The Korea Herald

소아쌤

India reports new TB strain resistant to all drugs

By

Published : Jan. 16, 2012 - 17:41

    • Link copied

Indian doctors have reported the country's first cases of ``totally drug-resistant tuberculosis,'' a long-feared and virtually untreatable form of the killer lung disease.

(MCT) (MCT)


It's not the first time highly resistant cases like this have been seen. Since 2003, patients have been documented in Italy and Iran. It has mostly been limited to impoverished areas, and has not spread widely. But experts believe there could be many undocumented cases.

No one expects the Indian TB strains to rapidly spread elsewhere. The airborne disease is mainly transmitted through close personal contact and isn't nearly as contagious as the flu. Indeed, most of the cases of this kind of TB were not from person-to-person infection but were mutations that occurred in poorly treated patients.

What's more, there's a debate within the public health community about whether to even label TB infections as totally drug resistant. The World Health Organization hasn't accepted the term and still considers the cases to be what's now called extensively drug-resistant TB, or XDR. However, Dr. Paul Nunn, a coordinator at the WHO's Stop TB Department in Geneva, said there is ample proof that these virtually untreatable cases do exist.

The Indian hospital that saw the initial cases tested a dozen medicines and none of them worked, a pretty comprehensive assessment. A TB expert at the U.S. Centers for Disease Control and Prevention said they do appear to be totally resistant to available drugs.

``It is concerning,'' said Dr. Kenneth Castro, director of the CDC's Division of Tuberculosis Elimination. ``Anytime we see something like this, we better get on top of it before it becomes a more widespread problem.''

Ordinary TB is easily cured by taking antibiotics for six to nine months. However, if that treatment is interrupted or the dose is cut down, the stubborn bacteria battle back and mutate into a tougher strain that can no longer be killed by standard drugs. The disease becomes harder and more expensive to treat.

In India, doctors in Mumbai have reported a total of 12 patients who failed initial treatment and also didn't respond to the medicines tried next over an average of two to three years. Three have died. None of the others have been successfully treated.

The doctors detailed the first four cases in a letter to a U.S. medical journal last month, blaming private doctors for prescribing inappropriate drug plans that sparked greater resistance in three of those four patients.

``These three patients had received erratic, unsupervised second-line drugs, added individually and often in incorrect doses, from multiple private practitioners,'' wrote the doctors from P.D. Hinduja National Hospital and Medical Research Center in the journal Clinical Infectious Diseases.

One of the doctors, Zarir Udwadia, in a phone interview, said there is little hope for the surviving nine patients, all poor slum dwellers living in the community. He said he has detected one case of a mother passing the strain to a daughter living in close quarters. One of the patients was also infected with HIV, which typically results in faster death.

Udwadia criticized the testing and treatment methods of the Indian government's TB program, which he says forces patients to turn to private doctors, many of whom do not understand how to properly treat TB or the risks of increasing drug resistance by prescribing the wrong drugs.

``It was a given that this would happen,'' Udwadia said. ``They have had no help from the Indian TB system. They are the untouchables, so no one is making a fuss. They don't have the power to vocalize. There's going to be more family contacts. It's going to spread for sure.''

India's Health Ministry did not respond to phone calls and written requests for comment Monday and last week.

Similar highly resistant cases have been noted before. In 2003, two Italian women died and there were 15 cases reported from Iran in 2009. That same year, The Associated Press reported on a case of a Peruvian teenager who was infected at home but diagnosed while visiting Florida. He was successfully treated for a year and a half with experimental high doses of medicines not typically used for TB, costing about $500,000.

Those resources are unthinkable in the developing world, where TB remains a menacing killer and where few hospitals can perform tests to find out which antibiotics might work.

``For there to be another report coming out from India is no surprise at all. Indeed, in a sense, it's surprising it's taken so long,'' said WHO's Nunn. This is ``yet another alarm call for countries and others engaged in TB control to do their jobs properly.''

Tuberculosis is an age-old scourge that lies dormant in an estimated 1 in 3 people worldwide. About 10 percent of those people eventually develop active TB, which kills roughly 2 million a year, according to the WHO. Each victim infects an average of 10 to 15 others every year, typically through sneezing or coughing.

If a TB case is found to be resistant to the two most powerful anti-TB drugs, the patient is classified as having multi drug-resistant TB (MDR). An even worse classification of TB _ one the WHO accepts _ is extensively drug-resistant TB (XDR), a form of the disease that was first reported in 2006 and is virtually resistant to all drugs.

An estimated 20 percent of the world's multi-drug-resistant cases are found in India, which is home to a quarter of all types of tuberculosis cases worldwide. (AP)

 

<한글기사>

'모든 약에 내성' 슈퍼결핵균 또 발견

이탈리아, 이란 이어 인도서도

이탈리아와 이란에 이어 인도에서도 모든 약이 듣지 않는  '완전 내성 결핵균'이 처음 확인됐다고 AP통신이 16일 보도했다.

통신에 따르면 인도 뭄바이 소재 P.D. 힌두자 국립병원 소속 의료진은 시판  중 인 결핵치료제에 전혀 반응하지 않는 환자 12명의 사례를 미국의 한 학술지에  지난 달 보고했다.

의료진은 1차 약물로 치료에 실패한 후 2차 치료제까지 총 10여종의 약물을  차 례로 투여하며 2~3년간 관찰했으나 3명이 사망하고 나머지 환자도 결국 치료하지 못 했다고 밝혔다.

의료진은 이에 따라 이들의 결핵균이 '완전 내성 결핵'이라고 결론지었다.

지금까지 개발된 어떤 치료제도 듣지 않는 '완전 내성' 또는 '전면 내성' 결핵 환자는 지난 2003년 이탈리아에서 2명이 발견됐고 이어 2009년 이란에서 15건이  보 고됐다.

완전 내성 결핵은 아직 의학적으로 확립된 개념은 아니다.

세계보건기구(WHO)는 1차 치료 약물 2종에 내성인 결핵은 '다제 내성 결핵(MDR- TB)'으로, 비교적 최신 약물인 2차 치료제에도 내성인 경우 '광범위 내성 결핵(XDR- TB)'으로 정의한다. 광범위 내성 결핵은 흔히 '슈퍼 결핵'으로 불린다.

내성 결핵은 사람 간 감염에 의해 전파되기보다는 의료진과 환자가 정확한 약물 치료 방법을 준수하지 않아 결핵균이 유전자 변이를 일으킴으로써 발생한다.

이번 연구를 실시한 의료진은 정부의 잘못된 결핵관리 정책과 민간 병원의 전문 성 부족으로 내성 결핵이 생겨나고 있다고 지적했다.