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Extreme Strain of TB Appears in S Africa

Health officials in South Africa are fighting to contain the spread of a deadly, drug-resistant strain of tuberculosis after an HIV-positive woman with the disease refused treatment and walked out of a Johannesburg hospital.

Doctors have since located and quarantined the woman, but fear she might have infected several others with extremely drug resistant tuberculosis (XDR TB), a virulent disease that has already killed 52 people in the east-coast province of KwaZulu-Natal.

"We have collected the women with an ambulance and will seek a court order to get her back into hospital if she again refuses treatment," said Dr Abdul Rahman, chief of operations at Gauteng Province's Department of Health.

"We will now trace her contacts with hospital staff and members of her family and anyone else, and test them for the XDR tuberculosis strain," he said. "If there are any signs she has spread the disease we will isolate those patients and begin treatment immediately."

The emergence of XDR tuberculosis has put doctors and health officials on high alert across South Africa, where one in nine of the population is HIV-positive and an estimated 900 die every day from AIDS.

Medical experts from the World Health Organization and America's Centers for Disease Control gathered in Johannesburg last week and urged immediate action to fight XDR TB, fearing South Africa's high rates of HIV could speed the spread of the deadly TB through the population.

All 52 patients killed by XDR TB in KwaZulu-Natal were HIV positive and died within an average of 16 days after diagnosis. Worryingly for the scientific community, all the patients were receiving antiretroviral (ARV) therapy at the time.

"HIV has the potential to fast track XDR TB into an uncontrollable epidemic," said Dr Karin Weyer, TB Research Director at the South African Medical Research Council (SAMRC). "Infection control precautions are needed now, and must be scaled up without delay in settings where HIV patients are brought together."

South Africa's Department of Health, lampooned by critics for championing a diet of garlic, lemon and African potato as an alternative treatment for HIV/AIDS, has promized to roll out two powerful antibiotic drugs as early as next week to fight XDR TB.

"The Department of Health is making progress in ascertaining supply of additional drugs -- Capreomycin and Para Amino Salicylic Acid -- to deal with extremely drug resistant tuberculosis, with a local company agreeing to provide one of the drugs," the Department of Health said in a statement.

"These drugs are being reintroduced because of resistance to the first and second line of drugs. There has been no invention of new TB drugs over the past four decades ... The XDR TB strain has resistance to all first-level drugs [used to treat ordinary TB] and it also has resistance to two of the major classes of the second-level drugs used to treat patients with multidrug-resistant [MDR] TB," the department said.


TB, an airborne disease, spreads much like the common cold through the coughs and sneezes of infected people, killing an estimated 1.7 million people a year around the world, according to the SAMRC. The first symptoms of the illness include weight loss, fever and night sweats. In the advanced stages victims cough up blood. If untreated, TB can kill a patient by gradually boring holes in his lungs.

TB poses an acute threat in South Africa, where half the adult population has latent TB. It is the most common opportunistic infection in HIV-positive people, and the health system is already strained by huge caseloads of HIV/AIDS. Overcrowded townships, some plagued by Victorian standards of hygiene and sanitation, present an ideal environment for its spread. Only about half the treatable cases are cured.

Officials at Gauteng's Department of Health called for calm, saying the spread of XDR TB was "neither an epidemic nor a crisis," and they were working to determine whether the XDR found in Johannesburg was the same as the KwaZulu-Natal strain. They would meet with specialists to devise a treatment program.

The SAMRC has laid out a seven-point program to combat the disease, including increased research into anti-TB drugs and promoting universal access to ARVs, while urging the government to set out an emergency plan.

© IRIN   [Integrated Regional Information Networks is a project the UN Office for the Coordination of Humanitarian Affairs. This article does not necessarily reflect the views of the United Nations or its agencies.]

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Albion Monitor   September 11, 2006   (

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