Home' Trinidad and Tobago Guardian : May 31st 2014 Contents A32
body & soul
Guardian www.guardian.co.tt Saturday, May 31, 2014
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"Sometimes I ask myself, why me?
Why did this have to happen again?"
says 31-year-old Andile from the
Khayelitsha township in Cape Town,
South Africa. "But the problem is I
could have got it anywhere, on the
bus, in a taxi, in my work. It s every-
Andile has extensively drug-resistant
tuberculosis (XDR-TB), a form of the
airborne disease that is resistant to the
four main groups of drugs used to treat
it, meaning treatment can take years
and requires alternative drugs that have
more side effects.
He s had tuberculosis for more than
two years but it s not the first time he s
"Where I stay, the environment is
not right, it s not clean. I could have
got TB there, or on the taxis we use as
they never open the windows," he says.
TB has long been known as a disease
of poverty. Dense housing, shared living
space, poor ventilation, poor nutrition
and poor healthcare systems are the
prime conditions for the infection to
spread, and thrive.
This ancient disease was known as
the "White Plague" in 18th century
Europe and still kills more than one
million people a year globally.
It s a complicated disease with the
potential to affect many parts of the
body and it can remain latent in people
for many years, leaving them unaware
they are infected. The main active form
of the disease affects the lungs; if left
untreated it can cause considerable lung
damage, resulting in eventual death.
After repeated exposure, Andile has
extensive damage to his lungs, leaving
him reliant on an oxygen tank as he
receives his treatment from Medecin
Sans Frontiers. The NGO plays a large
role in treating TB in Khayelitsha, one
of the largest townships in the country.
Andile is one of thousands of people
who contract the extensively drug-
resistant form each year and he makes
a crucial point---TB is everywhere in
South Africa and is the leading cause
Looking at the disease globally, in
2013 there were 72 cases of drug-resis-
tant TB in the United States. In 2012
there were 64,000 cases in India and
59,000 in China. The more people and
the closer their proximity, the easier
the disease spreads.
Drug resistance can develop for a
variety of reasons. For TB, the origins
lie in incomplete treatment regimens
where people did not complete their
course of antibiotics due either to poor
health systems or personal preference
or complacency. Incomplete treatments
mean the bacteria behind the disease---
Mycobacterium tuberculosis---have had
some, but not full, exposure to the
drugs prescribed to kill them, giving
them the opportunity to mutate and
become resistant. The result today is
such vast resistance that in some set-
tings, all known drugs have been ren-
dered useless and these forms are now
transmitting between people.
The problem is now global. XDR-TB
has its highest prevalence in Russia,
Eastern Europe, China and India, with
the latter reporting cases of total drug
resistance. But according to the 2013
Global TB report from the World Health
Organization (WHO), this extensive
form of resistant TB has been reported
in 92 countries, and is likely to be in
"It s probably in every country," says
David Heymann, head of the Center
on Global Health Security at think tank
Chatham House and chair of the Health
Protection Agency in the UK.
The man in charge of the controlling
the problem globally is Mario Rav-
iglione, director of the Global Tuber-
culosis Program at the WHO.
"TB is competing with HIV/Aids as
the number one killer among the infec-
tious diseases," explains Raviglione.
"There are about 450,000 new drug-
resistant TB cases every year and this
is the scariest part of tuberculosis as
you are left with less options to treat
people, many of which are toxic."
Raviglione stresses that the epidemic
may differ in different parts of the world
but is very much an international issue.
"Russia, India, China and South Africa
have about 60 per cent of the world
cases, so if they don t improve there is
no way the world can progress," he
Raviglione is especially concerned
about the increased rates of drug-resis-
tant TB seen in Southern Africa.
"This scares us most because in that
part of the world there is a lot of HIV
and so it can become explosive and
really spread and move fast as HIV
amplifies the effect of tuberculosis."
The ability of HIV to suppress human
immune systems enables TB bacteria
to take over the body.
The WHO strategy therefore is to
target high-burden countries and
improve the diagnosis and treatment
of drug-resistant TB. Because patients
must take drugs for at least two years,
getting them to stick with the treatment
is essential, and transmission must also
be controlled. Not a simple feat.
"This threat has to be prevented and
when it does occur, extraordinary meas-
ures must be put in place to diagnose
and treat to stop it spreading to others,"
states Raviglione. (cnn.com)
YOUR DAILY HEALTH
News and advice
Fears over the rise
of 'incurable' TB
A TB patient in India which is reporting increases in the disease. Health organisations are reporting a rise in
the drug-resistant TB. AP PHOTO
For TB, the origins lie in
regimens where people did
not complete their course of
antibiotics due either to
poor health systems or
personal preference or
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