Combine treatment to fight dangerous TB - report

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WASHINGTON, Oct 26 (Reuters) Simple, common-sense measures such as opening hospital windows and using face masks would greatly reduce the number of new cases of extensively drug-resistant or XDR tuberculosis, doctors reported.

Use of face masks, reducing how long patients spend in the hospital and treating more people as outpatients could prevent nearly a third of new XDR TB infections, at least in one area of rural South Africa, the researchers reported yesterday in the Lancet medical journal.

''Supplementing this approach with improved ventilation, rapid drug-resistance testing, HIV treatment, and tuberculosis isolation facilities could avert 48 per cent of XDR tuberculosis cases by the end of 2012,'' Dr Sanjay Basu of Yale University in Connecticut and colleagues wrote.

XDR TB is the most dangerous form of the common infection. It resists many of the antibiotics used to treat the disease and is far more likely to kill patients.

XDR tuberculosis has been reported in 37 countries but South Africa has had the largest cluster of cases.

''The first 53 cases were reported from the rural town of Tugela Ferry, where infected patients had a median survival time of only 16 days from sputum collection, and had a 98 per cent mortality rate,'' Basu's team wrote.

Ironically, more than half the cases appeared to have originated in the hospital, they said.

Basu and colleagues combined computer modeling with data from a multiyear study of TB incidence to investigate the effect od various control measures.

They found that if nothing was done, around 1,300 new cases of XDR tuberculosis could occur in the Tugela Ferry area by 2012, more than half which are likely to be transmitted within the hospital.

Use of masks alone would prevent just under 10 per cent of new infections but might protect hospital staff.

They said their findings probably apply to similar rural African settings, where XDR TB is growing.

''Multidrug and extensive drug resistance are monsters of our own creation,'' Dr Travis Porco of the University of California, San Francisco, and Dr Wayne Getz of the University of California, Berkeley, wrote in a commentary in Lancet.

''They might be with us longer than we think and might need us to spend more than governments or institutions are willing or able to pay. Although scientific warnings are often ignored until too late, effective interventions for the control of XDR tuberculosis in Africa are national and international responsibilities, and the world community ignores this message at great peril,'' they wrote.

The World Health Organization estimates that a third of the world's population is infected with TB, most with a latent form of the bacterial infection that does not make them ill.

WHO estimates that up to 30,000 people have XDR TB.

REUTERS ARB KN0844

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