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Totally drug resistant tuberculosis?

January 12, 2012 at 11:42 pm By Roz Potter

From Maryn McKenna’s blog, Superbug, at Wired.com,  Link

Tuberculosis is one of the world’s most lethal communicable diseases, accounting  for  9.4 million cases and 1.7 million deaths in 2009, according to the World Health Organization. That death toll may soon be much higher.

Due to incomplete and incorrect treatment regimens, the bacteria has developed resistance to all drugs known to effectively treat it, according to a group of doctors in Mumbai, India.

The World Health Organization takes issue with the notion that the bacteria is totally drug-resistant, or TDR, since experimental drugs have not yet been tried.

Excerpts:

News of some of the cases was published Dec. 21 in an ahead-of-print letter to the journal Clinical Infectious Diseases…

On Saturday, the Times of India disclosed that there are actually 12 known cases just in one hospital, the P. D. Hinduja National Hospital and Medical Research Centre; in the article, Hinduja’s Dr. Amita Athawale admits, “The cases we clinically isolate are just the tip of the iceberg.” And as a followup, the Hindustan Times reported yesterday that most hospitals in the city — by extension, most Indian cities — don’t have the facilities to identify the TDR strain, making it more likely that unrecognized cases can go on to infect others.

***

Because of the mismatch between treatment and symptoms, people often don’t take their full course of drugs — and from that (and some other factors I’ll talk about in a minute) we get multi-drug resistant and extensively drug-resistant, MDR and XDR, TB. MDR is resistant to the first-choice drugs, requiring that patients instead be treated with a larger cocktail of “second-line” agents, which are less effective, have more side effects, and take much longer to effect a cure, sometimes 2 years or more. XDR is resistant to the three first-line drugs and several of the nine or so drugs usually recognized as being second choice.

***

As of last spring, according to the WHO, there were about 440,000 cases of MDR-TB per year, accounting for 150,000 deaths, and 25,000 cases of XDR. At the time, the WHO predicted there would be 2 million MDR or XDR cases in the word by 2012.

That was before TDR-TB.

The first cases, as it turns out, were not these Indian ones, but an equally under-reported cluster of 15 patients in Iran in 2009. They were embedded in a larger outbreak of 146 cases of MDR-TB, and what most worried the physicians who saw them was that the drug resistance was occurring in immigrants and cross-border migrants as well as Iranians: Half of the patients were Iranian, and the rest Afghan, Azerbaijani and Iraqi. The Iranian team raised the possibility at the time that rates of TDR were higher than they knew, especially in border areas where there would be little diagnostic capacity or even basic medical care.

The Indian cases disclosed before Christmas demonstrate what happens when TB patients don’t get good medical care. The letter to CID describes the course of four of the 12 patients; all four saw two to four doctors during their illness, and at least three got multiple, partial courses of the wrong antibiotics. The authors say this is not unusual:

NYT: When food kills – antibiotic overuse in animals and the emerging antibiotic resistant organisms that kill humans

June 12, 2011 at 11:13 am By Roz Potter

From the NYT:  Link

Excerpts:

The deaths of 31 people in Europe from a little-known strain of E. coli have raised alarms worldwide, but we shouldn’t be surprised. Our food often betrays us. (editor’s note: in Europe, more than 3283 people have confirmed cases and at least 100 of these need kidney transplants, due to severe damage to their kidneys from the Shiga toxin-producing bacteria. Many more who have been sickened are not in the official count, for a variety of reasons).

Just a few days ago, a 2-year-old girl in Dryden, Va., died in a hospital after suffering bloody diarrhea linked to another strain of E. coli. Her brother was also hospitalized but survived.

Every year in the United States, 325,000 people are hospitalized because of food-borne illnesses and 5,000 die, according to the Centers for Disease Control and Prevention. That’s right: food kills one person every two hours.

Yet while the terrorist attacks of 2001 led us to transform the way we approach national security, the deaths of almost twice as many people annually have still not generated basic food-safety initiatives. We have an industrial farming system that is a marvel for producing cheap food, but its lobbyists block initiatives to make food safer.

Perhaps the most disgraceful aspect of our agricultural system — I say this as an Oregon farmboy who once raised sheep, cattle and hogs — is the way antibiotics are recklessly stuffed into healthy animals to make them grow faster.

The Food and Drug Administration reported recently that 80 percent of antibiotics in the United States go to livestock, not humans. And 90 percent of the livestock antibiotics are administered in their food or water, typically to healthy animals to keep them from getting sick when they are confined in squalid and crowded conditions.

The single state of North Carolina uses more antibiotics for livestock than the entire United States uses for humans.

This cavalier use of low-level antibiotics creates a perfect breeding ground for antibiotic-resistant pathogens. The upshot is that ailments can become pretty much untreatable.

Is U.S. vulnerable to E. coli outbreak like Europe’s?

June 9, 2011 at 9:36 am By Roz Potter

From the NPR health blog, Shots:  Link

Excerpts:

Dr. Christopher Braden, the chief of food- and waterborne diseases at the Centers for Disease Control and Prevention, doesn’t expect the Escherichia coli bug causing serious illness in northern Europe to leapfrog the Atlantic anytime soon.

Still, Braden tells Shots, “I am concerned about something similar that could happen in the United States.”

That’s because the U.S. already sees “quite a few infections every year” from Shiga-toxin-producing E. coli. That’s the dangerous kind that can destroy blood cells, clog arteries, cause intestinal bleeding and lead to kidney failure and death.

***

Officials estimate that at least 100,000 Americans suffer E. coli infections from toxin-producing organisms every year, sending thousands to the hospital and killing about 80 people. That’s a much bigger toll than the current German-centered outbreak — more than 2,400 cases, including more than 600 cases of kidney failure, and 23 deaths. But most cases occur one-by-one, not in big outbreaks.

There’s controversy over why the European bug is so bad.

Some experts think it’s not really more dangerous than earlier strains. It’s just that more people got exposed to it, or perhaps there was an unusually high level of contamination on whatever foods affected people ate.

Another hypothesis: Perhaps some of the most seriously ill cases were treated with antibiotics. Paradoxically, some think that can make matters worse. Some say that’s because more toxin is released from the E. coli that are killed off. Others think, in the case of a highly antibiotic-resistant bug like O104:H4, antibiotics kill off other intestinal flora but not the E. coli, leaving them a clear field.

University of Wisconsin infectious disease specialist Dr. Dennis Maki dismisses these theories. He has treated lots of people with bad E. coli infections over the years, and he says this one is clearly different.

Earlier strains were far less likely to put victims in the hospital with severe anemia and kidney failure, Braden says, with “rarely over 10 percent” of patients affected.

By contrast, Maki notes the European strain is hospitalizing about a third of its victims. “That’s extraordinary,” he tells Shots. “This is an extraordinarily virulent strain of E. coli. I think that’s becoming clear.”

Maki predicts that “we will see U.S. cases” of the European bug as it gets carried back to North America by travelers. “We could have a big outbreak with this strain in a year or two or three,” he says. “It’s not out of the question at all.”

Osterholm agrees that the bug will get around. “Are there going to be more outbreaks like we see in Germany right now occurring around the world?” he says. “I bet you there will be.”

That’s why experts want to learn everything they can about the European bug – how it got there, why it’s so deadly, and above all, how it gets into food.

***

“For a number of years, almost all of the strains of this kind of E. coli were that O157:H7,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “Over the past 15 years, we’ve seen a very sizable increase in the number of non-O157:H7 strains.”

That’s thought to be due in large part to improvements food safety aimed at detecting and eliminating O157 strains from the food supply. But that has opened a path for other types of toxin-producing strains — of which there are hundreds.

It’s unclear how many of these non-O157 strains are involved in U.S. food-borne infections because they’re harder to test for. “But when we do studies looking for them, they make up well over half of all the hemorrhagic E. coli illnesses out there,” Osterholm tells Shots. “And we think that number is actually increasing, not decreasing.”

To read the full article, Link

New and deadly E-coli strain causes epidemic in 12 countries, spreading kidney failure, serious neurological symptoms, and death

June 4, 2011 at 2:53 pm By Roz Potter

Sources:

World Health Organization update #6   Link

Center for Infectious Disease Research and Policy from the Univ of Minnesota:   Link

June 2011 update from Eurosurveillance:   Link

From H5N1 blog:  a translation of an article from the German Ärzte Zeitung: EHEC: Early neurological therapy recommended, Link

Excerpts:

The count of cases (some severely ill with renal failure and serious neurological symptoms) and deaths in Europe’s Escherichia coli outbreak pushes higher daily, with official case counts of around 1700, with many others likely uncounted. The epidemic has been traced to Hamburg, Germany but the exact source remains unknown.  Many who are infected attended a 2 day Festival in Hamburg.

A WHO expert, Donato Greco, told the Italian newspaper La Repubblica: “The virus is found in intestines of cattle and therefore usually in raw meat such as tartar or poorly cooked hamburgers.” He said he had never yet seen such dangerous intestinal bacteria on fruits and vegetables.

There are two types of infection, one,with fewer victims involves hemolytic uremic syndrome (HUS), or potentially fatal kidney failure. A number of victims are on dialysis.

*****

The German Society of Neurology (DGN) has reported that about half of patients with hemolytic-uremic syndrome (HUS) may also suffer from severe and sometimes irreversible neurological disorders.

Two Hamburg neurologists, Professor Joachim Roether and Professor Christian Gerloff, say that is is alarming that the neurological condition in spite of early plasmapheresis does not improve or even deteriorates.

Gerloff is director of neurology at the University Hospital Hamburg-Eppendorf (UKE), Roether is Chief of Neurology at the Asklepios Clinic Altona.

Espeically striking is the early appearance of neurological symptoms, says Gerloff. “It can develop simultaneously with renal and gastroenterological symptoms.”

Crucial features of HUS are bloody diarrhea, hemolysis, and renal dysfunction.  In the neurological symptom complex in HUS, the first are confusion, reduced vigilance, irritability and delirium. There are also many cases of aphasia and apraxia, and disturbances of the brain stem functions. In severe cases, patients develop myoclonic seizures and sometimes that can lead to coma.

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