XDR-TB Might Be More Widespread Than Previously Thought, Doctor Who Discovered Strain Says

A strain of XDR-TB -- tuberculosis that is resistant to first- and second-line drugs -- probably has spread beyond the rural area in South Africa's KwaZulu-Natal Province where it recently has been recorded, Tony Moll, the doctor who discovered the strain, said this week, the AP/Yahoo! News reports (Faul, AP/Yahoo! News, 9/6). According to a study presented last month at the XVI International AIDS Conference in Toronto, XDR-TB has appeared among HIV-positive people in KwaZulu-Natal. Gerald Friedland of Yale University and colleagues examined the sputum samples of 536 people living with TB in the town of Tugela Ferry in the Msinga district of KwaZulu-Natal that were collected between January 2005 and March 2006. They found that 221 -- or 41% -- of the study participants had multi-drug resistant TB, and of these, 53 had XDR-TB. All of the people with XDR-TB were HIV-positive. According to study co-author Neel Gandhi of the Albert Einstein College of Medicine at Yeshiva University, most of the people with XDR-TB were carrying a genetically similar strain. According to the study, 52 of the 53 people with XDR-TB died, most within 30 days of having their sputum collected. The average survival period among the people with XDR-TB was 16 days, according to the researchers. According to Friedland, most of the participants who died had progressed to AIDS, and about half had contracted XDR-TB at hospitals or clinics. Because most of the people with XDR-TB had never been treated for TB, the researchers concluded that they did not develop resistance to treatment but had contracted the resistant strains from other people (GlobalHealthReporting.org, 9/5). Moll -- who works at a government hospital in the KwaZulu-Natal's capital, Durban -- said the scope of the outbreak was not known because the required tests were costly and specialized. He also said XDR-TB has been detected in miners, who are highly mobile, and that the strains likely are present throughout South Africa. According to experts from CDC and the World Health Organization and African officials -- all of whom are scheduled to meet in Johannesburg, South Africa, for a conference to address the issue -- cases of XDR-TB are increasing in Botswana, Mozambique and South Africa. Conference organizers also said that XDR-TB is a "major threat to successful HIV treatment and care in sub-Saharan Africa" (AP/Yahoo! News, 9/6).

Province Seeks New Drugs To Treat XDR-TB
The KwaZulu-Natal Health Department on Wednesday announced that it is seeking to determine how far XDR-TB has spread and to obtain new drugs to treat it, the SAPA/Independent Online reports. Health department spokesperson Nhlanhla Nkosi said the department's efforts include rapid diagnosis, sequestering patients and increased tracing of patient contacts to detect the disease before it can spread. South Africa has access to nine of the 11 drugs available to treat TB, but XDR-TB is resistant to seven of them, Nkosi said. The department is seeking to get access to the two drugs South Africa does not have, according to the SAPA/Independent Online. Nkosi also said tests are being conducted to determine whether the two drugs are effective to treat XDR-TB (SAPA/Independent Online, 9/6).