Drug-resistant TB finds way to the US

Immigrants may be steadily taking new cases of drug-resistant tuberculosis into the United States, hampering efforts to eradicate the deadly infection, researchers said recently.

A special issue of the Journal of the American Medical Association focusing on TB, showed the need for global control of the ancient disease, the researchers said.

The World Health Organisation estimates two billion people have tuberculosis. The disease, which has troubled humankind for thousands of years, kills two million people a year.

The AIDS epidemic has fuelled a resurgence of TB. which is especially deadly to those with immune systems weakened by HIV. Efforts to treat TB have resulted in mutated forms called drug-resistant TB, which results when patients do not complete months of treatment with a cocktail of antibiotics.

Dr. Reuben Granich of the Centre for Disease Control and Prevention said while TB fell overall by 33 per cent in California between 1994 and 2003, the proportion of cases that resisted more than two drugs, called multi-drug-resistant(MDR TB) remained steady.

His team studied all reported cases of tuberculosis in California, the state with the most cases of TB in the United States.

They looked at the more than 38,000 cases reported across the state over that time, especially the 28,700 tested for resistance to the two mainstay drugs, isoniazid and rifampin.

Of the 28,700 cases, 1.4 per cent were resistant to the drugs, meaning a different cocktail would be needed to treat those patients. That percentage stayed steady over the 10-year period.

Granich also found that 83 per cent of the MDR cases were in foreign-born people from 30 different countries. “We didn't find multi-drug-resistant TB was associated with homelessness or using injected drugs or HIV and AIDS or being incarcerated,” he said.

Cases were spread across the state, meaning a big expense for some clinics that may not be set up to absorb the costs, or for insurers. Treating a single case of MDR TB can cost anywhere between USD 28.217 and USD 1.2 million.

Only 67 per cent of those in the study completed the 18 to 24 months of drug cocktail therapy needed to cure them. Fourteen percent died and 14 per cent moved before they could finish, meaning they could spread their drug resistant infections to others.

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