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Source: http://america.aljazeera.com/articles/2014/12/29/drug-resistant-tuberculosis.html
[h=1]Drug-resistant tuberculosis patients face dwindling treatment options[/h]
[h=2]Doctors believe there is greater drug resistance and complexity of TB, which disproportionally affects immigrants[/h] December 29, 2014 5:00AM ET
by Katya Cengel Stephanie, 29, doesn?t know what to say when her brother, who has what his doctor says is the most drug-resistant tuberculosis ever diagnosed in the U.S., asks her what kind of life he is going to have if he can?t walk, use his hands or hear.
?I just say, ?But you?re alive,?? she says.
Her brother, Gary, is 37 and has extensively drug-resistant tuberculosis (XDR TB), a rare type of multidrug-resistant (MDR) tuberculosis that does not respond to almost any of the drugs used to treat TB. A year ago his family thought he would die. He still could. In November he was admitted to the hospital for a cold, a simple sickness that for Gary could prove deadly. He has only one lung, extreme hearing loss and disabling nerve damage to his hands and feet that makes it painful to walk. He suffers from paranoia and memory loss, and his skin is covered in pimples.
The disease has damaged his lungs; the treatment is destroying his body and mind. Gary and Stephanie requested that their last names not be used because of the stigma associated with the disease.
Once the leading cause of death in the United States, tuberculosis rates in the U.S. have been in decline for decades. Effective drug treatments in the 1940s all but erased tuberculosis from modern U.S. memory, until the mid-1990s, when a resurgence was blamed on AIDS, growing drug resistance and decreased funding. Renewed investment in TB prevention helped reverse the trend, and numbers once again went down, with fewer than 10,000 new cases reported in 2013. Half the cases occur in four states: Texas, New York, Florida and California. Over the last decade the rates of MDR TB have remained relatively constant, at about 1 percent of cases, or 86 in 2012, said Dr. Sundari Mase of the division for tuberculosis elimination at the U.S. Centers for Disease Control and Prevention (CDC).
But that number is only new cases. Because of the long length of treatment, there are twice as many at any given time if you include patients still in treatment, said Dr. Jennifer Flood, president of the National Tuberculosis Controllers Association and chief of the TB control branch at the California Department of Public Health. Even doubled, the number is small, but the threat and effort to make sure it doesn?t spread have more to do with the consequences than the quantity. And with MDR TB, the repercussions are both human and economic. Treatment for MDR TB takes years, not months. It is incredibly costly: about $260,000 (in 2010 dollars) in direct costs plus lost productivity for an average MDR TB patient and $554,000 for an XDR TB patient, according to a 2014 CDC study that looked at cases from 2005 to 2007. Even with treatment, 9 percent of those surveyed in the study died.
Although there is not enough information to make an official comparison, ?anecdotally many experts in the field feel that we are seeing greater complexity and greater drug resistance,? said Mase. Dr. Caitlin Reed, medical director of the inpatient TB unit at UCLA?s Olive View Medical Center, where Gary was eventually treated, said his case is the ?most drug resistant that?s ever been diagnosed or treated in the United States.?...
[h=1]Drug-resistant tuberculosis patients face dwindling treatment options[/h]
[h=2]Doctors believe there is greater drug resistance and complexity of TB, which disproportionally affects immigrants[/h] December 29, 2014 5:00AM ET
by Katya Cengel Stephanie, 29, doesn?t know what to say when her brother, who has what his doctor says is the most drug-resistant tuberculosis ever diagnosed in the U.S., asks her what kind of life he is going to have if he can?t walk, use his hands or hear.
?I just say, ?But you?re alive,?? she says.
Her brother, Gary, is 37 and has extensively drug-resistant tuberculosis (XDR TB), a rare type of multidrug-resistant (MDR) tuberculosis that does not respond to almost any of the drugs used to treat TB. A year ago his family thought he would die. He still could. In November he was admitted to the hospital for a cold, a simple sickness that for Gary could prove deadly. He has only one lung, extreme hearing loss and disabling nerve damage to his hands and feet that makes it painful to walk. He suffers from paranoia and memory loss, and his skin is covered in pimples.
The disease has damaged his lungs; the treatment is destroying his body and mind. Gary and Stephanie requested that their last names not be used because of the stigma associated with the disease.
Once the leading cause of death in the United States, tuberculosis rates in the U.S. have been in decline for decades. Effective drug treatments in the 1940s all but erased tuberculosis from modern U.S. memory, until the mid-1990s, when a resurgence was blamed on AIDS, growing drug resistance and decreased funding. Renewed investment in TB prevention helped reverse the trend, and numbers once again went down, with fewer than 10,000 new cases reported in 2013. Half the cases occur in four states: Texas, New York, Florida and California. Over the last decade the rates of MDR TB have remained relatively constant, at about 1 percent of cases, or 86 in 2012, said Dr. Sundari Mase of the division for tuberculosis elimination at the U.S. Centers for Disease Control and Prevention (CDC).
But that number is only new cases. Because of the long length of treatment, there are twice as many at any given time if you include patients still in treatment, said Dr. Jennifer Flood, president of the National Tuberculosis Controllers Association and chief of the TB control branch at the California Department of Public Health. Even doubled, the number is small, but the threat and effort to make sure it doesn?t spread have more to do with the consequences than the quantity. And with MDR TB, the repercussions are both human and economic. Treatment for MDR TB takes years, not months. It is incredibly costly: about $260,000 (in 2010 dollars) in direct costs plus lost productivity for an average MDR TB patient and $554,000 for an XDR TB patient, according to a 2014 CDC study that looked at cases from 2005 to 2007. Even with treatment, 9 percent of those surveyed in the study died.
Although there is not enough information to make an official comparison, ?anecdotally many experts in the field feel that we are seeing greater complexity and greater drug resistance,? said Mase. Dr. Caitlin Reed, medical director of the inpatient TB unit at UCLA?s Olive View Medical Center, where Gary was eventually treated, said his case is the ?most drug resistant that?s ever been diagnosed or treated in the United States.?...