Poverty’s Child and MDR-TB: Multidrug-resistant Tuberculosis

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CAPE TOWN, South Africa — “TB is the child of poverty – and also its parent and provider.” – Archbishop Desmond Tutu.

Tuberculosis might identify as an antiquated disease of Bohemians and 19th century garrets, but areas of extreme poverty are witnessing a modern resurgence of the disease. This newest global health concern is called Multidrug-resistant tuberculosis, or MDR-TB.

The formidable MDR-TB strain emerges when patients of regular drug-susceptible tuberculosis do not complete the full course of antibiotics treatment due to shortage of drugs, failure of healthcare personnel to deliver the correct medication or drugs of deficient quality.

By reason, it is a disease associated with the poorest of the world.

MDR-TB transmission happens in the same way as regular TB infections: the bacteria spread through the air via means such as coughing, sneezing, speaking and singing. The potentiality of this new dangerous and highly difficult strain of the disease spreading is high.

Some call it the revenge of tuberculosis.

There also exists an Extensively Drug-resistant TB (XDR-TB) strain, cases of which have particularly arisen in HIV patients with compromised immune systems. The strain is prevalent among populations in Africa; longitudinal treatment studies in South Africa reported that only 11% of XDR-TB patients had “favorable” outcomes after five years of treatment.

When modern TB drugs are no longer effective against drug-resistant strains, doctors are often forced to prescribe older medications that have more devastating side-effects including deafness, chronic aches, blindness and depression.

Treatments for MDR-TB are very costly. In Moldova, the most impoverished country in Eastern Europe and, coincidentally, the country outside of Africa with the highest rate of arising MDR-TB cases, treatment for a single case could cost up to $5,000. According to the World Health Organization’s Global Plan to Stop TB, global management of TB will require 47 billion between 2011 and 2015.

The global management of MDR-TB is projected to rise from 1 billion in 2011 to 2 billion in 2015. But an investment in the control of worldwide TB infections has several economic pay-offs, such as the reduction of the over costs of healthcare expenditures. But, there are real dollar figures involved in such economics.

In a report released by the World Bank in 2007, the economic burden between 2006 and 2015 of TB-associated deaths in 22 high-burden countries was estimated to range from 3.33 billion for Zimbabwe and 1.175 billion for China if the Stop TB Plan was not implemented. If the Plan were implemented, the high-risk countries would see economic gains of around 1.6 trillion.

For now, a glimmer of hope has been discovered in the labs of a Copenhagen-based chemist. Jørn Bolstad Christensen and his colleagues have processed a patent for a drug that will work against MDR-TB to make such strains susceptible to drugs once again.

Drug-resistance in TB bacteria work as pumps; essentially, once an antibacterial drug gets into the resistant TB bacterium, the bacterium spits out the antimicrobial substance before it can kill it. Christensen’s drug blocks the action of these efflux pumps, allowing the drugs to once again take effect on the TB microbes.

Christensen has high hopes and is very aware of TB’s association with the poor and the destitute,”I would rather donate this discovery to an NGO able to use this substance in poor countries that suffer from drug-resistance problems than watch it collect dust in the industrialised world. So, I hope that an investor comes along to develop this ground-breaking substance.”

– Malika Gumpangkum

Sources: Action.org, The Lancet, NPR, World Bank, WHO, WHO, News Medical, CDC, Nature, Lung, WHO, CDC
Photo: Peter Caton

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