Probe highlights risk from South Africa's drug-resistant TB

January 17, 2014

A long-term probe has found that South Africans with highly drug-resistant TB are "systematically" discharged from hospital without being cured, placing themselves and others at risk, its authors said Friday.

"Treatment failure and discharge of such patients into the wider community is occurring systematically on a country-wide level," said Keertan Dheda, a University of Cape Town professor of pulmonology who led the study.

Experts have long warned that patients with drug-resistant TB who are released without support have a low chance of survival—and may also infect others with the dangerous germ.

But the extent of the problem has not been known, until now.

Reporting in The Lancet, Dheda's team followed 107 people in three provinces who had been hospitalised with extensively drug-resistant (XDR) tuberculosis—meaning they had failed to respond to most or all the main classes of antibiotics.

Forty-four of them were also co-infected with HIV—an extremely dangerous condition that amplifies both diseases.

After four years, 79 of them (74 percent) had died, 32 of whom also had the HIV co-infection.

Seven were still alive and 11 could not be located, the investigation found.

During the study period, 45 of the patients were discharged from hospital.

Just under half of them had failed to respond to treatment and lived less than 20 months on average before they died.

This survival period amounts to a major risk for others in the community, said the study.

In one case, DNA finger-printing of a TB strain confirmed that one XDR-TB patient who had failed treatment and was discharged, transmitted the same germ to his brother, who also died.

"Many patients who fail treatment are being discharged back into the community because little bed space is available in designated tuberculosis hospitals and alternative long-term residential and palliative care facilities are scarce," said Dheda.

He called for the testing of new combined drugs and "tough community infection control plans" to minimise the spread of XDR TB.

Community stay facilities and better home-based care "are urgently needed," he said.

The UN's World Health Organisation (WHO) last year reported that the global incidence of TB is declining, at about two percent a year.

In 2012, 8.6 million people had TB, and 1.3 million died of the disease.

The report warned, though, of little progress in controlling XDR strains and a worrying but slightly less dangerous category called multidrug-resistant (MDR) tuberculosis.

South Africa, along with Swaziland, has the highest rates of prevalence of TB in the world, with nearly 1,000 cases per 100,000 people.

It also has one of the highest rates for diagnosed MDR and the most confirmed cases of XDR TB.

In 2012, about 8,100 cases, 8.5 percent of diagnosed TB cases, were MDR TB, compared with 3.1 percent a decade earlier.

In 2011, about 500 cases were confirmed by lab tests as being XDR, the Lancet report said.

Treating drug-resistant gobbled up almost 45 percent of South Africa's national TB budget, it added.

Explore further: Large numbers of patients in South Africa with untreatable tuberculosis are discharged into community

Related Stories

Large numbers of patients in South Africa with untreatable tuberculosis are discharged into community

January 16, 2014
Substantial numbers of patients in South Africa with extensively-drug resistant TB and totally resistant TB, who have exhausted available treatment options, are being discharged from hospital, potentially exposing the wider ...

TB drug could reduce mortality for MDR-TB and XDR-TB cases

September 26, 2012
Results from an observational study evaluating a new anti-TB drug have found that the treatment can improve outcomes and reduce mortality among patients with both MDR-TB and XDR-TB.

Drug resistance-associated genes: A cornerstone for the control and protection against tuberculosis

September 5, 2013
BGI in collaboration with Institute of Biophysics, Chinese Academy of Sciences, and other Chinese institutes, have completed the genome sequencing of 161 Mycobacterium tuberculosis that can cause an infectious disease tuberculosis ...

Management of TB cases falls short of international standards

February 9, 2012
The management of tuberculosis cases in the European Union (EU) is not meeting international standards, according to new research.

Early signs that patient's own bone-marrow stem cells could treat multi-drug resistant tuberculosis

January 8, 2014
Findings of a preliminary study published in The Lancet Respiratory Medicine suggest that a patient's own bone-marrow stromal (stem) cells could be used to treat multidrug-resistant and extensively-drug tuberculosis.

International study reveals alarming levels of extensively drug-resistant tuberculosis

August 29, 2012
A large, international study published Online First in The Lancet reveals alarming levels of tuberculosis (TB) that are resistant to both first-line and second-line drugs. The findings show high prevalence of resistance to ...

Recommended for you

Co-infection with two common gut pathogens worsens malnutrition in mice

July 27, 2017
Two gut pathogens commonly found in malnourished children combine to worsen malnutrition and impair growth in laboratory mice, according to new research published in PLOS Pathogens.

Finish your antibiotics course? Maybe not, experts say

July 27, 2017
British disease experts on Thursday suggested doing away with the "incorrect" advice to always finish a course of antibiotics, saying the approach was fuelling the spread of drug resistance.

Phase 3 trial confirms superiority of tocilizumab to steroids for giant cell arteritis

July 26, 2017
A phase 3 clinical trial has confirmed that regular treatment with tocilizumab, an inhibitor of interleukin-6, successfully reduced both symptoms of and the need for high-dose steroid treatment for giant cell arteritis, the ...

A large-scale 'germ trap' solution for hospitals

July 26, 2017
When an infectious airborne illness strikes, some hospitals use negative pressure rooms to isolate and treat patients. These rooms use ventilation controls to keep germ-filled air contained rather than letting it circulate ...

Researchers report new system to study chronic hepatitis B

July 25, 2017
Scientists from Princeton University's Department of Molecular Biology have successfully tested a cell-culture system that will allow researchers to perform laboratory-based studies of long-term hepatitis B virus (HBV) infections. ...

Male hepatitis B patients suffer worse liver ailments, regardless of lifestyle

July 25, 2017
Why men with hepatitis B remain more than twice as likely to develop severe liver disease than women remains a mystery, even after a study led by a recent Drexel University graduate took lifestyle choices and environments ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.