Glasgow Man Treated For Drug Resistant TB
Mar 22 2008 By Craig McDonald

DOCTORS in Glasgow are treating the first patient in the UK to be diagnosed with a super-strong form of tuberculosis.

The man, who is in his 30s and came to Britain from Somalia last year, is in an isolation unit at Gartnavel General Hospital.

He is suffering from Extreme drug-resistant (XDR) tuberculosis, which cannot be treated with standard antibiotics.

Tuberculosis is not highly infectious and experts insist there is no risk of the disease spreading to the general public.

But doctors are keeping a watch on people who have spent long periods in close contact with the infected man. Glasgow public health consultant Dr Oliver Blatchford said yesterday: "They are being screened and will be monitored closely to ensure that any further cases are identified and treated quickly."

The patient was screened for infectious diseases when he arrived at Heathrow last November. An X-ray revealed TB scars on his lungs but the disease was not active at that time.

The man, who is understood to have claimed political asylum, told doctors at the airport that he had recently had six months of treatment for TB.

He was given permission to travel to Scotland, where he fell ill. He went into hospital in January.

Normal TB drugs do not work on XDR, so a cocktail of different medicines is used to contain the disease. A full course of treatment takes up to 18 months and costs more than £100,000.

Tuberculosis was once one of Britain's biggest killers.

But the disease was virtually wiped out in this country by the discovery of antibiotics, and most of the patients now treated in the UK become infected in other parts of the world where TB is still common.

South-east Asia, sub-Saharan Africa and parts of eastern Europe have high rates of TB infection.

Tests last week revealed that 20 children at Notre Dame primary school in Dowanhill, Glasgow, had been exposed to TB. The results came weeks after a teacher at the school fell ill with the disease.

Only one of the youngsters was confirmed as being infected with TB. The other 19 were put on antibiotics as a precaution.













WHO concern over extensive drug resistant TB strains that are virtually untreatable

5 SEPTEMBER 2006 | GENEVA -- The World Health Organization (WHO) has expressed concern over the emergence of virulent drug-resistant strains of tuberculosis (TB) and is calling for measures to be strengthened and implemented to prevent the global spread of the deadly TB strains. This follows research showing the extent of XDR-TB, a newly identified TB threat which leaves patients (including many people living with HIV) virtually untreatable using currently available anti-TB drugs.

Later this week, WHO will join other TB experts at a two-day meeting in South Africa (7-8 September) to assess the response required to critically address TB drug resistance, particularly in Africa, and will take part in a news conference scheduled for Thursday, 7 September in Johannesburg.

What is XDR-TB?

MDR-TB (Multidrug Resistant TB) describes strains of tuberculosis that are resistant to at least the two main first-line TB drugs - isoniazid and rifampicin. XDR-TB, or Extensive Drug Resistant TB (also referred to as Extreme Drug Resistance) is MDR-TB that is also resistant to three or more of the six classes of second-line drugs.

The description of XDR-TB was first used earlier in 2006, following a joint survey by WHO and the US Centers for Disease Control and Prevention (CDC).

Resistance to anti-TB drugs in populations is a phenomenon that occurs primarily due to poorly managed TB care. Problems include incorrect drug prescribing practices by providers, poor quality drugs or erratic supply of drugs, and also patient non-adherence.

What is the current evidence of XDR-TB?

Recent findings from a survey conducted by WHO and CDC on data from 2000-2004 found that XDR-TB has been identified in all regions of the world but is most frequent in the countries of the former Soviet Union and in Asia.

In the United States, 4% of MDR-TB cases met the criteria for XDR-TB.

In Latvia, a country with one of the highest rates of MDR-TB, 19% of MDR-TB cases met the XDR-TB criteria.

Separate data on a recent outbreak of XDR-TB in an HIV-positive population in Kwazulu-Natal in South Africa was characterized by alarmingly high mortality rates.

Of the 544 patients studied, 221 had MDR-TB. Of the 221 MDR-TB cases, 53 were defined as XDR-TB. Of the 53 patients, 44 had been tested for HIV and all were HIV-positive.

52 of 53 patients died, on average, within 25 days including those benefiting from antiretroviral drugs.

Scarce drug resistance data available from Africa indicate that while population prevalence of drug resistant TB appears to be low compared to Eastern Europe and Asia, drug resistance in the region is on the rise.

Given the underlying HIV epidemic, drug-resistant TB could have a severe impact on mortality in Africa and requires urgent preventative action.

What action is required to prevent XDR-TB?

XDR-TB poses a grave public health threat, especially in populations with high rates of HIV and where there are few health care resources. Recommendations outlined in the WHO Guidelines for the Programmatic Management of Drug Resistant Tuberculosis include:

  • strengthen basic TB care to prevent the emergence of drug-resistance
  • ensure prompt diagnosis and treatment of drug resistant cases to cure existing cases and prevent further transmission
  • increase collaboration between HIV and TB control programmes to provide necessary prevention and care to co-infected patients
  • increase investment in laboratory infrastructures to enable better detection and management of resistant cases.

The Expert Consultation on Drug Resistant TB, hosted by the South African Medical Research Council with support from WHO and CDC, takes place in Johannesburg, 7-8 September.

A news conference will be held at 12.30pm, Thursday, 7 September, at the conference venue: Sunnyside Park Hotel, Parktown, Johannesburg.

For more information contact:

Glenn Thomas
Stop TB Department
Mobile: +41 79 5 09 06 77

Dr Karin Weyer
Director, South African Medical Research Council
Unit for TB Operational and Policy Research
Tel: +27 12 3 39 85 50
Mobile: +27 82 4 60 88 36