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India Reports Completely Drug-Resistant TB

NappuccinoNappuccino Registered User regular
edited January 2012 in Debate and/or Discourse
I didn't see this posted around here yet or heard any of the news media talking about this. Seems pretty important considering...
Over the past 48 hours, news has broken in India of the existence of at least 12 patients infected with tuberculosis that has become resistant to all the drugs used against the disease. Physicians in Mumbai are calling the strain TDR, for Totally Drug-Resistant. In other words, it is untreatable as far as they know.

...

Why this is bad news: TB is already one of the world’s worst killers, up there with malaria and HIV/AIDS, accounting for 9.4 million cases and 1.7 million deaths in 2009, according to the WHO. At the best of times, TB treatment is difficult, requiring at least 6 months of pill combinations that have unpleasant side effects and must be taken long after the patient begins to feel well.

Because of the mismatch between treatment and symptoms, people often don’t take their full course of drugs — and from that (and some other factors I’ll talk about in a minute) we get multi-drug resistant and extensively drug-resistant, MDR and XDR, TB. MDR is resistant to the first-choice drugs, requiring that patients instead be treated with a larger cocktail of “second-line” agents, which are less effective, have more side effects, and take much longer to effect a cure, sometimes 2 years or more. XDR is resistant to the three first-line drugs and several of the nine or so drugs usually recognized as being second choice.

...

That’s for MDR. None of the TDR patients have been recorded cured, and at least one of the known Indian patients has died.

Meanwhile, health authorities estimate that one patient with active TB can infect up to 15 others. And thus resistant TB spreads: XDR-TB was first identified just in 2006, and it has since been found in 69 countries around the world.

The article goes on, but I think I got the most important points.

source: http://www.wired.com/wiredscience/2012/01/invincible-tb-india/

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Posts

  • UnknownSaintUnknownSaint Registered User
    That is completely horrifying.

  • Styrofoam SammichStyrofoam Sammich WANT. Registered User regular
    Might be nit-picking but once it can resist all known antibiotics doesn't that make it drug-immune, not resistant?

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  • NappuccinoNappuccino Registered User regular
    Might be nit-picking but once it can resist all known antibiotics doesn't that make it drug-immune, not resistant?

    That would mean that nothing could possibly work against it... which i'm sure isn't a leap they want to make yet.

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  • AbsalonAbsalon Registered User regular
    edited January 2012
    Give these countries a fucking break.

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  • electricitylikesmeelectricitylikesme Registered User regular
    Holy shit.

    This is pretty god damn calamitous.

  • HenroidHenroid Nobody Nowhere fastRegistered User regular
    Well this won't be "End of the world" like plenty of people will react with, but this can be pretty fucking awful if a solution isn't discovered soon.

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  • NappuccinoNappuccino Registered User regular
    Henroid wrote:
    Well this won't be "End of the world" like plenty of people will react with, but this can be pretty fucking awful if a solution isn't discovered soon.

    Hopefully it either a) works its course without killing too many people or b) a cure is found quickly.

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  • MazzyxMazzyx A Restoration through Revolution. Registered User regular
    Might be nit-picking but once it can resist all known antibiotics doesn't that make it drug-immune, not resistant?

    TB comes in three variations now. Normal TB which we can treat. MDR or Multiple Drug Resistant TB. And the new TDR or total drug resistant TB. The drugs are resisted but doesn't make it immune. That is the difference here. But for the purpose treatment they are basically immune.

    TB is a pretty damn tough disease as is. The reason you get mutations like this is because of the drug treatment not being followed through. There are some different programs on how to keep people on these very strict regimes but it is hard to do in countries like India. This is scary though, and just because you may be in the US or a country with very limited TB exposure doesn't mean it can't travel to where you are. One of the reasons it is a big thing on the watch list.

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  • TL DRTL DR Registered User regular
    edited January 2012
    IIRC, isn't the tactic against drug-resistant strains usually to quarantine, stop all antibiotic treatment, and then attack with a combination of drugs once the population mutates back to a more efficient (in an antibiotic-free environment) and susceptible form?

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  • HenroidHenroid Nobody Nowhere fastRegistered User regular
    Nappuccino wrote:
    Henroid wrote:
    Well this won't be "End of the world" like plenty of people will react with, but this can be pretty fucking awful if a solution isn't discovered soon.

    Hopefully it either a) works its course without killing too many people or b) a cure is found quickly.

    As in the 12 people and a few more are all that's it with effective quarantine? There's still gotta be a source somewhere.

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  • NappuccinoNappuccino Registered User regular
    edited January 2012
    Henroid wrote:
    Nappuccino wrote:
    Henroid wrote:
    Well this won't be "End of the world" like plenty of people will react with, but this can be pretty fucking awful if a solution isn't discovered soon.

    Hopefully it either a) works its course without killing too many people or b) a cure is found quickly.

    As in the 12 people and a few more are all that's it with effective quarantine? There's still gotta be a source somewhere.

    Surely there are more out there. I just mean that, if this form of TB can be fought off by your body with relative consistency (a la swine flu) or of they find a cure, this won't be too bad.

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  • MalReynoldsMalReynolds The Hunter S Thompson of incredibly mild medicines Registered User regular
    Well, time to move to Madagascar.

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  • FeralFeral Who needs a medical license when you've got style? Registered User regular
    Nappuccino wrote:
    I just mean that, if this form of TB can be fought off by your body with relative consistency (a la swine flu) or of they find a cure, this won't be too bad.

    The pathogen that causes TB is ubiquitous. There's a decent chance you're carrying it. If you live in a country in which it's endemic, or you've spent any time in such a country, it's almost guaranteed that you've been exposed.

    TB is largely an opportunistic infection. It flourishes into full-blown disease when the immune system is compromised by some other issue - HIV, cancer, diabetes, pregnancy, advanced age, malnutrition, etc.

    In this way, all TB "can be fought off by your body" until your body can't fight it off anymore.

    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
    the "no true scotch, man" fallacy.
  • electricitylikesmeelectricitylikesme Registered User regular
    Well, time to move to Madagascar.

    You're probably too late.

  • FeralFeral Who needs a medical license when you've got style? Registered User regular
    edited January 2012
    Mazzyx wrote:
    Might be nit-picking but once it can resist all known antibiotics doesn't that make it drug-immune, not resistant?

    TB comes in three variations now. Normal TB which we can treat. MDR or Multiple Drug Resistant TB. And the new TDR or total drug resistant TB. The drugs are resisted but doesn't make it immune. That is the difference here. But for the purpose treatment they are basically immune.

    It appears that when they say "total drug resistant" they don't mean "resistant to every possible drug imaginable," but "resistant to the accepted treatments."

    I don't have access to the full text journal article, which is here: http://cid.oxfordjournals.org/content/early/2011/11/24/cid.cir889.extract

    This link goes a little more in-depth regarding the drug resistance: http://www.dnaindia.com/mumbai/report_first-cases-of-totally-drug-resistant-tb-in-india-one-dead_1634439

    November 2011, the hospital got four TB patients resistant to all first-line (Isoniazid, Rifampicin, Ethambutol, Pyrazinamide and Streptomycin) and second-line (Ofloxacin, Moxifloxacin, Kanamycin, Amikacin, Capreomycin, Para-aminosalicylic acid and Ethionamide) drugs.

    Basically, there are three broad classes of TB drugs. First-line therapies, which are safe and widely available. Second-line therapies, which are either more expensive or have worse side effects than the first-line therapies. And everything else. Within the "everything else" category are drugs that are effective but prohibitively expensive in the developing world (ciprofloxacin), effective but dangerous (cycloserine), or seemingly effective but require more research (linezolid).

    It looks like this strain fights off the first and second line therapies, leaving those of us in the developed world with access to new fancy drugs to try things out of the "everything else" category while those of us in the developing world get to die.

    Feral on
    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
    the "no true scotch, man" fallacy.
  • DoctorArchDoctorArch Curmudgeon Registered User regular
    Well fuck. That does not bode well for 3rd world countries, and will probably make immigration that much harder.

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  • MalReynoldsMalReynolds The Hunter S Thompson of incredibly mild medicines Registered User regular
    Well, time to move to Madagascar.

    You're probably too late.

    My guy just told me the borders are closed.

    Fuck.

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  • Hahnsoo1Hahnsoo1 Registered User regular
    edited January 2012
    Feral wrote:
    It looks like this strain fights off the first and second line therapies, leaving those of us in the developed world with access to new fancy drugs to try things out of the "everything else" category while those of us in the developing world get to die.
    Well, the therapies in the "everything else" category includes drugs that are readily available but are dangerous to use (think chemotherapy drugs, things that are toxic to humans and bacteria alike). The physician and patient would have to balance risk versus reward in using those treatments. Given the option of "death by TB - high probability" and "death by dangerous drug - low probability, especially if managed in a hospital for noxious effects", I think most people would go for the latter. It's a terrible choice, to be sure.

    Also, the initial article that I read is unclear as to how they determined resistance (either by failed treatment regimen, which can be explained by noncompliance or malpractice, as the article seems to indicate, or sputum culture, which would show "holy crap, it's resistant to all of these particular drugs at our standard dosages"... the standard sputum culture isn't completely exhaustive, either). Sputum cultures take quite a long time, longer than the patient may have if you don't put him/her on a treatment regimen right away. I may want to go back to the original source for this information.

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  • Gigazombie CybermageGigazombie Cybermage Registered User, __BANNED USERS regular
    Well, time to move to Madagascar.

    I was just playing Pandemic 2. XD

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  • BurtletoyBurtletoy Registered User regular
    Feral wrote:
    Basically, there are three broad classes of TB drugs. First-line therapies, which are safe and widely available. Second-line therapies, which are either more expensive or have worse side effects than the first-line therapies.

    This is true for, basically, everything.

  • FeralFeral Who needs a medical license when you've got style? Registered User regular
    Hahnsoo1 wrote:
    Feral wrote:
    It looks like this strain fights off the first and second line therapies, leaving those of us in the developed world with access to new fancy drugs to try things out of the "everything else" category while those of us in the developing world get to die.
    Well, the therapies in the "everything else" category includes drugs that are readily available but are dangerous to use (think chemotherapy drugs, things that are toxic to humans and bacteria alike). The physician and patient would have to balance risk versus reward in using those treatments. Given the option of "death by TB - high probability" and "death by dangerous drug - low probability, especially if managed in a hospital for noxious effects", I think most people would go for the latter. It's a terrible choice, to be sure.

    Yeah. And this is likely in a patient who is already compromised in some way.

    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
    the "no true scotch, man" fallacy.
  • Evil MultifariousEvil Multifarious Registered User regular
    my girlfriend says this is apparently secondary resistance, not primary resistance (in that the resistance was caused by improper treatment, and not the spread of a resistant infection), which is not as bad but could eventually create the latter

    apparently some of the patients had multiple courses of incorrect antibiotics.

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  • NappuccinoNappuccino Registered User regular
    Feral wrote:
    Nappuccino wrote:
    I just mean that, if this form of TB can be fought off by your body with relative consistency (a la swine flu) or of they find a cure, this won't be too bad.

    The pathogen that causes TB is ubiquitous. There's a decent chance you're carrying it. If you live in a country in which it's endemic, or you've spent any time in such a country, it's almost guaranteed that you've been exposed.

    TB is largely an opportunistic infection. It flourishes into full-blown disease when the immune system is compromised by some other issue - HIV, cancer, diabetes, pregnancy, advanced age, malnutrition, etc.

    In this way, all TB "can be fought off by your body" until your body can't fight it off anymore.

    Interesting... although not exactly what I'd like to hear

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  • Magus`Magus` Registered User regular
    Let's hope no one weaponizes this.

  • The EnderThe Ender Registered User regular
    Magus` wrote:
    Let's hope no one weaponizes this.

    You can't really 'weaponize' TB, for all of the reasons Feral already stated; you're probably already hosting the pathogen, like most people in the world.


    A microbiologist I used to chat with once told me that, essentially, the bugs are always going to win (partly because we can't anticipate mutations very well, partly because we do not-so-smart things with the treatments we develop, like using them in acne products until bacterial resistance to the medication is more or less ubiquitous) - it's just a matter of waiting to see how lethal & transmissible the next winner is.

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  • psyck0psyck0 Registered User regular
    Two billion people worldwide have TB. Two billion. About 10% of them will one day get an active, symptomatic outbreak. That's a very scary number. The vaccine is ineffective, and there is very little research being done on this disease.

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  • Linespider5Linespider5 It’s cool to have a code name. It’s not that weird.Registered User regular
    I'll respectfully wait to freak out until it hits the state of Florida Missouri Illinois.

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  • The EnderThe Ender Registered User regular
    psyck0 wrote:
    Two billion people worldwide have TB. Two billion. About 10% of them will one day get an active, symptomatic outbreak. That's a very scary number. The vaccine is ineffective, and there is very little research being done on this disease.

    Well, there are still potential treatment options. As Feral & others stated, some of the expensive drugs with unpleasant side effects haven't been tested against the new resistant strain yet, and presumably they would work. Of course, the drawback is the 'expensive' and 'unpleasant side effects' part.

    But yeah, this is not a good situation.

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  • CasualCasual flap flap flap wiggle wiggle wiggle Registered User regular
    Well shit. I can't decide if this makes it better or worse that I never had my TB jab.

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  • SiskaSiska Registered User regular
    I read somewhere that TB is very common in US prisons. Not sure if it because they aren't very diligent with treating it there, with the "inmates deserve to suffer and we don't like to spend money on them" attitudes.Or if it's because with so many people in close quarters it's impossible to completely nip in the bud. Regardless, there is probably just a matter of time before it starts cropping up in the US.

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  • psyck0psyck0 Registered User regular
    Both. It's common in most prisons. Some of the worst strains likely came out of Russian prisons. A big problem is that even when inmates ARE treated, they are lost to follow-up when they get out. It's also endemic in the Canadian Aboriginal population.

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  • shrykeshryke Member of the Beast Registered User regular
    Time to build that bubble that seals all of India in.

  • The EnderThe Ender Registered User regular
    We just need to get someone in there to take a few cubes out before there's chain of outbreaks.

    TOG Solid wrote:
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  • CantidoCantido Registered User regular
    Oh jeez, TB is a nasty, nasty disease.

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  • lonelyahavalonelyahava One day, I will be able to say to myself "I am beautiful and I am perfect just the way I am"Registered User regular
    I think i remember reading something briefly about this last year. but I think there were only the 4 cases.

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  • FeralFeral Who needs a medical license when you've got style? Registered User regular
    Siska wrote:
    I read somewhere that TB is very common in US prisons. Not sure if it because they aren't very diligent with treating it there, with the "inmates deserve to suffer and we don't like to spend money on them" attitudes.Or if it's because with so many people in close quarters it's impossible to completely nip in the bud. Regardless, there is probably just a matter of time before it starts cropping up in the US.

    Pretty much any housing institution with a dense population is a breeding ground for disease. Prisons, hospitals, college dorms, convalescent homes, psychiatric institutions, military barracks, etc. And not just TB, but other common pathogens like staph and strep. But, yeah, prisons are particularly bad for a multitude of reasons, and not wanting to spend much money on prisoner medical care is one of those.

    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
    the "no true scotch, man" fallacy.
  • SmokeStacksSmokeStacks License Number 137596Registered User regular
    I was just having a joke conversation with a friend of mine over the phone about building a quarantine bunker and that story came up.

  • FeralFeral Who needs a medical license when you've got style? Registered User regular
    Burtletoy wrote:
    Feral wrote:
    Basically, there are three broad classes of TB drugs. First-line therapies, which are safe and widely available. Second-line therapies, which are either more expensive or have worse side effects than the first-line therapies.

    This is true for, basically, everything.

    Well, to a certain degree, yeah, I was being Captain Obvious. Mostly I just wanted to give the thread some perspective as to what was going on.

    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
    the "no true scotch, man" fallacy.
  • mrt144mrt144 King of the Numbernames Registered User regular
  • BagginsesBagginses __BANNED USERS regular
    I suppose something would have to fill the rhinderpest gap.

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