North Somerset Primary Care Trust, North Somerset Council, and Weston General Hospital to control the outbreak.
It is not believed the disease is likely to cause a major health concern in the area and a major vaccination programme is not deemed necessary but health officials are urging residents to be aware of the symptoms.

TB is spread through the air when people who have the disease cough or sneeze, but you need to be in very close contact with an infectious person for many days before you could catch it.

Symptoms include a persistent cough that gets progressively worse over several weeks, coughing up blood, loss of weight for no obvious reason, fever, an unusual feeling of being tired and unwell and a lack of appetite.

TB is treated by a course of antibiotics lasting up to six months, and it is important that patients complete the course of drugs.
Anyone with symptoms is urged to see their GP for medical advice.

The Elm Tree pub was shut for several weeks before the outbreak was discovered and has since been refurbished and opened again under new management.
The agency said the pub did not pose a threat to public health.
Dr Joyshri Sarangi, director of the Avon, Gloucestershire and Wiltshire Health Protection Unit, said: "Tuberculosis is spread by people, not places, and the cases we are seeing are among a wider social circle in Weston.

"It appears that older men who may be pub regulars have so far been most at risk from this outbreak. Tuberculosis can be easily diagnosed and treated but, if neglected, the disease can be life-threatening.

"I would urge anyone who thinks they may have the symptoms of tuberculosis to see their GP quickly, so that they can receive appropriate medical advice.
"We are in touch with those people who have had close contact with the known cases of TB so that we can offer them advice and referral to specialist clinics for further investigation.

"Generally, the number of new tuberculosis cases in North Somerset remains very low. As long as any tuberculosis case is diagnosed and treated promptly, there will be no further spread of the disease."

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: February 15 2007 at 5:52am
  Extreme drug resistant tuberculosis, or XDR-TB, has killed at least 183 people in South Africa since September.

SA alters Aids plan after extreme TB threat

February 15, 2007, 14:45

South Africa is overhauling its Aids strategy in a bid to counter the rise of extreme drug resistant tuberculosis which is proving a serious threat to those suffering HIV/Aids, a senior official said today. Extreme drug resistant tuberculosis, or XDR-TB, has killed at least 183 people in South Africa since September.

Most of the victims were already HIV-positive and their immune systems severely weakened by the Aids virus. "One of the areas that we are working on is strengthening specifically that aspect that deals with HIV/TB collaboration," said Nomonde Xundu, the health department's chief director for HIV and tuberculosis (TB).

South Africa is suffering one of the world's worst HIV/Aids crisis, with over 5 million of its 45 million population infected with the virus and up to 1 000 people dying of Aids-related illnesses each day. XDR-TB, which is easily spread in poor areas where people live in close quarters, threatens to compound the crisis as the new strain is immune to almost all drugs now used to treat TB.

Health planners were looking at ways to deal with co-infection of TB and HIV and improve TB screening ahead of the launch of a new Aids strategy in March, said Xundu.

Patient isolation insufficient in preventing spread of TB
Manto Tshabalala-Msimang, the health minister, said drug-resistant mutations of the virus were emerging because TB patients were failing to complete the required course of drug treatment. "Our biggest challenge will still remain the same to ensure that patients complete the prolonged TB treatment," she said.

"Patients understand the need for hospitalisation, fortunately for all of us, and none of the XDR patients have declined treatment after appropriate counselling," she said.

The government did not think measures such as the forcible isolation of XDR-TB patients to prevent the spread of an outbreak was currently necessary, she said. - Reuters

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Post Options Post Options   Thanks (0) Thanks(0)   Quote tony m Quote  Post ReplyReply Direct Link To This Post Posted: February 15 2007 at 7:09am

Perhaps then, South African health officials are finally waking up to the reality that you cannot solve "HIV" without coming to grips with all forms of TB including MDR TB. Of course traditional belief calls for the fact that since "HIV" causes AIDS, TB hops on board afterwards. Oh, is that so?!!

At the risk of being repetitive:

WHICH IS MDR-TB AND WHICH IS HIV? (.........or....which came first, the chicken or the egg)

WHO:
"At least two in three South African TB sufferers are H.I.V. positive."

Although it seems comforting, for those of us who do not have HIV to believe this, there are many reasons to question this notion that most world-based active TB, including MDR and XDR strains need "HIV" to explain "AIDS":

It was in this very same Africa that HIV faced its first and most serious challanges. Not only were over 65% of African AIDS patients not HIV positive (Lancet, Oct. 17, 1992) but, of those that tested positive, data suggested that the antigens in HIV-1 Elisa and Western Blots, initially claimed to belong solely to HIV, were in fact cross-reacting with tuberculosis and the mycobacteria, which includes leprosy. (Kashala,O Infection with human immunodeficiency virus type 1 (HIV-1) and human T-cell lymphotropic viruses among leprosy patients and contacts: correlation between HIV-1 cross-reactivity and antibodies to lipoarabinomannan. J. Infectious Diseases 169(2):296-304. 1994 Feb)

Mycobacterial cell wall components, found in all strains of TB, such as phenolic glycolipid (PGL) and lipoara-binomannan (LAM) were noted not only to strongly cross- react with p24, the sacred cow of 'HIV' isolation, but p31, also favored in the detection of HIV in the blood (Kashala, 1994). Even the most prominent and persistently detected antiben in AIDS tests (Veronese, 1985), p41, could be found in bacteria such as tuberculosis.

The take home message, at the end of the day, is just this: Just how many of these positive AIDs tests are being caused by TB and the mycobacteria?
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 TonyM just how your post said it which comes first the chicken or the egg == Dr. Keith Cloete, director of TB for the province, said a 23-year-old
Cape Town woman had died in the Brooklyn Chest Hospital on 5 Feb
2007,
but XDR TB had only been diagnosed after death.
Archive Number 20070220.0638
Published Date 20-FEB-2007
Subject PRO/EDR> Tuberculosis, XDR - South Africa (04)
TUBERCULOSIS, XDR - SOUTH AFRICA (04)
*************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 20 Feb 2007
From: ProMED-mail <promed@promedmail.org>
Source: Independent Online [edited]
<http://www.iol.co.za/index.php?set_id=14&click_id=125&art_id=vn20070220112202862C923242>


The deadly drug-resistant strain of tuberculosis has claimed its 1st 
life in the Western Cape and 5 new sufferers have been diagnosed.

This brings to 8 the number of people identified with "extensively 
drug-resistant" tuberculosis -- XDR TB -- in the province so far.

Dr. Keith Cloete, director of TB for the province, said a 23-year-old 
Cape Town woman had died in the Brooklyn Chest Hospital on 5 Feb 
2007, but XDR TB had only been diagnosed after death.

In 2006, this strain killed more than 50 people in KwaZulu-Natal and 
more than 300 cases have been confirmed countrywide.

Four of the 5 new local cases have been admitted to Brooklyn Chest 
Hospital, where they are being treated in isolation along with the 
1st 2 cases, an 11-month-old baby from Khayelitsha and a 43-year-old 
woman from the Eastern Cape, who fell ill while visiting Cape Town 
over Christmas.

--
ProMED-mail
<promed@promedmail.org>

[Many of the initial cases described in KwaZulu-Natal also died 
before the diagnosis of XDR TB was made. This reflects the rapid 
progression of the disease when not treated properly and the 
co-infection (in almost all) with HIV.

The presence of XDR TB in an 11-month-old child underscores the 
observation that much of the disease is due to acquisition of the 
resistant bug, not selection of resistance in a patient non-adherent 
to therapy for an initially more sensitive mycobacterium. Young 
children with TB usually mean active disease in close family members 
or other caretakers.

A map of South Africa showing the Eastern and Western Cape Provinces 
can be found at:
<http://www.un.org/Depts/Cartographic/map/profile/southafr.pdf> - Mod.LL]

[see also:
Tuberculosis, XDR - South Africa (03)   20070209.0504
Tuberculosis, XDR - worldwide   20070205.0456
Tuberculosis, XDR - South Africa (02)   20070128.0375
Tuberculosis, XDR - South Africa: interventions   20070126.0349
Tuberculosis, extensively drug-resistant - Canada (ON) (02)   20070125.0340
Tuberculosis, extensively drug-resistant - Canada (ON)   20070124.0318
2006
----
Tuberculosis, multiresistant - Hungary   20061110.3233
Tuberculosis, multiresistant - South Africa (KN)(04):nationwide   20061019.3003
Tuberculosis, multi-drug resistant - South Africa (KN)   20060904.2514]
......................ll/mj/dk

http://www.promedmail.org/pls/promed/f?p=2400:1001:4326725834056541844::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1010,36408
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Post Options Post Options   Thanks (0) Thanks(0)   Quote tony m Quote  Post ReplyReply Direct Link To This Post Posted: February 20 2007 at 4:15pm
Here's what happens when you are BIG PHARMA and you know only too well that your test can be positive not only for "HIV" but for TB and MDR-TB.Kindly note the statement
AIDS, AIDS-related complex and pre-AIDS ARE THOUGHT to be caused by HIV.
Now, what if they are not caused by "HIV". Here's what. First pharmaceutical houses will lose billions each year by breaking their stranglehold on poor AIDS victims wallets. Second, by being forced to address the real etiology behind AIDS, that condition itself might be cured as a by-product of the successful developement of an MDR-TB biological that can be used in treatment and cure. Third, WHO will have to revise its annual mortality rating for TB and MDR-TB from "almost 2 million" to in excess of 5.


Companies back down on HIV∫AIDS claim

Astonishing revelation on Barnes blog by Culshaw

Elite critics reach critical mass on expanded blog

In an extraordinary development, companies making HIV tests are backing down on their claim that HIV is the undisputed cause of AIDS.

Mathematician Rebecca Culshaw has just posted a very important note on the blog Barnesworld, now renamed "You Bet Your Life", at Dear Dr. Culshaw: "Well, What About Those Tests?".

Culshaw has discovered that the inserts with AIDS tests show that the companies that make them have been backing down over the past year or two in the firmness of their statements that HIV is the cause of AIDS. She writes:
I doubt even more that the majority of medical practitioners are aware of the subtle but significant shift in the language used in HIV test kits since the beginning of the AIDS era. For example, from 1984 until the very recent past, test kit inserts contained the unambiguous statement AIDS is caused by HIV. In 2002, the OraSure toned down that statement to say: AIDS, AIDS-related complex and pre-AIDS are thought to be caused by HIV.

But just this year, in a remarkable and potentially significant shift in thinking, the trend seems to be toward making an even less committal statement. For example, Abbott Diagnostics ELISA test insert contains the following sentence: Epidemiologic data suggest that the Acquired Immune Deficiency Syndrome (AIDS) is caused by at least two types of human immunodeficiency viruses, collectively known as HIV.

Vironostika appears to be even less willing to support a true causal role, as their 2006 test kit insert says: Published data indicate a strong correlation between the acquired immune deficiency syndrome (AIDS) and a retrovirus referred to as Human Immunodeficiency Virus (HIV).
This remarkable shift in corporate conviction is as yet unexplained, but we suspect it has a lot to do with the appearance on the Web over the last two years of a copious amount of intelligent material undermining the sanctity of the paradigm, now increasingly crippled by mainstream papers removing the pillars of evidence supporting it.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: February 24 2007 at 5:54am
 Testing testing 123 testing....
TB patients misdiagnosed

    February 24 2007 at 12:59PM

By Tash Reddy

South Africa's desperate tuberculosis epidemic can only get worse as thousands of infected people have been sent back into their communities because of inadequate testing.

The World Health Organisation in October last year advised the South African national Department of Health to adopt more expensive screening methods.

Before this thousands of TB infected people went undetected as screening methods used - a standard, smear-sputum test - failed to diagnose the disease, resulting in misdiagnosed, infected people spreading the disease unknowingly in their communities.

Pietermaritzburg physician Doug Wilson, an expert on smear-negative TB, said about 60 percent of TB cases are smear-negative. "In communities with high HIV prevalence (ie. most of South Africa) smear-negative TB is a major health issue, and probably also a major cause of death," he said.

He said these cases are much more difficult to diagnose and can usually only be done by experienced doctors who are trained to recognise the condition.

He added that smear-negative TB is more common in people living with HIV and up until the recent adoption of the WHO amendments, diagnostic tests were inadequate.

"TB was diagnosed by detecting acid-fast bacilli (the TB germ) in sputum specimens using a test called the sputum smear. This is a quick, cheap test (turn-around time usually 48 hours) and is good at detecting highly contagious forms of pulmonary TB.

"However, people with smear-negative TB will go to their clinic with TB symptoms, and are sometimes told that they don't have TB because their sputum tests are negative. These patients can become very ill from TB before it is diagnosed in a hospital setting." Wilson added that the best way to diagnose TB is by doing a culture - usually on a sputum specimen. "This is a lot more sensitive and will usually pick up those cases. Culture results are much slower than smear tests (up to 6 weeks) and much more expensive," he added.

Deputy director of the Centre for the Aids Programme of Research in South Africa (CAPRISA), Nesri Padayatchi agreed that it is a problem as the South African guidelines still focus mainly on smear-positive TB.

"One of the problems with the dual epidemics of TB and HIV is that in co-infected patients that are immunocompromised, these patients are unable to mount an immune response and subsequently they present with pauci bacillary TB (ie. there are few TB organisms in their sputum) and the diagnosis in such patients may be missed." she said.

However, National Department of Health spokesman Charity Bhengu said the department has already adopted the WHO amendments and are committed to ensuring no TB infected person goes undetected. "If the HIV status is unknown and sputum is negative on microscopy but on clinical grounds we have a strong suspicion of pulmonary TB, then culture and sensitivity of the sputum will be undertaken," she said.

A report released by the Treatment Action Campaign said SA not only has one of the highest HIV and Aids rate in the world but also one of the highest incidence rates for TB worldwide (558 per 100 000) and this is increasing drastically as the HIV epidemic worsens.

Meanwhile,the SA Medical Research Council (MRC) has high hopes that South Africa will have a new test for extremely-drug resistant tuberculosis (XDR-TB) as early as the end of the year. It will cut diagnosis time from two months to just two days. This was disclosed by MRC head Professor Anthony Mbewu on Friday as news broke that XDR-TB had claimed its first life in the Western Cape.

Late last year, Find Diagnostics (Foundation for Innovative New Diagnostics) announced the development of a molecular test to screen for multi-drug resistant TB. Effectively, according to a press statement from the foundation, the test is done directly on sputum from patients with advanced disease, "dramatically speeding up the detection of drug resistance by giving next-day results".

The foundation said the move to fine-tune this test was a rapid response to outbreaks of untreatable and often fatal XDR-TB detected in South Africa and other countries.

"Detecting and effectively treating multi-drug resistant TB helps prevent the development of XDR-TB," they said.
http://www.iol.co.za/index.php?set_id=1&click_id=13&art_id=vn20070224084546586C432393
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"these patients are unable to mount an immune response and subsequently they present with pauci bacillary TB (ie. there are few TB organisms in their sputum) and the diagnosis in such patients may be missed, she said."

First of all TB in and of itself is often and traditionally "pauci bacillary", but there is a larger diagnostic problem here that is being completely ignored, as is why they are missing visualization of the germ left and right. This is touched upon by Lida Mattman in her description of TB and MDR-TB in "Cell Wall Deficient Forms - Stealth Pathogens":

It is apparent that in any tissue the tubercle bacillus grows minimally as an acid-fast rod, the predominant growth consisting of pleomorphic structures, acid-fast only with modified stains. (Xalabarder, C., Formas L de microbacterias y nefritis cronicas, Publ. Instit. Antitubercul. Sup., 7:1-83, 1970)

These are the viral-like forms of TB with no intact cell-wall membrane, which look like viruses and evade the radar (stealth pathogens) of traditional TB staining. They are also the preferred form that TB and the mycobacteria, for protective reasons, like to assume.

In a long series of cases, employing the sensitive auramine-rhodamine fluorescent stain, only 50% of the specimens eventually yielded positive cultures which showed bacilli indirect smears. (Pollack HM and wieman EJ. Smear results in the diagnosis of mycobacterioses using blue light microscoy, J. Clin Microbiol., 5:329-331, 1977)

Furthermore, Mattman goes on to point out: Blood (above sputum) is an exellent source for which to find these viral-like cell wall deficient forms of TB, SINCE APPROXIMATELY HALF OF PATIENTS WITH ACTIVE TUBERCULOSIS PRODUCE NO SPUTUM.(Chawla R Pant K. Fibeoptic bronoscopy in smear-negative pulmonary tuberculosis, Eur. respir. J., 1:804-806, 1988)

Also there is no confusion (using blood) caused by the rich normal flora of organisms native to sputum and gastic washings. Blood usually yields a positive culture whether the tuberculous infection is in lung, meninges or other organs.

The problem these people are facing is not in culturing these stealth forms of TB and MRD-TB because they can culture them in any of their standard culture media, it is in the staining that they are off. They should be using Kinyoun's stain, acridine-orange stain, Victoria Blue stain and the periodic acid method. And until they do so, they are getting,at most, half the story.
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Now its the money $$$$$$$$$$
 
Drug-Resistant TB Needs $650 Million Effort, WHO Says (Update2)

By John Lauerman and Lisa Rapaport

Feb. 26 (Bloomberg) -- Hospitals and clinics in developing countries need infection control equipment and personnel to stop the spread of drug-resistant tuberculosis that kills two-thirds of people infected, doctors said today.

A strain of the disease, called XDR-TB, has reached at least 28 countries, including the U.S., and is not yet under control, said Paul Nunn, head of the World Health Organization's Stop TB department at a meeting in Los Angeles today. That compares with 17 less than a year ago, he said.

The WHO yesterday said it is asking the U.S. and other donor countries and groups to provide $650 million to improve diagnosis and treatment for XDR-TB, an increase of almost a half-billion dollars over 2006. The strain can raise treatment costs from about $60 to as much as $15,000 per case in some poor countries because so few drugs can be used, doctors said.

In South Africa, ``there are literally thousands of patients in long waiting lines and congested waiting rooms who are at risk of being exposed,'' said Karin Weyer, head of TB control for the South Africa Medical Research Council, in an interview. `I'm very concerned.''

Resistant strains themselves probably aren't spreading from country to country, Nunn said. The bloom in XDR-TB, or extensively drug-resistant tuberculosis, is most likely linked to inadequate treatment of tuberculosis in a variety of settings and countries. In the U.S., about four percent of TB patients have the resistant form.

``The drugs used are more or less the same everywhere,'' he said today in a speech at the 14th annual Conference on Retroviruses and Opportunistic Infections. ``Unfortunately, so are the defects in TB control.''

Lilly's Capastat

Treating resistant strains such as XDR-TB requires drugs such as Eli Lilly & Co.'s Capastat, which can cost more than $4,000 per case, Nunn said. Weyer said in South Africa those costs can reach as high as $15,000.

New drugs that might be effective against XDR-TB are at least five years away from testing, Nunn said.

People with impaired immune systems, particularly those with HIV, are susceptible to tuberculosis. That presents problems because as many as one-third of South African health workers have the disease, Weyer said.

African hospitals need ventilation systems and people specifically trained in infection control to prevent the spread of tuberculosis germs through the air, she said.

``This is something that the HIV community needs to be aware of,'' Nunn said.

There were an estimated 650 XDR-TB cases in South Africa last year, 330 of them confirmed, and all nine provinces were affected. There were 106 cases of XDR TB confimed last year in an outbreak in Tugela Ferry alone, the focus of the KwaZulu- Natal outbreak in South Africa, Weyer said.

Link to HIV

The vast majority of XDR-TB infections occur in people whose immune systems are damaged by HIV, and about 84 percent of those patients died, she said. About one-third of South African health-care workers are thought to be HIV-infected.

``This raises difficult issues for HIV testing for health care workers in this environment,'' said Kevin de Cock, director of the WHO's HIV/AIDS program, in the news conference.

The report was presented at the 14th Conference on Retroviruses and Opportunistic Infections.

To contact the reporter on this story: John Lauerman in Boston at jlauerman@bloomberg.net .

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ProMed post below for West Cape Area this post East Cape
 
Posted to the web on: 28 February 2007
Eight new XDR-TB cases in Eastern Cape 
Sapa

EIGHT new cases of extreme drug resistant tuberculosis (XDR-TB) have been diagnosed in Eastern Cape, the provinces health department said today.

It said this brought to 41 the number of patients identified with the disease in the province since November last year. During this period the disease had claimed at least five lives.

The new cases were discovered in patients already admitted to Port Elizabeths Jose Pearson TB hospital for multi-drug resistant TB.

"The situation is under control as the infectious disease is not spreading at an alarming rate in the province," the department said in a statement. It said it was on full alert, and had established isolation wards at Jose Pearson, Fort Grey TB Hospital in East London, and Nelson Mandela Academic Hospital in Mthatha.

XDR-TB first emerged in SA in the Tugela Ferry region of KwaZulu-Natal in 2005. The strain has killed more than 50 people in KwaZulu-Natal and more than 300 cases have been confirmed countrywide.

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For those that think that TB cannot kill in a matter of weeks: "At present, it has killed 98% of those infected within about two weeks."

And for those who think that MDR-TB is not on a par with Bird Flu: "The World Health Organization has called for the world to prioritise XDR-TB on par with bird flu and recommended governments in impoverished sub-Saharan Africa develop one strategy to deal with the twin
challenges of HIV and TB".

Story below:


Call for deadly TB isolation move

South Africa should forcibly isolate patients infected with a deadly strain of TB to stop the disease spreading on the HIV-hit continent, experts say.

South Africa's outbreak of the multi drug-resistant XDR-TB has killed at least 74 people in the past few months.

Writing in the PLoS Medicine journal, the ethicists and HIV experts said the outbreak represented a "major threat"

They said it may force authorities to override personal rights for the greater good.

"Ultimately in such crises, the interests of public health must prevail over the rights of the individual"
said Jerome Singh, of the Centre for Aids Programme of Research

Jerome Singh, a lawyer at the Centre for the Aids Programme of Research in Durban, South Africa, said: "XDR-TB represents a major threat to public health. If the only way to manage it is to forcibly
confine then it needs to be done.

TB, an airborne bacillus spread through coughing or sneezing, can usually be cured through treatment.

However, the XDR-TB strain may have mutated when patients skipped treatment or were dispensed inadequate antibiotic cocktails.

The study, co-authored by the Aids programme and the University of Toronto's Joint Centre for Bioethics, said South Africa has logged almost 400 cases of XDR-TB, which is virtually impervious to treatment by most common TB drugs, and an unprecedented 30 new cases are
diagnosed every month.

At present, it has killed 98% of those infected within about two weeks.

The outbreak has alarmed medical experts who say XDR-TB poses a particular danger to HIV-positive people whose immune systems are already severely compromised by the AIDS virus.

South Africa has one of the highest HIV rates in the world with about 5.5m people infected in a population of 45m.

Most of those who died of XDR-TB have tested positive for HIV.

Mr Singh said South Africa's highly mobile workforce, rising overseas tourism, and the prevalence of XDR-TB in Johannesburg, the main transportation hub, increases the chance of XDR-TB spreading past national borders and into other African countries struggling with high
HIV/AIDS infection rates.

Duty

And he added it was the public's duty to press the government into opening the debate.

In South Africa, XDR-TB patients may visit hospitals as out-patients and then go home, which means they can easily pass the disease in their community.

However, the experts said the challenge to control XDR-TB requires not just policy changes but also more state spending.

Mr Singh said long-term hospital stays increase the national health-care tab and burden overstretched clinics particularly in rural areas with heavy patient loads, adding hospitalized XDR-TB patients
should automatically qualify for a social grant.

The World Health Organization has called for the world to prioritise XDR-TB on par with bird flu and recommended governments in impoverished sub-Saharan Africa develop one strategy to deal with the twin
challenges of HIV and TB.

South Africa's health department said it had discussed the possibility of enforced isolation with the World Health Organization, but had not yet reached a conclusion.

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr//2/hi/health/6289841.stm

Published: 2007/01/23 10:06:46 GMT

BBC MMVII
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Lets get to know Russia and TB   MRD   Drug-resistant TB on rise in Russia...

 

Experts fear world health crisis as new strains flourish in poor conditions

Mar 03, 2007 04:30 AM

Michael Mainville
Special to the Star

MOSCOWOnce a hospital for Napoleon's troops, Moscow's Phthisio-Pulmonary Institute is now home to hundreds of Russian patients suffering from dangerous new strains of tuberculosis. Quarantined for months on end, they rest on shabby beds or shuffle through the corridors in cotton face masks. On the ground floor, a young man in pyjamas sits by a window looking out onto a snowy courtyard, chatting on his cellphone with a pretty girl shivering in the cold outside.

The patients have been sent here from across Russia after they failed to respond to traditional drug treatment for TB, a highly contagious bacterial infection that can be deadly.

TB remains one of the most common infections in the world's poorer countries. As in most Western countries, TB was all but eliminated in Russia under the Soviet system. But it has flourished here in recent years, feeding on the poverty and lack of proper health care that followed the Soviet collapse. According to the World Health Organization, Russia registered nearly 120,000 new TB cases in 2005, compared with only 1,616 in Canada.

Worryingly, Russia has also become a breeding ground for drug-resistant strains of TB. According to the WHO, nearly 20 per cent of patients in Russia are suffering from multi-drug-resistant TB, or MDR-TB, which develops if patients are treated improperly and then becomes contagious as a new strain.

Of those, some are developing a virulent and incurable strain known as extensive-drug-resistant tuberculosis, or XDR-TB, which experts warn could cause a global health crisis.

"This is a very serious health problem, with very serious risks," says Sergei Borisov, the Phthisio-Pulmonary Institute's deputy director. "XDR-TB is the next step in the evolution of TB. We already have 30,000 people with drug-resistant strains who are a danger to the people around them and to the whole world."

The majority of Russia's TB cases can be traced to the country's overcrowded and underfunded prison system. Alcoholics, the homeless and migrant workers are also especially susceptible to the disease. But health experts say TB is increasingly spreading into the general population.

Dmitri Kozlov, a 24-year-old patient at the institute, was an active student when he was diagnosed with TB two years ago. He says he has no idea how he contracted the disease. He didn't respond to a first round of treatments and was diagnosed with MDR-TB eight months ago. After being sent to the institute, he had a second round of drug treatments and seems to be recovering.

"It's been a very difficult time, but I've made a lot of progress and I hope I will be going home soon," he says, his voice muffled by a cotton mask he must wear over his mouth and nose.

Borisov says he's happy for his young patient, but still worries.

"If he has a relapse, there's a strong chance it will develop as XDR-TB," Borisov says.

Few Russian doctors, even TB specialists, seem to be aware of the new strain. Murray Feshbach, an expert on Russian health policy at the Washington-based Woodrow Wilson International Centre for Scholars, says that on a recent fact-finding trip to Russia almost none of the doctors he interviewed in Moscow and St. Petersburg knew about XDR-TB.

"At first, HIV/AIDS was ignored and the same thing appears to be happening here," says Feshbach, who is researching a report on XDR-TB in Russia. In the early 1990s, Russian health officials refused to accept the dangers of HIV/AIDS and today the country is suffering from a severe epidemic of the disease, with an estimated 1 million Russians infected with HIV.

"We need to head this off before it gets worse. Russia is potentially a source for a very dangerous form of drug-resistant TB," Feshbach says.

Attempts are being made to tackle Russia's TB epidemic and with state coffers swelling thanks to booming energy prices, the Russian government is spending more. Health Minister Mikhail Zurabov last month announced a five-year, $3 billion (U.S.) program to fight diseases such as TB, diabetes, HIV/AIDS and cancer, saying the government hopes to stem Russia's rapid population decline.

More money is also coming from the international community. The Global Fund to Fight AIDS, Tuberculosis and Malaria, which has received about $430 million in funding from the Canadian government, is providing about $100 million for TB projects in Russia over the next five years, mostly focusing on increasing doctor training and buying new equipment to fight drug-resistant strains.

Sitting in his cramped office at the Phthisio-Pulmonary Institute, Borisov says he believes more money for training and equipment will help. But he says Russia also needs to tackle social ills like rampant alcoholism, poverty and inadequate housing if it wants to come to grips with TB and stop it from spreading.

"The fight against TB in Russia is not only a medical problem. It's a social problem."

 http://www.thestar.com/News/article/187819

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Lets get to know Russia and TB MRD Drug-resistant TB on rise in Russia......or, by getting to know Russia's problem, we get to know a bit more about our own. Not only are adults getting hit, but children as well.


A major part of this MDR-TB resurgence in Russia, as elsewhere, is fueled by cell-wall-deficient (CWD) forms of TB, also called "L-forms", which are stealth viral-like and resistant to conventional TB treatment. It is not that Russian scientists have been unfamiliar with this. On the contrary:

By the 1990s the Russians had hit their stride with regards to L-forms, light years ahead of American scientists, many of whom either completely ignored them as nonexistant, or made light of their importence.

Gadzhievs study, in a target-oriented search for the altered L-Forms of tuberculosis in children,using special L-Form stains, provided a significant increase in the proportion of the cases that were documented as smear-positive for tuberculous meningitis. Again, these same L-forms persisted, even during taking TB medication, indicating the possibility of a chronic and relapsing disease. (Gadzhiev GS Characteristics of the mycobacteria in children with tuberculous meningitis Probl Tuberk. (11):8-10 1990)

And just how high the percentage of L-forms can be in not only children, but adults with TB meningits was shown by Insanov in his comparative analysis. L-forms in tuberculosis meningitis accounted for 87.6% of the tuberculosis found in children with TB meningitis and 87.3% of those organisms like-wise isolated in adults. (Insanov AB Gadzhiev FS Comparative analysis of the results of spinal fluid microbiological study in children and adults who suffered from tuberculous meningitis. Probl tuberk. 1996; (5):25-8)

Why? Because it is exactly these filterable units of CWD tuberculosis or L-forms that can easily penetrate the blood-brain barrier (Biron MG Soloveva Acute hematogenic generalization of tuberculosis caused by L forms of Mycobacteria Probl. Tuberk., 8:75-6, 1989), especially the blood brain barrier of the not fully immunocompetant neonate or infant or young child.

Insanov added to this knowledge, saying that the viral-like L-forms of tuberculosis not only made tuberculosis chemotherapy less effective but were also accompanied by an insidious onset and the slow accumulation of pathologic change in children, not only making the disease more difficult to diagnose, but allowing months to years before its full spectrum of pathologic change was felt.

Russian Cases of children who have died exclusively from L-forms are on record, such as the 3-year-old in Zemskovas documentation (Zemskova ZS Generalized TB Caused by L Forms of TB Mycobacteria In a Child Prob. Tuberk. 2:64-6 1985.)





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