Tag Archives: tuberculosis

Virtually untreatable tuberculosis danger

Plans to tackle tuberculosis are failing and a new visionary approach is needed, according to an international group of doctors and scientists.

There is mounting concern that a rise in “virtually untreatable” tuberculosis poses a threat to countries around the world.

Writing in the Lancet medical journal, the group said governments were “complacent” and “neglectful”.

It called for countries to do more to tackle the problem.

The World Health Organization says nearly nine million people become sick and 1.4 million die from tuberculosis each year.

Some countries are facing problems with drug resistance, with many first-choice antibiotics no longer working against some strains of the tuberculosis bacterium.

It is particularly acute in some parts of eastern Europe and central Asia, where up to a third of cases can be multi-drug resistant, known as MDR-TB.

The number of laboratory-confirmed cases of MDR-TB around the world has gone from 12,000 in 2005 to 62,000 in 2011. However, the real figure is thought to be closer to 300,000.

An even more stubborn version, resistant to more antibiotics, is called extensively drug-resistant tuberculosis and has been detected in 84 countries.

Tuberculosis

Tuberculosis

“With ease of international travel, and increased rates of MDR tuberculosis in eastern Europe, central Asia, and elsewhere, the threat and range of the spread of untreatable tuberculosis is very real,” the report said.

It argued that countries had spent decades being complacent in their response to the infection and that a “major conceptual change and visionary global leadership” were needed.


“To prevent further cases of multi-drug-resistant and extensively drug-resistant tuberculosis, a radical change in political and scientific thinking, and the implementation of specific measures worldwide, are needed.

“The global economic crisis and reduced investments in health services threaten national tuberculosis programmes and the gains made in global tuberculosis control.”

One of the report’s authors, Prof Alimuddin Zumla, said: “”It’s a growing problem in London and a huge, huge problem in Europe – it’s in our backyard at the moment.”

However, he warned there was “no overnight solution” for tuberculosis.

He said many of the necessary tools, such as antibiotics, had already been developed, but the challenge was using them appropriately in often poor countries.

Prof Zumla argues that Europe overcame tuberculosis by tackling poverty; however, “that’s an ideal that I don’t think is going to happen [for the rest of the world]“, he said.

Dr John Moore-Gillon, a medical adviser for the British Lung Foundation, told the BBC: “They are not scaremongering this at all.

“Tuberculosis is perceived as someone else’s problem, there’s no doubt we need a bit of political leadership.”

He said there had been a “shameful” lack of investment in tuberculosis treatment and research.

“With global population movement, tuberculosis is in everyone’s backyard.”

Threat from drug resistant superbugs

The rise of drug-resistant superbugs will drag the health service back ‘to the early 19th century’, Britain’s most senior medical adviser has warned.

Unless urgent action is taken, the ‘ticking timebomb’ of growing antibiotic resistance could leave millions vulnerable to untreatable bugs within a generation.

This could make even routine operations such as hip surgery deadly, said Chief Medical Officer Professor Dame Sally Davies.

In an attempt to tackle the problem, GPs will be ordered to prescribe fewer antibiotics.

While infections are becoming increasingly difficult to beat, no new class of antibiotic has been discovered since 1987. In contrast, a new infection emerges on an almost yearly basis.

Dame Sally said the ‘catastrophic threat’ from infections resistant to frontline antibiotics is so serious that she has asked the Government to put antibiotic resistance on the national risk register – ranking it alongside a large-scale terrorist attack or flu pandemic.

‘That is one way of getting central and cross-government action internationally,’ she said. ‘It should be [on the register] because this is a growing problem. And if we don’t get it right, we will find ourselves in a health system not dissimilar to the early 19th century at some point.

‘If we don’t act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics. And routine operations like hip replacements or organ transplants could be deadly because of the risk of infection.’

Acknowledging that ‘global action’ must be taken, she said: ‘This is an international threat.’

In the past five years, the number of cases of blood poisoning from antimicrobial resistant (AMR) forms of E. coli – which is twice as fatal as the normal bug – has gone up 60 per cent.

The drug-resistant gut bug alone, which is picked up in hospital in half of cases, could be responsible for up to 2,500 deaths in 2011 – more than MRSA and C. difficile combined.

And a deadly strain of tuberculosis which cannot be dealt with by most treatments has trebled in Britain in little over a decade.

Antibiotics

Antibiotics

Figures from the Health Protection Agency (HPA) show that instances of ‘multidrug resistant’ tuberculosis were 81 in 2011, up from just 28 in 2000, with around half of the patients dying.


Cases of extensively-resistant TB, which resists almost all types of drugs, have also emerged in the UK, with 12 in the past two years – as many as in the previous 15 years.

Another worrying trend is the rise in infections resistant to powerful antibiotics called carbapenems, the last line of treatment to tackle the most serious infections.

Figures from the HPA show samples testing positive for resistance to the drug have gone up more than 250-fold in the past decade, from three in 2003 to 800 in 2012.

Warning that ‘widespread’ AMR would be an ‘apocalyptic scenario’, Dame Sally has called for improved protection of our current stock of antibiotics, better incentives for the pharmaceutical industry to develop new drugs, and improved hygiene in hospitals.

But with antibiotics liberally used in agriculture, and available over the counter in many countries, these efforts will be undermined without a united global effort.

In 2010, infectious diseases accounted for 7 per cent of all deaths and 4 per cent of all potential years of life lost in England.

They also lose the economy a staggering £30billion a year in direct costs to the NHS and indirect costs to industry in terms of lost work hours.

Emeritus Professor Richard James, former director of the centre for healthcare associated infections at the University of Nottingham, called for ‘effective antibiotic stewardship to prevent the overuse/misuse of antibiotics’.