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Super resistant XDR TB rears its head in KZN

TORONTO ‘€“ A study from KwaZulu-Natal has revealed shocking details of a super-tuberculosis strain ‘€“ XDR TB ‘€“ that is resistant to all first and second line TB drugs and has an extraordinary high death rate.South Africa does not yet have any drugs to treat people with XDR TB.

Earlier this year, Health-e reported that a deadly new strain of multi-drug-resistant TB had been picked up by doctors at Church of Scotland Hospital at Tugela Ferry in Msinga.

At the time approximately 80 patients from the area had been referred to King George V Hospital in Durban, the province’€™s only facility dealing with MDR TB, but their chances of recovery were poor.

‘€œThese patients are resistant to three of the second line drugs we use for treating MDR TB,’€ Dr Aruna Ramjee, a TB doctor who has been at the hospital for almost two decades, said at the time.

A late breaker abstract due to be presented to International AIDS conference on Thursday (17 August), reports on a study of the sputum (mucus sample) of 536 TB patients at Tugela Ferry collected between January last year and March this year.

Of these, 221 (41 percent) had multi-drug resistant (MDR) TB and 53 of these patients had the XDR strain that was resistant to all the first and second line drugs tested.

Further tests revealed that most of the 53 XDR TB patients were infected with a genetically similar TB strain.

All but one of these patients died within 25 days of their sputum being collected for initial testing.

Most of the XDR TB patients were also HIV positive. A small number were previously treated for TB while over half had been previously hospitalized.

This led researchers to believe that the XDR patients had contracted the super-resistant strain during recent hospital visits or from people within their community rather than resistance developing from them not taking their TB drugs properly.

However, the KwaZulu-Natal health department has blamed ‘€œpoor adherence to TB treatment’€ and poverty for some 225 cases of MDR TB in Msinga.
The Church of Scotland Hospital picked up the XDR cases when they found that some of their HIV positive patients who also had TB were dying while on antiretroviral treatment, despite the fact that the ARVs were improving their CD4 counts.

‘€œThis made them look again at their TB, and they found they were multi-drug resistant so they were sent to us,’€ said Dr Garth Osburn from King George V Hospital.

Doctors at King George Hospital have for some time been concerned about the fact that they discharge MDR patients who have failed to respond to treatment into communities that are vulnerable to getting the disease.

People who have not taken their TB treatment properly can develop MDR TB, but once they have MDR TB they can then infect anyone who is exposed to their sneezing and coughing with it.

MDR TB is very expensive and hard to treat, costing approximately R20 000 for an 18 month course.

Currently, little over 40% of all those admitted to King George with MDR TB are cured. Internationally, little more than half MDR patients are cured.

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Anso Thom