Drug-Resistant “White Plague” Lurks Among Rich and Poor

Kate Kelland, Yahoo! News, March 19, 2012

On New Year’s Eve 2004, after months of losing weight and suffering fevers, night sweats and shortness of breath, student Anna Watterson was taken into hospital coughing up blood.

It was strange to be diagnosed with tuberculosis (TB)—an ancient disease associated with poverty—especially since Watterson was a well-off trainee lawyer living in the affluent British capital of London. {snip}

But when Watterson’s infection refused to yield to the three-pronged antibiotic attack doctors prescribed to fight it, her relief turned to dread.

After six weeks of taking pills that had no effect, Watterson was told she had multi-drug resistant TB, or MDR-TB, and faced months in an isolation ward on a regimen of injected drugs that left her nauseous, bruised and unable to go out in the sun.

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Tuberculosis is often seen in the wealthy West as a disease of bygone eras—evoking impoverished 18th or 19th century women and children dying slowly of a disease then commonly known as “consumption” or the “white plague”.

But rapidly rising rates of drug-resistant TB in some of the wealthiest cities in the world, as well as across Africa and Asia, are again making history.

London has been dubbed the “tuberculosis capital of Europe”, and a startling recent study documenting new cases of so-called “totally drug resistant” TB in India suggests the modern-day tale of this disease could get a lot worse.

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

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TB is a bacterial infection that destroys patients’ lung tissue, making them cough and sneeze, and spread germs through the air. Anyone with active TB can easily infect another 10 to 15 people a year.

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Little surprise, then, that the apparently totally untreatable cases in India have raised international alarm.

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Non-prescription and over-the-counter antibiotic use is rife in India and it may be no coincidence that the country now has one of the highest burdens on MDR-TB in the world, with more than 100,000 cases.

Udwadia’s team conducted a recent study in Mumbai, home to more than 12 million people often living in harsh and overcrowded conditions, and found in one district only five out of 106 doctors in the unregulated private sector could give a correct prescription for a hypothetical patient with MDR-TB.

Most of the prescriptions were “inappropriate” and would only have made the patient worse—driving the conversion of MDR [multi-drug resistant] tuberculosis to XDR [extensively drug resistant] and then to TDR [totally drug resistant] tuberculosis.

The Mumbai findings show that totally drug-resistant TB “was an accident waiting to happen,” Udwadia said.

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

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