Report from India suggests so. Can we ever trounce the mutant bacteria?
New strain of TB may yet succumb to some antibiotic, but victory will be short-lived.

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Health Canada is crafting a new plan to tackle TB. Long overdue, say those who see its toll.
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Sickening inequality, climbing cholera, drug resistant bugs, and more.
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The 1898 outbreak gave us Big Pharma and vaccine deniers, pitting public health against personal choice.
An obscure report from researchers in India appeared online late last year and sent a shiver through the medical community. In the weeks since then, the report has come under close scrutiny. As well it should, since it suggests we could lose a century of progress and find ourselves dying in the millions from tuberculosis, just like our 19th-century ancestors.
According to the original report, published Dec. 21 in Clinical Infectious Diseases, a hospital in Mumbai, India had identified 12 TB patients whose disease resisted all antibiotics. Nothing worked with them. All the patients appeared to have strains of TB known as multi-drug resistant (MDR-TB) and extremely drug resistant (XDR-TB).
They had been given antibiotics, but had not completed their course of treatment. Or they had been given the wrong antibiotics altogether, a common experience worldwide. Anything that doesn't kill the TB bacillus makes it stronger, and the doctors at PD Hinduja Hospital found nothing that could kill these patients' TB. As an Indian news report began, "This is as scary as it can get."
Scary, but not surprising. Ever since the advent of sulfa drugs and penicillin, we have been locked in an arms race with bacteria. Antibiotics originally had wonderfully lethal effects on many infections. But in some cases a few bacteria had genetic resistance to a given drug, or the treatment wasn't long or intense enough. Either way, the survivors learned to best such drugs. We came up with new drugs, and again they worked -- until a few bacteria survived and multiplied.
The age of superbugs
This is why we now have "superbugs" like MRSA (multiple-drug-resistant Staphylococcus aureus) and C. difficile, which spread easily in hospitals. In 2005, 94,000 Americans contracted MRSA and 18,650 died from it -- more than died from AIDS. In Canada, an estimated 220,000 hospital-acquired infections result in at least 8,000 deaths a year.
According to the Public Health Agency of Canada, drug-resistant TB is not yet a problem here. But out of 18,000 cases studied between 1998 and 2010, 210 (1.2 per cent) were multi-drug-resistant and five (0.03 per cent) were extremely drug-resistant.
So the report of a totally drug-resistant tuberculosis in India was not welcomed, in India or anywhere else. An Indian paper added to public worries by reporting in mid-January that out of 100 randomly selected TB patients in Bangalore -- almost 1,000 kilometres from Mumbai -- six were carrying the "TDR" strain.
Impossible to contain
A quick search on Google Scholar shows that the 12 Mumbai patients were not the first. In 2006, an Iranian team in Tehran had identified 15 TDR-TB cases in patients who included immigrants from Afghanistan, Azerbaijan, and Iraq. And two women in Italy had died in 2003 after years of unsuccessful treatment with all available drugs.
This untreatable TB strain, in other words, has been around for over a decade, and it has now turned up from Italy to Mumbai. It seems unlikely that we will be able to contain it. We can expect to find it in more places, if only because we'll now be looking for it.
The implication of TDR-TB is of course a rollback to the 19th century, when "consumption" was a major cause of death around the world. It is still a threat to poor people; the World Health Organization says that "one-third of the world's population is currently infected with the TB bacillus." WHO also estimates that 1.7 million people, mostly Africans, died of TB in 2009 -- 4,657 deaths every day of the year.
So the prospect of untreatable TB is a disturbing one. WHO notes that in the Americas, only 2.1 persons per 100,000 die of TB. With a totally drug-resistant strain, that rate could easily exceed Africa's current rate of 50 deaths per 100,000.
Not everyone accepts the Mumbai findings. The British medical journal The Lancet has reported on them without objections. But WHO has published an FAQ that takes issue with the whole idea: "the term 'totally drug resistant' tuberculosis is not yet recognised by the WHO. For now these cases are extensively drug resistant tuberculosis (XDR-TB), according to WHO definitions."
Indian health authorities have been quick to support WHO. The Ministry of Health and Family Welfare also dismissed the Mumbai cases as XDR-TB (which itself was appalling when WHO first defined it in 2006).
Grounds for caution
Both institutions have reason to be politically cautious. WHO was sharply criticized in 2009 when it declared the H1N1 flu to be a "pandemic," though very few people died from it.
India actively promotes medical tourism, inviting westerners to take advantage of cheap surgery. When the super-resistant NDM-1 enzyme was identified last year in India, the government and medical experts protested that it was just a plot to hurt the medical tourism industry. Their effort at damage control backfired, so WHO's skepticism about TDR-TB was welcome.
This new strain of TB may yet succumb to some antibiotic we'll discover before long. But even if we do succeed in controlling it, our victory will be short-lived. TB and a host of other diseases will always mutate one step ahead of us. Until we remove their root causes -- poverty, malnutrition, poor sanitation, ignorance -- we will remain both their victims and their allies. ![[Tyee]](http://thetyee.cachefly.net/ui/img/ico_fishie.png)
Crawford Kilian is a contributing editor of The Tyee.
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miguel
1 year ago
TB in Russia
MDR-TB has been a problem in the overcrowded Russian prison system for some years. But it doesn't stay inside the prisons.
Fiat lux
1 year ago
As an 18 year old veteran of
As an 18 year old veteran of the Hungarian army, I've spent 14 months in a primitive German MASH hospital after the war, in Austria. 3 months with a legwound and 11 months as a volunteer orderly, working mostly with amputees.
We were in a former artillery training camp, under the most primitive conditions. Antibiotics were unknown at the time in Europe. We hardly had any medications and were almost starving, surviving on very low quality foods.
We lived in huts with wooden floors, no clean beds , my future wife's parents were doing the laundry, like blood soaked bandages etc., by hand. No washing machines.
We were amputating, with me holding the legs of the victims, in the dining room of the former camp, with a wooden floor. The doctors and some nurses were wearing rubber gloves and white coats, but nobody had masks. I was wearing some old uniform pants, no gloves, covered down with a sheet with a hole in it to stick the victim's leg through.
Anesthesia was by a nurse dripping ether in a mask on the victim's face. The only treatments the patients had was the changing of the many times washed bandages, paper bandages, and some liquid sulpha squeezed on the wounds with a sringe.
Yet, there were no infections and nobody died.
Some years ago I was talking to a guy who was doing the same job during the Korean war in a proper hospital in Minnesota, with all the antibiotics, medications, cleanliness, best of foods. They had a 30%, some very serious infection rate.
The difference was that in our case, people still had a great degree of immunity and the human body could recover. But even then, after the war, US soldiers had to have special gardeners growing special vegetables both in parts of Europe and especially in Japan, because their bodies have already then been stripped of natural immunities.
Now thew whole world is surviving on daily doses of artificial foods and medications and I'm not surprised to see incurable illnesses sweeping the globe, sooner, or later.
The present epidemics of cancers etc., that didn't exist before, are the best examples, growing by the day, while the chemical food, and drug companies are getting filthy rich and the medical costs of the populations and governments are going ballistic.
Ed Deak.
snert
1 year ago
No, we haven't.
It's just going to take a while to figure out how to restore order.
Granville
1 year ago
The war between antibiotics and bacteria is an old one
There have always been incurable diseases and there always will be. Before penicillin and other antibiotics, it was staphylococcal infections, syphilis, polio, smallpox and TB. Add meningitis and a few other killers and there you are.
The overuse of antibiotics has produced resistance, there is no doubt about it. (Doctor, my kid has flu. Give him antibiotics). Transferable drug resistance is an old problem.
Research into new antibiotics has been stalled for decades for various reasons. It doesn't matter; we keep abusing the ones we have, so new antibiotics are not the answer, just more of the same.
No matter how good medical technology gets, people will still die. Thank your lucky stars we do, otherwise this planet would get awful crowded.
That is half the problem; overcrowding. There are too many of us already. Everyone knows that disease spreads quickly through chicken factory farms, and yet people are still flocking to the cities, around the globe.
It may not be flattering to think of humans as factory-farmed chickens, but there are many similarities. For one thing, we squawk at every epidemic like it is the end of the world. Get used to it.
judycross
1 year ago
Diet has a great deal to do with susceptability
In the 1970s I ran across "Nutrition and Physical Degeneration" by Weston A Price at the library. He was a dentist who traveled the world taking photos of people and examining their nutrition and how it altered with the influx of highly sugared modern foods. One of the things he found was that those who lived on a traditional diet had perfect teeth and bone structure and those that were paid in sugar, white flour, jam and tea had crowded rotten teeth, poor bone structure and high levels of TB.
Today a search turned this up:
Treatment of Tuberculosis with a Low Carbohydrate Diet
American Revue of Tuberculosis, 46:238-261, 1942.
Drs. Benjamin P. Sandler and R. Berke
“Guinea pigs fed carbohydrate-rich diet and inoculated with TB developed a more severe and virulent form of TB."“Ten patients with advanced pulmonary TB were placed on a low carbohydrate diet.
(Bread, sugar, etc., completely eliminated.) All ten patients improved in strength, some gained weight, general improvement, healing of cavities and clearing of infiltrations.
DIGESTIVE, CARDIAC, RESPIRATORY, NERVOUS, and MENTAL symptoms were rapidly relieved and relief was sustained"
A few years back, research showed the effects of sugars on the immune system.
"In one study, the ingestion of 100 gram (roughly 3-1/2 ounces) portions of carbohydrate as glucose, fructose, sucrose, honey, and pasteurized orange juice all significantly reduced the ability of white blood cells (neutrophils) to engulf and destroy bacteria. In contrast, the ingestion of 100 grams of starch had no effect. These effects started within less than 30 minutes after ingestion and lasted for over 5 hours. Typically, there was at least a 50% reduction in neutrophil activity two hours after ingestion. Since neutrophils constitute 60-to-70% of the total circulating white blood cells, impairment of their activity leads to depressed immunity."
Poverty is often accompanied by a high sugar, low protein, low vitamin diet making people far more prone to numerous infections.
Granville
1 year ago
Judy: So sugar = White Death. I knew it!
What keeps me awake at night is the thought that there are more bacterial cells contained within the human gut than there are human cells in the rest of the body. Thank God they don't all get to vote!
People aren't really human after all. We are walking bacteriology labs. It is enough to put me off dating ever again.
Granville
1 year ago
To revive discussion on this topic; Transferable drug resistance
About 40 years ago when I first worked in the pharmaceuatical industry, transferrable drug resistance was a hot topic. The exchange of (mitochonrial?) DNA between organisms of the same and different species was considered a threat.
E.coli from a cow that had been fed anitbiotics could develop resistance, then pass that resistance to other E. coli that had never been subjected to the drug(s).
It was a theoretetical and academic issue back then. Is it in fact a problem today? Is transferable drug resistance the threat it was felt to be in 1972?
grapevine
1 year ago
Diet has a great deal to do with susceptability
There is a very compelling case made for this by Cardiologist Doctor William Davis in his book Wheat Belly. After reading it, my biggest concern is that it makes such a strong case against "modern" wheat, ie. new varieties from breeding within the last 50 - 60 years, and other sugar and carbohydrate laden foods for many related disease issues, that the food "lobbies" in the grain and food processing industries will do everything they can to attempt to discredit it or lobby against any government supported research along the same lines. He might even need body-guards. Anyone wondering about some of our modern epidemic diseases / conditions and how to avoid them needs to read that book for an inciteful point of view. Like some other MDs such as the Health Canada doctor Jay Wortmant involved in CBC's My Big Fat Diet, Richard K. Bernstein, himself a Type 1 diabetic, in the Diabetes Solution, and a few others, they clearly show that fat in our diet is not the problem, wheat flour, sugar and other such carbohydrate load foods seem to be the real key but who's actually listening? The low fat phenomenon for groceries and nutrionists just won't go away. They actually promote whole grains as "heart healthy". What a crock!! I am a diabetic but I manage my health without any medication and I AVOID EATING MOST GRAINS as much as possible.
Buxag
1 year ago
Another area with growing
Another area with growing MDR-TB crisis is Peru, which has only in the past decade been successful in controlling TB. There are now 65,000 new TB cases every year, ranking Peru 20th in the world. In national study, MDR-TB was found in 15.7 percent of the patients previously treated. -CPR Certification