Drug resistant TB in Europe

by **DUNCAN** » Wed Sep 14, 2011 8:35 am

Here are a couple links to news reports:

http://www.msnbc.msn.com/id/44510556/ns/health-infectious_diseases/

http://www.foxnews.com/health/2011/09/14/who-dangerous-tb-spreading-at-alarming-rate-in-europe/

These are the kinds of zombies that keep me awake at night.

by **carolinafan** » Wed Sep 14, 2011 9:08 am

The movie Contagion comes out, then we hear stories about this. Coincidence? Happenstance?

Seriously though, this is the stuff that worries me too.

by **andygates** » Wed Sep 14, 2011 1:31 pm

http://www.bbc.co.uk/news/health-14902186

A plan has been drawn up to try to tackle cases of drug-resistant tuberculosis in 53 European countries.

The World Health Organisation (WHO) has described the problem as "alarming".

Eastern Europe has the highest level of infection, while in Western Europe, London has the highest TB rate of any capital city.

The WHO estimates there are 81,000 cases of drug-resistant TB a year in Europe, although many countries are failing to diagnose it.

The plan aims to increase diagnosis and access to treatment. Experts believe it has the potential to save several billion pounds and 120,000 lives by 2015.

Russia, Ukraine and Azerbaijan are among the countries with the highest burden of illness.

TB cases in the UK are concentrated in large cities. There are 3,500 cases in London each year.

In 2009, there were 58 cases of drug-resistant TB in the UK.

by **phil_in_cs** » Wed Sep 14, 2011 1:46 pm

We have drug resistant TB here, but it is mostly confined to the drug users and prison crowds. Both are often HIV positive, which doesn't help them fight it off.

58 cases in the whole UK? You're getting close to the "more likely to be struck by lightning" percentage.

by **DUNCAN** » Thu Sep 15, 2011 1:33 pm

phil_in_cs wrote:We have drug resistant TB here, but it is mostly confined to the drug users and prison crowds. Both are often HIV positive, which doesn't help them fight it off.

58 cases in the whole UK? You're getting close to the "more likely to be struck by lightning" percentage.

You're probably right. Still, these are the zombies that concern me most.

"The WHO estimates there are 81,000 cases of drug-resistant TB a year in Europe, although many countries are failing to diagnose it."

Sounds significant, but perhaps I need some perspective.

by **phil_in_cs** » Thu Sep 15, 2011 1:55 pm

DUNCAN wrote:
phil_in_cs wrote:We have drug resistant TB here, but it is mostly confined to the drug users and prison crowds. Both are often HIV positive, which doesn't help them fight it off.

58 cases in the whole UK? You're getting close to the "more likely to be struck by lightning" percentage.

You're probably right. Still, these are the zombies that concern me most.

"The WHO estimates there are 81,000 cases of drug-resistant TB a year in Europe, although many countries are failing to diagnose it."

Sounds significant, but perhaps I need some perspective.

For perspective, how many die in accidents? Car wrecks? drownings? How many of the 81,000 cases result in death or a debilitating after effect? How many were in what the US CDC calls "at risk" patients, meaning those who are otherwise already sick (HIV, taking Chemo or Radiation for cancer, etc)

Europe is a big place too, and the quality of medical care varies quite a bit from Scandinavia to Moldova.

by **silversnake** » Thu Sep 15, 2011 3:04 pm

phil_in_cs wrote:
DUNCAN wrote:
phil_in_cs wrote:We have drug resistant TB here, but it is mostly confined to the drug users and prison crowds. Both are often HIV positive, which doesn't help them fight it off.

58 cases in the whole UK? You're getting close to the "more likely to be struck by lightning" percentage.

You're probably right. Still, these are the zombies that concern me most.

"The WHO estimates there are 81,000 cases of drug-resistant TB a year in Europe, although many countries are failing to diagnose it."

Sounds significant, but perhaps I need some perspective.

For perspective, how many die in accidents? Car wrecks? drownings? How many of the 81,000 cases result in death or a debilitating after effect? How many were in what the US CDC calls "at risk" patients, meaning those who are otherwise already sick (HIV, taking Chemo or Radiation for cancer, etc)

Europe is a big place too, and the quality of medical care varies quite a bit from Scandinavia to Moldova.

Agree that the numbers are still relatively low and thus your chances of infection in general are low. However, the worry with this and things like MRSA is that it becomes ever more common as people fail to finish courses of antibiotics, abuse them through use when they're not needed (we all know the stories of people demanding an antibiotic from their doctor even though they've got the flu), and their uses in the food system and other settings.

Just think about it, TB used to be rampant in Europe and the US until antibiotics. Now, the simplified story is that crowded health care settings with lots of bacteria and antibiotics flying around (hospitals) and the fact that half the population seems incapable of taking a 10-day course of antibiotics all the way to the end gave us our friend MRSA. Combine those two facts with the extra little fact that TB treatment is a year-long course of antibiotics (non-compliance can be high in many populations) and you have a good mix for promoting more drug-resistant TB. I'd say that counts as something to keep a cautious eye on.

Let's all just hope the media doesn't take this and run with it in the "OMG! the bird flu is going to kill us all!!!!!!" style. The only thing worse than disease is irrational large-scale fear of a disease.

by **wee drop o' bush** » Thu Sep 15, 2011 4:20 pm

I developed bronchitis after a bad cold 3 years ago, I was really poorly for months with breathing difficulties & now have Asthma.

TB was one of the diseases I was screened for but thankfully the X-Rays were clear

When ever I think of Tuberculosis I think of it's other name 'Consumption' and that is an unsettling thought.

by **andygates** » Sat Sep 17, 2011 3:35 am

Yipe, you'll be sipping laudanum and writing Romantic poetry before long, a horrible prospect..!

Don't forget that there are different grades of drug resistance out there. Multi-drug resistant (MDR-TB) and Extensively drug resistant (XDR-TB). XDR probably develops from MDR when even those nuclear treatment options are goofed (dear patient: please take the goddamn pills, kthx? No, don't sell them on freaking craigslist!).

Evolution is a beautiful bad bitch.

by **wee drop o' bush** » Sat Sep 17, 2011 4:07 am

andygates wrote:Yipe, you'll be sipping laudanum and writing Romantic poetry before long, a horrible prospect..!:)

I was imagining all the gothic glory of 'succumbing to Consumption' at a tender age! :lol:

But fortunately it was robust brochitis making me wheeze & rattle like a Starling

by **Jamie** » Sat Sep 17, 2011 5:14 am

I picked up a raunchy case of TB when working at an Outdoor Education center about 20 years ago...the working theory is that a couple of us got it during our work with a group of special needs kids from a Russian orphanage, that had recently moved to the US en masse thanks to a charity organization...I took beefy, gut-killing meds for 6 months, which my doctor assured me would kill it, but still tested positive the last time I had to do the 4-pin test...my assumption is that TB, like malaria and some other bugs can live in your system forever at a sub-clinical level...

The world will end, not with a bang (or a bite), but with a wet and raspy cough...

Jamie

by **TacAir** » Sat Sep 17, 2011 11:07 am

Jamie wrote:I picked up a raunchy case of TB when working at an Outdoor Education center about 20 years ago...the working theory is that a couple of us got it during our work with a group of special needs kids from a Russian orphanage, that had recently moved to the US en masse thanks to a charity organization...I took beefy, gut-killing meds for 6 months, which my doctor assured me would kill it, but still tested positive the last time I had to do the 4-pin test...my assumption is that TB, like malaria and some other bugs can live in your system forever at a sub-clinical level...

The world will end, not with a bang (or a bite), but with a wet and raspy cough...

Jamie

You can test positive to TB by exposure. I grew up in Tucson, home to a large TB 'sanatorium' (sanitarium) - and have always tested positive to a host of 'lung diseases'

As a side note that may be of interest...
Western states developed their own (TB treatment) facilities, advertising to city-bred sufferers that clean mountain or desert air was far superior to Eastern locales. By 1900 one fourth of the migrants to California, and a third of those who came to Colorado made the trip for health reasons. Towns such as Pasadena (CA), Colorado Springs and Denver (CO), Tucson (AZ), El Paso (TX), and Albuquerque (NM) were settled by large numbers of TB patients and their families. Some smaller towns were founded by TB sufferers: Sierra Madre (CA), Silver City (NM), and San Angelo (TX) are included in this group.

Western towns often promoted the healthful qualities of their climate, hoping to lure TB patients and their families as settlers. The Albuquerque Civic Council published a flyer in 1925 designed to attract patients – it reads in part, “The fact that Albuquerque is practically made up of people who have either regained their health here or have come with others who have, accounts for the unique tone of the city, its air of cheerfulness and of easy living, and its inspiring example for new arrivals. A person with incipient or active tuberculosis cannot withstand damp, foggy, penetrating weather. He needs rest, fresh air, and good food, and a total absence of the rigorous northern and eastern winters and the humid, sticky, damp summers.”

(Source)

Thank goodness for modern meds!

by **MikeDoyle** » Tue Jan 10, 2012 8:45 pm

Sorry for the necro, but things got a whole lot worse:

Wired.com: India Reports Completely Drug-Resistant TB. Following the links within Wired's blogpost, I found a Times of India article that asserts that the TDR strain was first reported in Iran three years ago.

Epidemiology is beyond the scope of my expertise, I'm afraid; I don't know what I don't know. What are some good resources for getting up to speed?

by **Horatio_Tyllis** » Wed Jan 11, 2012 2:37 pm

Don't appologise. That is a totally appropriate necro. And severely disturbing.

by **Krustofski** » Wed Jan 11, 2012 2:47 pm

MikeDoyle wrote:What are some good resources for getting up to speed?

This is one of those rare instances where wikipedia is actually good for info about a health-related topic. I would start there.

All I have to say is that I learned TB diagnosis the old-fashioned way (poor, poor guinea pigs

), and I'm soooo grateful for modern diagnostics. TB is one of the few things that I'm genuinely afraid of.

ETA: Wait, even Linezolid doesn't do anything? Yeah, that's what we call "patients in deep shit".

by **phil_in_cs** » Wed Jan 11, 2012 2:54 pm

MikeDoyle wrote:Sorry for the necro, but things got a whole lot worse:

Bumping up an old post with new and significant information is not a necro. Your post is better appended here (where the previous info is) than in some stand alone post. Thanks for the news (bad as it is)

by **Jamie** » Thu Jan 12, 2012 4:35 am

I like to think that having had it before will help my body deal with it the next time around, due to some excess antibodies kicking around in my system...I have similar hopes for swine flu...

Jamie

by **wee drop o' bush** » Thu Jan 12, 2012 6:18 am

Jamie wrote:I like to think that having had it before will help my body deal with it the next time around, due to some excess antibodies kicking around in my system...I have similar hopes for swine flu...

Jamie

Hopefully, but forgive me for being Job's Comforter here...it could also mean that your respiratory system is weakened despite the antibodies.
I'm only saying that from my mums experience of having Whooping Cough as a child, then repeated chest infections & Pleurisy as an adult. My own experience too of repeated bouts of Chronic Bronchitis giving me Asthma.
TB does worry me.

by **Bonecrusher Doc** » Thu Jan 12, 2012 2:29 pm

Here we go again:
http://www.npr.org/blogs/health/2012/01 ... s=sh_sthdl

by **andygates** » Thu Jan 12, 2012 4:59 pm

Totally resistant TB in India? I'll see your subcontinent and raise you Italy:

http://www.wired.com/wiredscience/2012/ ... rst-italy/

by **Blast** » Thu Jan 12, 2012 5:54 pm

GeorGeDaViD wrote:We have drug resistant TB here, but it is mostly confined to the drug users and prison crowds. Both are often HIV positive, which doesn't help them fight it off. 58 cases in the whole UK? You're getting close to the "more likely to be struck by lightning" percentage.

However, lightening doesn't increase exponentially...

A small number of cases can grow into a large number of cases. I'm concerned that the current economic situation in Europe will result in people not getting proper treatment, either from a lack of meds (Greece), people not being able to afford the meds, or even selling the meds on the street.

-Blast

by **andygates** » Sat Jan 14, 2012 5:08 am

Hey, I was going to say that! Lightning isn't contagious. But some non-disease killers -- stupid driving, for example -- seem to be sometimes.

Blast, your worry sounds a lot like the African HIV sufferers who sell their pills. TB's a bit different -- it's obviously nasty right now, unlike the vague wasting threat of HIV. But when a person needs money to feed an addiction (or is just a dumbass), it'll happen. Bah.

by **Evan the Diplomat** » Thu Jan 19, 2012 1:12 pm

This recent development has me very concerned. Over the past 5 years Greece has seen a huge increase in South Asians. The tightly packed conditions of Kolkatta or Mumbai are ideal for a disease like TB to spread and one person visiting home brings it back to Greece or Italy, where a half dozen of so South Asian men share an apartment. They go out into the street, particularly the ones selling sunglasses or DVDs and the fuse for a pandemic is lit.

by **duodecima** » Thu Jan 19, 2012 1:21 pm

Evan the Diplomat wrote:This recent development has me very concerned. Over the past 5 years Greece has seen a huge increase in South Asians. The tightly packed conditions of Kolkatta or Mumbai are ideal for a disease like TB to spread and one person visiting home brings it back to Greece or Italy, where a half dozen of so South Asian men share an apartment. They go out into the street, particularly the ones selling sunglasses or DVDs and the fuse for a pandemic is lit.

It won't go pandemic so quickly, like influenza, because a healthy (and well nourished) person's immune system can frequently keep it from affecting that person at that time. This is why the "sanitariums" seemed to work - underfed & overworked folks were sent somewhere to rest and get good food - and they'd get better, for a while. But M. tuberculosis is tricky, it'll wall itself off and find a hiding place to come out later, commonly when your immune system is not as great due to either age or other illness.

This is going to be a long, slow problem.