Another TB Scare as Woman With Rare Form of TB is Treated at the NIH

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( — June 9, 2015) –A woman with a form of drug resistant tuberculosis is being treated at the National Institutes of Health, as health officials seek those that she may have come in contact with while traveling on a flight from India as well as trips inside the United States.  In April of this year, the woman traveled from India via Chicago O’Hare International Airport and also visited Missouri and Tennessee.

Seven weeks after she got to the United States, she sought treatment and was diagnosed with active TB, officials said. She is currently in stable condition in an isolation unit at the NIH Clinical Center in Bethesda. Health care providers and infectious disease specialists are concerned about this form of TB that is resistant all the usual drugs that are used for treating TB.  

The World Health Organization declared TB a “global health emergency” in 1993, and in 2006, the Stop TB Partnership developed a Global Plan to Stop Tuberculosis that aims to save 14 million lives between its launch and 2015. A number of targets they have set are not likely to be achieved by 2015, mostly due to the increase in HIV-associated tuberculosis and the emergence of multiple drug-resistant tuberculosis (MDR-TB). A tuberculosis classification system developed by the American Thoracic Society is used primarily in public health programs.

Currents tests are very expensive, time consuming, and not useful in third world countries.  One third of the world’s population is thought to be or has been infected with M. tuberculosis (World Health Organization (2009) in their publication “Epidemiology,” Global tuberculosis control: epidemiology, strategy, financing. pp. 6–33).   

Skin tests are often anergic and they fail to show hidden TB by a falsely negative skin test in some 50% of immune compromised patients.  These are the patients most likely to get TB and may have one or more immune suppression conditions such as HIV-AIDS.  Cultures can take 6 to 8 weeks and are difficult to obtain (bronchoscopy is not feasible).   Serum tests for TB are much too expensive.

There is an additional problem of drug resistance due to compliance and high death rate due to other infections.  Spreading diseases is a big worldwide concern.

Drug resistance

Drug-resistant tuberculosis (TB) is a serious emerging problem in many low-resource countries,  and the World Health Organization declared TB a “global health emergency” in 1993.  The increase in the number of TB cases that now worldwide and resistance to all drugs is becoming a serious concern with few new solutions.

TB epidemic:  there are an estimated 9.4 million new cases globally, tuberculosis (TB) continues to be a major public health concern. Eighty percent of all cases worldwide occur in 22 high-burden, mainly resource-poor settings. This devastating impact of tuberculosis on vulnerable populations is also driven by its deadly synergy with HIV. Therefore, building capacity and enhancing universal access to rapid and accurate laboratory diagnostics are necessary to control TB and HIV-TB coinfections in resource-limited countries.

HIV infection in humans is considered pandemic by the World Health Organization and only 0.5% of women attending urban health facilities are counseled, tested or receive their test results. Further, because HIV testing is often unavailable in many third world countries, there are associated high rates of undetected HIV, high rates of transmission, and high rates of associated diseases such as TB and some cancers.

In 2007, there were an estimated 13.7 million chronic active cases globally,[4] while in 2010, there were an estimated 8.8 million new cases and 1.5 million associated deaths, mostly occurring in developing countries.[5] The absolute number of tuberculosis cases has been decreasing since 2006, and new cases have decreased since 2002.[5] The distribution of tuberculosis is not uniform across the globe; about 80% of the population in many Asian and African countries test positive in tuberculin tests, while only 5–10% of the United States population tests positive.[1] More people in the developing world contract tuberculosis because of compromised immunity, largely due to high rates of HIV infection and the corresponding development of AIDS.[6]

About 5–10% of those without HIV, infected with tuberculosis, develop active disease during their lifetimes.[8] In contrast, 30% of those coinfected with HIV develop active disease.[8] Tuberculosis may infect any part of the body, but most commonly occurs in the lungs (known as pulmonary tuberculosis).[9] Extrapulmonary TB occurs when tuberculosis develops outside of the lungs. Extrapulmonary TB may coexist with pulmonary TB as well.[9] General signs and symptoms include fever, chills, night sweats, loss of appetite, weight loss, and fatigue,[9] and significant finger clubbing ay also occur.[8]

A number of factors make people more susceptible to TB infections. The most important risk factor globally is HIV; 13% of all TB cases are infected by the virus.[5] This is a particular problem in sub-Saharan Africa, where rates of HIV are high.  Tuberculosis is closely linked to both overcrowding and malnutrition, making it one of the principal diseases of poverty.[6] Those at high risk thus include: people who inject illicit drugs, inhabitants and employees of locales where vulnerable people gather (e.g. prisons and homeless shelters), medically underprivileged and resource-poor communities, high-risk ethnic minorities, children in close contact with high-risk category patients, and health care providers serving these clients.

Tuberculosis is the second most common cause of death from infectious disease (after those due to HIV/AIDS).[9] The absolute number of tuberculosis cases (“prevalence”) has been decreasing since 2005, while new cases (“incidence”) have decreased since 2002.[5] China has achieved particularly dramatic progress, with an approximate 80% reduction in its TB mortality rate between 1990 and 2010.[85] Tuberculosis is more common in developing countries; about 80% of the population in many Asian and African countries test positive in tuberculin tests, while only 5–10% of the US population test positive.[1] Hopes of totally controlling the disease have been dramatically dampened because of a number of factors, including the difficulty of developing an effective vaccine, the expensive and time-consuming diagnostic process, the necessity of many months of treatment, the increase in HIV-associated tuberculosis, and the emergence of drug-resistant cases in the 1980s

A Solution is point of care testing.  The Development of noninvasive methods for tuberculosis (TB) diagnosis, with the potential to be administered in field situations, remains as an unmet worldwide challenge so we need to revolutionize the diagnostic evaluation for TB tests with an inexpensive hand held device testing for to discriminate tuberculosis patients from healthy subjects primarily testing for the markers for this disease.   

About the Author

Dr. Kevin Buckman is the CEO of Viratech Corp, a company seeking to find new solutions for the rapid and early detection of diseases, while also using the power of social networking technologies for communication and research.