Drug-resistant TB

XDR TB found in 28 hospitals in South Africa

Keith Alcorn
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A strain of tuberculosis (TB) resistant to virtually all drugs available to treat it has been detected in 28 hospitals since its presence in South Africa was first revealed last month in one district hospital in Kwazulu-Natal, international health experts heard yesterday at an emergency meeting in Johannesburg.

XDR TB has also been identified in some mineworkers in South Africa, Dr Tony Moll, discoverer of the outbreak, told Associated Press yesterday. And Dr Karin Weyer of South Africa’s Medical Research Council (MRC) told a press conference that six cases of XDR TB were found in Gauteng several years ago, but research data were not compiled at the time.

"HIV has the potential to fast-track XDR-TB into an uncontrollable epidemic that we will not be able to manage or treat," she said.

Glossary

extensively drug-resistant TB (XDR-TB)

A form of drug-resistant tuberculosis in which bacteria are resistant to isoniazid and rifampicin, the two most powerful anti-TB drugs, plus any fluoroquinolone and at least one injectable second-line drug. 

capacity

In discussions of consent for medical treatment, the ability of a person to make a decision for themselves and understand its implications. Young children, people who are unconscious and some people with mental health problems may lack capacity. In the context of health services, the staff and resources that are available for patient care.

infection control

Infection prevention and control (IPC) aims to prevent or stop the spread of infections in healthcare settings. Standard precautions include hand hygiene, using personal protective equipment, safe handling and disposal of sharp objects (relevant for HIV and other blood-borne viruses), safe handling and disposal of waste, and spillage management.

strain

A variant characterised by a specific genotype.

 

drug resistance

A drug-resistant HIV strain is one which is less susceptible to the effects of one or more anti-HIV drugs because of an accumulation of HIV mutations in its genotype. Resistance can be the result of a poor adherence to treatment or of transmission of an already resistant virus.

"Infection control precautions must be scaled up without delay in settings where HIV patients are brought together," she went on.

According to the Daily News, six hospitals in the Durban area alone are treating patients with XDR TB, yet a spokesperson for the Kwazulu-Natal department of health insisted that there was `no outbreak` in the province.

The outbreak first came to light as the result of the rapid deaths of individuals receiving antiretroviral treatment at one hospital in Kwazulu-Natal, and the outbreak was traced to a single healthcare worker.

The discovery led international health experts to convene an emergency meeting in South Africa Medical Research Council, the United States Centres for Disease Control, the World Health Organization (WHO), with representatives from eleven southern African countries to develop an action plan.

Their seven-point action plan calls for countries to:

 

  • Conduct rapid surveys to detect cases of XDR-TB;
  • Enhance laboratory capacity for detection of drug resistance;
  • Improve technical capacity of clinical and public health managers to effectively respond to XDR-TB outbreaks;
  • Implement infection control precautions, especially in facilities where HIV-positive individuals are receiving care;
  • Increase research support for anti-TB drug development;
  • Increase research support for rapid diagnostic test development; and
  • Promote universal access to antiretroviral drugs under joint TB-HIV activities.

 

The South African government is also seeking to fast-track the importation of two drugs that may be partially effective in some cases of XDR TB.

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Drug-resistant TB
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