- International and regional medical personnel have gathered in South Africa where a new, virtually untreatable form of an old disease, tuberculosis or TB, has been found. Drug resistant TB has appeared elsewhere in the world, but the recent strain recorded in South Africa's east coast province of KwaZulu-Natal is a tougher, Extremely Drug Resistant (XDR) form of the bacteria.
According to the World Health Organisation (WHO) it is virtually untreatable.
Initial reports have confirmed XDR TB in 53 people, of whom 52 died within an average of 16 days of diagnosis. All of those diagnosed with XDR TB were HIV positive and receiving antiretroviral therapy.
"TB has always been a problem, but the development of XDR is unbelievably bad news for Southern Africa with its heavy HIV and TB burden," said Dr Francois Venter, of the Southern Africa HIV Clinicians Society.
Southern Africa has some of the highest HIV infection rates in the world, with upwards of 20 percent of the adult population estimated to be HIV positive. In South Africa, TB, a disease often associated with AIDS, affects half of the adult population, though many carry only a latent form of it.
TB spreads much like the common cold through the coughs and sneezes of carriers.
The first symptoms of the illness include weight loss, fever and night sweats. In the advanced stages victims cough up blood. If untreated, TB can kill a patient by gradually boring holes in his lungs.
Drug resistant TB occurs when antibiotic treatment is either not completed, or is unsuccessful.
According to the South African Medical Research Council (MRC), only about half of the treatable TB cases in South Africa are in fact cured.
Some 15 percent of people with regular TB do not complete first-line treatment, in which they must take a cocktail of antibiotics for six months. About a third of patients fail to complete second-line treatment for Multi-Drug Resistant (MDR) forms of TB. This treatment lasts for two years and involves months of hospitalisation with painful daily injections.
Health experts from the WHO, the US-based Centres for Disease Control, as well as regional and government representatives from the Southern African Development Community (SADC), have been in Johannesburg this week for talks due to end on Friday to discuss how to tackle XDR TB.
"We need to start developing strategies - the meeting will try to map out a strategy at a country and at a regional level to respond to the XDR TB strain, as well as the more drug-susceptible versions of the disease," said one of the meeting's co-ordinators, Dr Karin Weyer, of the Medical Research Council.
Their concern is that the high number of HIV and TB carriers in Southern Africa, makes it an environment ripe for the rapid spread of XDR TB. When someone's immune system becomes compromised, for instance by HIV, people who are already carriers of the TB bacteria are likely to develop an active form of the disease or catch TB from someone else.
The active form of TB is more infectious than the latent form, and some health experts believe XDR TB is even more virulent. "This particular strain has not only gained its fitness back, but it may be fitter," said Prof Willem Sturm, a microbiologist at KwaZulu-Natal University's Nelson Mandela School of Medicine, and one of the researchers investigating the new South African outbreak.
Mr Sturm's team is carrying out investigations to see if other TB deaths in South Africa have been caused by the XDR strain, and to identify carriers. Although XDR is considered virtually impossible to cure, isolating infected people - a traditional method for containing TB - can prevent the spread of it.
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