Associated Press

LUBBOCK, Texas - Concerned that about 2,800 people may have been exposed to tuberculosis at a West Texas hospital, state health officials are mailing warnings encouraging testing for the disease.

The possible exposure at Lubbock's University Medical Center occurred between September and November of last year, but the hospital was not alerted until last month. Privacy laws don't allow the hospital to name who caused the possible exposure to TB.

Hospital employees are tested for TB each year, hospital spokesman Greg Bruce.

The Texas Department of State Health Services said only people who receive the letter should be tested. The agency stressed this was not an outbreak.

"There's no immediate danger," Bruce told the Lubbock Avalanche-Journal for Thursday editions.

TB is caused by bacteria that can attack the kidney, spine and brain, according to the Centers for Disease Control and Prevention. The disease can be fatal if left untreated.

Letters are standard procedure whenever TB is reported, state health services spokesman Barry Wilson said. He noted that officials were very liberal in compiling the list of people who may have been exposed.

"Unless they've been coughing for three weeks or more, it's not something they should be overly concerned about," Wilson said. "This is really a routine procedure for us."  Thats like a Monty Python movie { only a flesh wound }

Dr. Richard Lampe, the hospital's chairman of infection control, said it was doubtful that anyone exposed at UMC would show symptoms yet.

“We are awed by our friend Warren Buffett’s decision to use his fortune to address the world's most challenging inequities, and we are humbled that he has chosen to direct a large portion of it to the Bill & Melinda Gates Foundation.

Over the past 15 years, we have enjoyed a special friendship with Warren, and his advice has had a major influence on us. Warren has not only an amazing intellect but also a strong sense of justice. Warren’s wisdom will help us do a better job and make it more fun at the same time.

The impact of Warren’s generosity will not be fully understood for decades. As we move forward with the work, we do so with a profound sense of responsibility. Working with Warren and with our partners around the world, we have a tremendous opportunity to make a positive difference in people’s lives.”

Read more about the announcement on http://money.cnn.com/2006/06/25/magazines/fortune/charity1.fortune/index.htm - Fortune.com .

###
http://www.gatesfoundation.org/ - Bill & Melinda Gates Foundation
Guided by the belief that every life has equal value, the Bill & Melinda Gates Foundation works to reduce inequities and improve lives around the world. In developing countries, it focuses on improving health, reducing extreme poverty, and increasing access to technology in public libraries. In the United States, the foundation seeks to ensure that all people have access to a great education and to technology in public libraries. In its local region, it focuses on improving the lives of low-income families. Based in Seattle, the foundation is led by CEO Patty Stonesifer and Co-chairs William H. Gates Sr., Bill Gates, and Melinda French Gates.

...................................................................................................................

Odds of TB are double for Type 2 diabetics

A 38-YEAR-OLD heroin addict was the thinnest man a doctor had carried out a post-mortem on in his whole career, an inquest heard.

Mark Cordina died at home in Normandy Close, Sydenham, on October 4 last year after a long struggle with his addiction and undiagnosed Tuberculosis.

The former mechanic fitter, unable to work since 2002, began having chest problems in 2003.After refusing treatment on several occasions and only contacting doctors at The Vale Medical Centre, Perry Vale, Forest Hill, by telephone, his condition worsened and made him unable to eat properly.

Mum Geraldine told Southwark Coroner's Court: "In the evenings I would make ham, egg and chips and a milkshake, but he'd never eat it all.

"When he had anything big, he couldn't breathe properly, so he would only have small amounts."

Two days before Mr Cordina's death, he was violently sick but refused to be taken to hospital.

Ms Cordina added: "The surgery faxed a script to the chemist to stop him being sick and said they would send a doctor if he did not get better.

"But the next day he seemed okay and we spent most of the evening watching television."

He woke his mum at 5.30am on the following morning, asked for a drink and then went back to bed.

Ms Cordina said: "I went back at about 9am and he was just lying there, cold and not breathing.

"I shook him, screaming to wake him up, but I knew he was dead."

Doctor Peter Jarreat, who performed Mr Cordina's post-mortem, said: "He was suffering from severe malnutrition.

"This, combined with the pulmonary TB, was a contributory factor in his death.

"TB would have been the reason for the malnutrition.

"I don't think I've seen a body that emaciated in my whole career."

Coroner John Sampson said Mr Cordina had declined intervention from the ambulance service.

He added: "I conclude the cause of death is natural cause."

9:43am today

It can take a very long time (months or even years) from the time a person is exposed to TB to them showing any symptoms of the disease.If the body's defences become weak the infection may reactivate, becoming full-blown TB   Question time if I may ..... with all the people unaware of TB in their system what would happen if they were to be hit with the BF virus ? Ages ago I read on gov site , can't find it now be kind I am a blonde who speed reads they , the gov site had a graph for pandemics , there was an unnamed one after BF . I have not seen a whisper of that graph since but often think about it .

This week's news that a second East Gadsden High School student had been discovered with tuberculosis was a shock to county residents. But officials say they're taking an aggressive approach to the health problem.

"Testing is ongoing," said Sylvia Byrd, administrator for the Gadsden County Health Department, which is reporting an abundance of phone calls from concerned residents, "and precautions are being taken to ensure transmission remains at a minimum."

"Common symptoms of TB include fever, cough, night sweats and weight loss," he noted. "Tuberculosis is treatable, and medicines can help a person fully recover."

The two students have been isolated from other students and given medication, he said. Department officials declined to comment on their current condition.

According to the Mayo Clinic's Web site ( http://www.mayoclinic.com/ - www.mayoclinic.com ), TB symptoms take several weeks to develop. It also stated that there are differences between TB infection and active TB. With TB infection, the bacteria remain dormant within the lung for a long time. The patient may not even feel sick.

If the disease is active, it can be transmitted to others by coughing, sneezing or even talking.

Byrd said that if you or someone you know needs to be tested, you should tell your primary health-care provider or the Gadsden County Health Department. The Health Department charges $10 for the TB skin test.

TUBERCULOSIS, EXTENSIVELY DRUG-RESISTANT - CANADA (ONTARIO)
***********************************************
A ProMED-mail post
< http://www.promedmail.org/ - http://www.promedmail.org >
ProMED-mail, a program of the
International Society for Infectious Diseases
< http://www.isid.org/ - http://www.isid.org >

Date: Wed 24 Jan 2007
From: Mary Marshall < mailto:tropical.forestry@btinternet.com - tropical.forestry@btinternet.com >
Source: Chronicle Herald (Nova Scotia) [edited]
< http://thechronicleherald.ca/Canada/554590.html - http://thechronicleherald.ca/Canada/554590.html >


A Toronto hospital is treating several cases of extensively drug 
resistant tuberculosis, with one of the patients being held in 
isolation under court order, the doctor overseeing the treatment said 
Mon 22 Jan 2007.

Public health experts fear the dangerous strain of tuberculosis, 
which is susceptible to very few of the anti-tuberculosis medications 
normally used to treat TB, is a global health crisis in the making. 
Dr. Monica Avendano, the physician in charge of the tuberculosis 
service at West Park Healthcare Centre, said since 2004, her unit has 
treated 5 or 6 patients with XDR TB, as it is called. All the 
patients were either infected abroad or infected by a family member 
who picked up the highly resistant strain elsewhere, she said.

"Currently, I am treating 3," said Avendano. "All of them have a 
previous history of tuberculosis that was not well managed."

Multi-drug resistant TB and the more difficult extensively drug 
resistant TB can arise one of 2 ways. A person with tuberculosis can 
fail to take all their medication, as in the case of the "not-well 
managed" patients to which Avendano referred. This spotty treatment 
allows the bacterium to survive the assault of the drugs and develop 
resistance to them. Or a person can be infected by contact with a 
person sick with XDR TB. Two of the cases Avendano has treated fall 
into this latter category.

"Both of the cases are young women who went to their country of 
origin to look after their ailing grandmothers. And the ailing 
grandmothers gave them TB. And it was XDR TB," she said.

She did not identify the countries involved. XDR TB has been found in 
a number of places, including China, South Africa, and many republics 
of the former Soviet Union. It is believed to have spread, still at 
low levels, from these jurisdictions to developed countries.

The Public Health Agency of Canada currently doesn't know the scope 
of the problem in this country. The last time Canadian TB statistics 
were gathered, the provinces and territories were not asked to report 
XDR TB cases. The TB statistics for 2006 -- which will be reported 
sometime in 2007 -- will include XDR TB figures, agency spokesperson 
Alain Desroches said in an e-mail.

Where such cases arise, they are treated in isolation, either with 
the consent of the patient or with the help of the courts. "All 
provinces and territories will use their public health legislation if 
necessary to ensure treatment of XDR TB," said Dr. Edward Ellis, 
manager of tuberculosis prevention and control with the public health 
agency. "With TB, in my experience, there's never a problem getting a 
court order if necessary. And nobody stands there saying: 'Oh, no, 
let them go.'"

Avendano said treatment with alternative drug regimes is effective, 
but it can take months of in-hospital care. Even then, it's not clear 
whether these patients -- who will be required to be seen on an 
ongoing basis -- are cured for life. That's because the strain hasn't 
been around long enough, and the treatment regime being used is too 
new to gauge its long-term efficacy.

[Byline: Helen Branswell]

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

[ProMED thanks Mary Marshall for this posting. A relevant discussion 
on the XDR problem in tuberculosis can be found at: CDC: Emergence of 
_Mycobacterium tuberculosis_ with Extensive Resistance to 2nd-Line 
Drugs --- Worldwide, 2000-2004. 2006;55: 301-305. Parts of the report 
are found below:

"17 690 isolates from the period 2000-2004 were tested for 
susceptibility to at least 3 of the 6 2nd line drugs (SLD) classes. 
Of these, 11 939 were from South Korea, of which 1298 (11 percent) 
were multidrug-resistant (MDR, defined as resistance to at least 
isoniazid and rifampin). From the other Global Supranational TB 
Reference Laboratory (SRLs), 2222 (39 percent) of 5751 isolates were MDR.

Of the 3520 MDR isolates, 347 (10 percent) were XDR (defined as cases 
in persons with TB whose isolates were resistant to isoniazid and 
rifampin and at least 3 of the 6 main classes of SLDs 
(aminoglycosides, polypeptides, fluoroquinolones, thioamides, 
cycloserine, and para-aminosalicyclic acid), including 200 (15 
percent) of 1298 from South Korea and 147 (7 percent) of 2222 from 
other SRLs. The drug-susceptibility testing results were tabulated by 
year and geographic region (on the basis of the country of origin of 
the isolates) (Table 1; for table, see original URL. - Mod.LL).

XDR TB was identified in all regions but was most common in South 
Korea (n = 200; 15 percent of all MDR TB isolates) and countries of 
eastern Europe/western Asia (Armenia, Azerbaijan, Czech Republic, 
Republic of Georgia, and Russia, n = 55; 14 percent of all MDR TB 
isolates). The total number and proportion of XDR TB isolates 
observed worldwide (excluding South Korea) increased from 14 (5 
percent of MDR TB isolates) in 2000 to 34 (7 percent of MDR TB 
isolates) in 2004. Year-specific proportions were stratified by 
geographic region. Increasing proportions of XDR TB were found among 
isolates from countries of eastern Europe/western Asia (n = 5 [9 
percent] in 2000; n = 11 [17 percent] in 2003) and the group of 
industrialized nations (Australia, Belgium, Canada, France, Germany, 
Ireland, Japan, Portugal, Spain, UK, and USA, n = 3 [3 percent] in 
2000; n = 25 [11 percent] in 2004).

USA national TB surveillance data included 169 654 patients with 
drug-susceptibility testing results. During 1993-2004, a total of 
2689 (1.6 percent) MDR TB cases were identified, of which 1814 (67 
percent) had results reported for 3 or more SLD classes. Of these, 74 
(4.1 percent) had resistance to 3 or more SLD classes and thus met 
the criteria for XDR TB. Despite an overall decline in MDR TB 
incidence in the USA, the proportion of XDR TB increased slightly, 
from 37 (3.9 percent) of 944 cases during 1993-1996 to 20 (4.1 
percent) of 489 during 1997-2000, to 17 (4.5 percent) of 381 in 
2001-2004 (chi-square test for trend = 0.20; p = 0.66). During 
1993-2002, patients with XDR TB were 64 percent more likely to die 
during treatment (relative risk [RR] = 1.6; 95 percent confidence 
interval [CI] = 1.2-2.2) than patients with MDR TB.

Among 605 MDR TB patients in Latvia who initiated therapy during 
2000-2002, 115 (19 percent) had XDR TB. The proportion with XDR TB 
increased from 30 (15 percent) of 204 in 2000, to 46 (21 percent) of 
215 in 2001, to 39 (21 percent) of 186 in 2002 (chi-square test for 
trend = 2.57; p = 0.11). Patients with XDR were 54 percent more 
likely to die or have treatment failure (RR = 1.5; CI = 1.1-2.2)."

A map of Ontario, Canada showing the location of Toronto can be found at:
< http://us.i1.yimg.com/us.yimg.com/i/travel/dg/maps/a2/750x750_ontario_m.gif - http://us.i1.yimg.com/us.yimg.com/i/travel/dg/maps/a2/750x750_ontario_m.gif >.
  - Mod.LL]
http://www.promedmail.org/pls/promed/f?p=2400:1000
[see also:
2006
----
Tuberculosis, multiresistant - Hungary  http://www.promedmail.org/pls/promed/f?p=2400:1001:10969756257800555856::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20061110.3233,Y - 20061110.3233 
Tuberculosis, multiresistant - South Africa (KN)(04):nationwide  http://www.promedmail.org/pls/promed/f?p=2400:1001:10969756257800555856::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20061019.3003,Y - 20061019.3003 
Tuberculosis, multi-drug resistant - South Africa (KN)  http://www.promedmail.org/pls/promed/f?p=2400:1001:10969756257800555856::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20060904.2514,Y - 20060904.2514 ]
........................................................................ll/msp/jw 

TUBERCULOSIS, STUDENTS - USA (FLORIDA)
**************************************
A ProMED-mail post
< http://www.promedmail.org/ - http://www.promedmail.org >
ProMED-mail is a program of the
International Society for Infectious Diseases
< http://www.isid.org/ - http://www.isid.org >

Date: Thu 8 Feb 2007
From: ProMED-mail < mailto:promed@promedmail.org - promed@promedmail.org >
Source: News4Jax [edited]
< http://www.news4jax.com/news/10965577/detail.html - 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
< mailto:promed@promedmail.org - 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 - 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 - http://pics2.city-data.com/city/maps/fr13.gif >. - Mod.LL]

[see also:
2005
----
Tuberculosis, nosocomial - USA (NY)   2003  http://www.promedmail.org/pls/promed/f?p=2400:1001:15332740727140660713::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20051223.3672,Y - 20051223.3672 
Tuberculosis, school - Sweden (Stockholm)    http://www.promedmail.org/pls/promed/f?p=2400:1001:15332740727140660713::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20051028.3140,Y - 20051028.3140 
Tuberculosis, hospital exposures - USA (MA)    http://www.promedmail.org/pls/promed/f?p=2400:1001:15332740727140660713::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20050616.1702,Y - 20050616.1702 
Tuberculosis, nursery school - Spain (Catalonia)    http://www.promedmail.org/pls/promed/f?p=2400:1001:15332740727140660713::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20050523.1416,Y - 20050523.1416 
Tuberculosis, supermarket exposure - Netherlands (Zeist)(03)    http://www.promedmail.org/pls/promed/f?p=2400:1001:15332740727140660713::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20050225.0602,Y - 20050225.0602 
Tuberculosis, supermarket exposure - Netherlands (Zeist)    http://www.promedmail.org/pls/promed/f?p=2400:1001:15332740727140660713::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20050207.0411,Y - 20050207.0411 ]
..............................ll/mj/mpp

Eastern Cape health is giving XDR-TB drugs 

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

SA alters Aids plan after extreme TB threat

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

TUBERCULOSIS, XDR - SOUTH AFRICA (04)
*************************************
A ProMED-mail post
< http://www.promedmail.org/ - http://www.promedmail.org >
ProMED-mail is a program of the
International Society for Infectious Diseases
< http://www.isid.org/ - http://www.isid.org >

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

[see also:
Tuberculosis, XDR - South Africa (03)    http://www.promedmail.org/pls/promed/f?p=2400:1001:4326725834056541844::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20070209.0504,Y - 20070209.0504 
Tuberculosis, XDR - worldwide    http://www.promedmail.org/pls/promed/f?p=2400:1001:4326725834056541844::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20070205.0456,Y - 20070205.0456 
Tuberculosis, XDR - South Africa (02)    http://www.promedmail.org/pls/promed/f?p=2400:1001:4326725834056541844::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20070128.0375,Y - 20070128.0375 
Tuberculosis, XDR - South Africa: interventions    http://www.promedmail.org/pls/promed/f?p=2400:1001:4326725834056541844::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20070126.0349,Y - 20070126.0349 
Tuberculosis, extensively drug-resistant - Canada (ON) (02)    http://www.promedmail.org/pls/promed/f?p=2400:1001:4326725834056541844::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20070125.0340,Y - 20070125.0340 
Tuberculosis, extensively drug-resistant - Canada (ON)    http://www.promedmail.org/pls/promed/f?p=2400:1001:4326725834056541844::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20070124.0318,Y - 20070124.0318 
2006
----
Tuberculosis, multiresistant - Hungary    http://www.promedmail.org/pls/promed/f?p=2400:1001:4326725834056541844::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20061110.3233,Y - 20061110.3233 
Tuberculosis, multiresistant - South Africa (KN)(04):nationwide    http://www.promedmail.org/pls/promed/f?p=2400:1001:4326725834056541844::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20061019.3003,Y - 20061019.3003 
Tuberculosis, multi-drug resistant - South Africa (KN)    http://www.promedmail.org/pls/promed/f?p=2400:1001:4326725834056541844::::F2400_P1001_BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P1001_USE_ARCHIVE:1001,20060904.2514,Y - 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

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 mailto:jlauerman@bloomberg.net - jlauerman@bloomberg.net .

The resumption of consumption-- a review on tuberculosis.

• http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_AbstractPlus&term=%22Ducati+RG%22%5BAuthor%5D - Ducati RG ,
• http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_AbstractPlus&term=%22Ruffino%2DNetto+A%22%5BAuthor%5D - Ruffino-Netto A ,
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Programa de Pos-graduacao em Biologia Celular e Molecular, UFRGS, Porto Alegre, RS, Brasil.

Among all infectious diseases that afflict humans, tuberculosis (TB) remains the deadliest. At present, epidemiologists estimate that one-third of the world population is infected with tubercle bacilli, which is responsible for 8 to 10 million new cases of TB and 3 million deaths annually throughout the world.

PMID: 17160276 [PubMed - in process]

Abstract