Young woman's death sparks fears of a killer TB strain on Australia's doorstep

March 14, 2013 – QUEENSLND – Australia’s first victim of a killer strain of drug-resistant tuberculosis has died, amid warnings of a looming health epidemic on Queensland’s doorstep. Medical experts are seriously concerned about the handling of the TB epidemic in Papua New Guinea after Catherina Abraham died last Thursday of an incurable form of the illness, known as XDR-TB (extensively drug resistant TB) in Cairns Base Hospital. The 20-year-old had been in an isolation ward since May last year after an outbreak of the highly-contagious mutated form of TB on Daru Island, off Cape York. Some doctors fear she will become the first of a wave medical refugees heading to Queensland for treatment. The State’s Chief Health officer Jeanette Young has urged people not to panic about the threat of an outbreak on the mainland. But respiratory physician Steve Vincent, who treated Ms Abraham, warned that there was a further threat of Totally Drug Resistant or TDR-TB “just around the corner. Her death is not unexpected given the fallout of this killer, incurable disease,” Dr Vincent said. “Despite all the first-world medical treatment, it shows how difficult it is to control. A Papua New Guinean man crosses the waters of the Torres Strait. “It exemplifies the fact with such a high mortality rate, PNG is going to have an extremely difficult time in handling this epidemic.” He said doctors may soon face the ethical dilemma, where it might be “more humane not to treat them and let them die,” as the disease was untreatable. Australian and Papua New Guinean authorities are trying to contain XDR-TB to the shanty towns of Daru Island as more than 14,500 TB cases are diagnosed in PNG’s Western Province every year. Federal MP Warren Entsch, whose electorate includes the Torres Strait, yesterday said the $31 million AusAid TB program in the Western Province was “riddled with corruption” and “completely inadequate.” He said Ms .Abraham’s death was a grim reminder of the ‘looming public health disaster on our doorstep.’ XDR-TB is estimated to cost between $500,000 and $1 million a patient to treat in Australian hospitals, with a low cure rate and high death rate. Dr. Young said she supported efforts to contain the epidemic to the PNG side of the border and not reopen clinics on the Torres Strait islands of Boigu or Saibai. She said re-opening health clinics on Boigu or Saibai islands would only increase the risk of cross-border infection in the Torres Strait. –Courier Mail

Drug-resistant TB case touches off scare in U.S. - We don’t know too much about a Nepalese man who’s in medical isolation in Texas while being treated for extensively drug-resistant tuberculosis, or XDR-TB, the most difficult-to-treat kind. Health authorities are keen to protect his privacy. But we do know that he traveled through 13 countries — from South Asia to somewhere in the Persian Gulf to Latin America — before he entered the U.S. illegally from Mexico in late November. He traveled by plane, bus, boat, car and on foot. And all the way he may have unwittingly put hundreds of other people at risk of getting the highly drug-resistant TB strain. That possibility has triggered a far-reaching investigation by the U.S. and other health authorities to track down potentially exposed people around the world. “It’s a huge effort that’s ongoing,” Dr. Martin Cetron, who heads the division of global management and quarantine at the Centers for Disease Control and Prevention, tells Shots. The case, first described by Betsy McKay at the The Wall Street Journal, provides a window on a problem that health officials say is sure to arise more and more often. XDR-TB is a more dangerous part of a bigger problem with multi-drug-resistant tuberculosis, or MDR-TB. “We estimate at any one time in the world there are about 630,000 cases of MDR-TB,” Dr. Dennis Falzon of the World Health Organization tells Shots, referring to multi-drug-resistant TB. MDR-TB isn’t vanquished by the two mainstay drugs isoniazid and rifampin and requires more complicated drug regimens. In 2007, a young lawyer named Andrew Speaker became the best-known case of MDR-TB when he flew to Europe, potentially exposing other passengers. XDR-TB is resistant not only to isoniazid and rifampin but also a class of drugs called fluoroquinolones and one or more potent injectable antibiotics. TB germs become drug-resistant when patients fail to complete a course of treatment. When a partly-resistant strain is treated with the wrong drugs, it can become extensively resistant. There are about 60,000 people with XDR-TB strains like the Nepalese man who’s in isolation, Falzon says. That means there are other people with XDR-TB traveling the world at any given time. Like the Nepalese man, until he got to the U.S., Falzon says, ‘many of these XDR cases aren’t even diagnosed.” –NPR

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