Something else to worry about

Tuberculosis, that old scourge of humanity that still infects about 8.7 million people a year and kills 2 million, might be on the verge of a major resurgence, according to a Reuters dispatch from Sunday.

Super drug-resistant forms of tuberculosis are at the tipping point of a global epidemic, and only small changes are needed to help them spread quickly, U.S. researchers predicted Sunday.

Two separate studies show that multiple-drug-resistant TB, which can only be cured with a carefully monitored cocktail of drugs taken for months on end, could easily start spreading more commonly.

The reports, to be published in Monday's issue of the journal Nature Medicine, coincide with another report published last week saying the World Health Organization's efforts to control multi-drug-resistant TB were not working as well as hoped.

The issue is that people who are infected with TB have to undergo a complete course of antibiotic treatment. The bacteria mutate easily and if they're not eradicated in the individual, the survivors - which would be those that have the most resistance to the drug(s) used - can spread.

However, it has been learned that the mutant strains, while harder to kill, do not spread as easily, leading health workers in many places to focus on non-resistant strains with the idea of controlling the spread of the disease.

The two papers in Nature Medicine say this could lead to disaster.

Even if just a few TB strains develop the ability to spread, they will eventually take over and dominate, say Sally Blower and Tom Chou of the University of California, Los Angeles and Megan Murray and Ted Cohen of the Harvard School of Public Health.

They developed separate mathematical models that show it would be easy for multi-drug-resistant TB to outcompete other strains and spread.

How bad could it get? At the opening of a two-day conference in Addis Ababa on Monday as reported by The Independent (South Africa), the WHO warned that the emergence of MDR-TB combined with spread of HIV/Aids (which helps to spread TB because of the lowered resistance it causes; TB is the most common infection among people living with HIV/Aids) presents the possibility of one billion new cases of TB over the next two decades - a nearly six-fold increase over present rates.

"It is imperative that strategies to control tuberculosis include measures to treat individuals with MDR (multi-drug-resistant) disease," Cohen added in a statement.

"It can be done. Our model shows why making this treatment available is absolutely necessary to avoid otherwise inevitable MDR-TB epidemics."

I guess the statement "it can be done" is the only good news in this.

Footnote One: A relevant, related issue not raised here is the entire one of over-prescription of drugs, of too many patients wanting a pill for every ache and sniffle and of too many doctors willing to oblige them, including the total waste of prescribing antibiotics against viral conditions. A fair number of those doctors will say they give in because "if I don't do it, they'll just find another doctor who will." Well then, dammit, let them! At least then you yourself will stop contributing to the problem of treatment-resistant conditions.

Footnote Two: The Independent article, after referring to a billion new TB cases over the next two decades, says "a staggering 35 million people could die of TB in that time." But at current rates of infection v. death, a billion cases should be associated with about 229 million deaths, and that doesn't account for an increased prevalence of the harder-to-treat MDR-TB. I suspect that The Independent dropped a zero in that phrase.