Wüstenschiff

TUBERCULOSIS, XDR - NAMIBIA
***************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Wed 2 Apr 2008
Source: AllAfrica, The Namibian (Windhoek) report [edited]
<http://allafrica.com/stories/200804020649.html>


Health professionals are quietly treating up to 24 confirmed cases of
extensively drug-resistant tuberculosis (XDR-TB), the worst form of TB with
seriously limited treatment options and chances of cure, in Namibian hospitals.

Well-placed health sources have confirmed to The Namibian that the extreme
form of TB is currently under control, but expressed fears that the country
does not have the capacity to deal with a major outbreak of XDR-TB.

The Namibian had been aware of at least one case being treated at Walvis
Bay since December 2007, but health sources said this week that the
situation was worse than initially thought.

On Friday [28 Mar 2008], health minister Dr Richard Kamwi only expressed
fears that Namibia was about to record its 1st cases of XDR-TB. "There are
currently 254 cases of multi-drug-resistant TB [resistant to the 2 best
1st-line anti-TB drugs INH (isoniacid) and rifampin - Mod.LL] under
treatment throughout the country. This is a great concern and is a clear
indication that it is only a matter of time before we will have extremely
drug-resistant cases, known as XDR tuberculosis, in Namibia [MDR-TB with
additional resistance to the oral fluoroquinolones, and at least one of the
3 injectable anti-tuberculosis drugs capreomycin, kanamycin, and amikacin -
Mod.LL])," Kamwi said at the World TB Day event staged at Mariental on
Friday [28 Mar 2008].

He said experts in the Ministry of Health were busy reviewing all TB cases
with drug resistance to verify the extent of the problem. "Given the large
number of cases, we may well find some XDR-TB amongst this group," Kamwi said.

Kamwi confirmed that Namibia was the country with the 2nd highest TB
incidence in the world after Swaziland, with 15 244 cases reported in 2007
alone.

The host region of this year's TB Day event, Hardap, had the highest
incidence of TB in Namibia in 2007, reporting a worrying 1294 cases per 100
000 people, Kamwi said.

The TB situation is exacerbated by the HIV-AIDS epidemic in the country.
"In 2007, 8186 TB patients representing 54 per cent of the total notified
patients were tested for HIV and 59 per cent were HIV positive," Kamwi
said. He said the impact of the dual infection of TB with HIV-AIDS was a
major cause for concern, in particular as it affected the Namibian workforce.

[byline: Christof Maletsky]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[Namibia shares a border with South Africa the country where the XDR-TB was
initially discovered linked primarily to HIV co-infected individuals. The
border can be found on a map at <http://en.wikipedia.org/wiki/Namibia>.

It is not clear from the posting if the presumed XDR-TB strain(s) are
identical to those from South Africa or other countries with the isolates.
- Mod.LL]

Der Regierung ist im Kampf gegen Tuberkulose (TB) ein entscheidender Erfolg gelungen. Wie Gesundheitsminister Richard Kamwi gestern in Windhoek erklärte, seien die registrierten Krankheitsfälle der so genannten X-DR-TB, also mit Resistenz gegen Medikamente, von 291 (Ende März) auf jetzt acht gesunken. Die fünf weiblichen und drei männlichen Patienten würden in verschiedenen Krankenhäusern behandelt, fuhr Kamwi fort und erneuerte seinen Aufruf an die Öffentlichkeit, den Kampf gegen TB ernst zu nehmen ...

Erfolg im Kampf gegen TB
16.05.2008 - AZ

Gruß
Birgitt

In vier afrikanischen Ländern soll nach UN-Angaben noch in diesem Jahr ein Schnelltest zur Diagnose von medikamentenrestisten Formen der Tuberkulosis eingeführt werden. Die WHO erklärte am Montag in Genf, dieser Test revolutioniere die Behandlung von gefährlicheren Formen der Krankheit. Die Diagnosezeit sinke von Monaten auf Stunden [...] Der Test soll zunächst in Lesotho, dann in Äthiopien, der Elfenbeinküste und im Kongo eingeführt werden ...

Schnelltest für medikamentenrestiste Tuberkulose
PR-inside.com - 30.06.2008

Rapid test for drug resistant TB
BBC - 30.06.2008

Gruß
Birgitt

TUBERCULOSIS - SOUTH AFRICA: HUMAN TO ANIMAL TRANSMISSION
*********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sun 24 Aug 2008
Source: The Times, South Africa [edited]
<http://www.thetimes.co.za/PrintEdition/ ... ?id=828700>


South Africa's tuberculosis [TB] epidemic has jumped from humans to pets,
zoo animals, and wildlife. The human strain of the disease has been found
in springbok, mongooses, baboons, chimpanzees and, most recently, a Maltese
poodle. Worldwide, the human strain of the disease, [_Mycobacterium
tuberculosis_], is rare in animals, who are more commonly infected with
another strain, _Mycobacterium bovis.

"While in most of the rest of the world animals are always regarded as a
potential source of TB, in this area we have to be worried about the
reverse situation," said veterinary pathologist Tertius Gous, who recently
diagnosed human TB in springbok near Cape Town, and a new TB strain in
dassies [according the Kruger National Park website, which has great
pictures of these undeniably engaging little animals, a dassie is a small,
plump, and tail-less guinea-pig-like animal, which is about as large as a
big rabbit and haunts rock outcrops, hillocks, and mountain cliffs. They
are the African elephants closest living relative. See website at
<http://www.krugerpark.co.za/africa_rock_dassie.html>. - Mod.PC]

The risk of contaminating pets is highest in low-income areas such as
townships, according to Sven Parsons from the University of Stellenbosch,
who recently recorded South Africa's 1st case of human TB in a dog, a stray
Maltese cross.

There is concern that animals with human TB could infect people although
this still needs to be researched.

[byline: Bobby Jordan]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[As the article indicates, this is not the 1st time that zoonotic
infections moving from humans to animals have been identified in South
Africa. In 1998, Anita Michel identified transmission between a chronically
infected human and a marmoset. See Michel AL, Huchzermeyer HF. The zoonotic
importance of _Mycobacterium tuberculosis_: transmission from human to
monkey. J S Afr Vet Assoc 1998; 69: 64-5. Abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/9760401>.

Formerly, the zoonotic disease nomenclature was divided by the direction of
transmission into anthropozoonoses and zooanthropozoonoses. As indicated in
a very nice little article by Zdenak Hubalek, which explores some of the
nuances of the zoonotic disease nomenclature, the directionality
terminology was dropped in 1959 by a WHO Expert committee because it was
cumbersome and commonly misinterpreted. See Hubalek Z. Emerging human
infectious diseases: anthroponoses, zoonoses, and sapronoses. Emerg Infect
Dis [serial online] 2003 Mar [date cited]. Available at
<http://www.cdc.gov/ncidod/EID/vol9no3/02-0208.htm>.

Similar human to animal zoonotic transmissions have been noticed around
ecotourist hubs in Uganda and other places. Such phenomena would benefit
from surveillance and active follow up to identify modes of transmission,
so that we can learn more about the epidemiology of these unusual
directions of infection diseases shared between mammals. - Mod.PC]

TUBERCULOSIS - SOUTH AFRICA (02): HUMAN TO ANIMAL TRANSMISSION
**************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 29 Aug 2008
From: Anita Michel
<MichelA@arc.agric.za>


In response to this posting on human to animal transmission of
_Mycobacterium tuberculosis_ [Tuberculosis - South Africa: human to animal
transmission 20080827.2680] I would like to add some clarifying comments.

It is a well known and documented fact that human tuberculosis can be
transmitted to domestic animals including pets wherever they live in close
contact. The isolation rate of _M. tuberculosis_ from slaughter pigs with
lymphadenitis in South Africa, especially during the 2nd half of the
previous century, was witness to the increasing infection rate in the human
population.

Wild animals in captivity can also contract the infection from humans and
cases have been reported internationally, especially from zoological
gardens including in Pretoria, South Africa (Michel, et al. J Zoo and Wildl
Med 2003; 34: 364-70), where it is no new finding at all. The infection was
diagnosed in isolated springbok in 1999 and in the meantime in several more
sporadic cases in different game species.

Game farming and other forms of closer association between humans and wild
animals are the most probable causes. The reference to mongooses must be
corrected as it did not occur in South Africa but in Botswana (Alexander,
et al. Emerg Infect Dis 2002; 8: 598-601).

All in all it should be emphasised that infected humans present a source of
infection to domestic and wild animals in their care but the risk for
humans contracting human tuberculosis (TB) from animals is probably
negligible when compared to human-to-human transmission. The infection is
not only so much rarer in animals than in humans (_M. tb_ accounts for 80
per cent of all notifiable human infections) but unlike in humans, where
coughing is the primary vehicle for transmission, respiratory symptoms were
generally not observed in infected animals.

--
Anita Michel
ARC-Onderstepoort Veterinary Institute
South Africa
<MichelA@arc.agric.za>

[ProMED-mail is very appreciative when a prominent scientist such as Dr
Michel voluntarily sends in comments that help us understand more about the
events we reported. We are indeed grateful for the local, informed
perspective. - Mod.PC]

Die Europäische Kommission investiert viel zu wenig in die Forschung zu Tuberkulose und anderen vernachlässigten Krankheiten. Dies zeigt ein heute in Brüssel veröffentlichter Bericht von Ärzte ohne Grenzen. Danach gibt die Kommission gerade einmal 18,7 Millionen Euro für Forschung und Entwicklung im Bereich Tuberkulose aus. Weltweit werden jährlich aber 1,45 Milliarden Euro benötigt. Ärzte ohne Grenzen ruft die Kommission daher auf, ihren Beitrag zur Tuberkuloseforschung zu verfünffachen ...

Tuberkulose: Europa hat keine adäquate Antwort auf die globale Bedrohung - Bericht von Ärzte ohne Grenzen deckt unzureichende Forschungsförderung auf
12.11.2008 - Ärzte ohne Grenzen

Gruß
Birgitt

Weltweit sterben immer mehr Menschen daran, dass sie sowohl mit HIV als auch mit Tuberkulose infiziert sind. Experten warnen davor, dass die Ausbreitung von HIV auch der Ausbreitung von Tuberkulose Vorschub leistet - und das sowohl in Afrika als auch in Osteuropa und Zentralasien. Hinzu kommt, dass viele TB-Erreger inzwischen resistent gegen Medikamente sind ...

HIV und Tuberkulose: Immer mehr Doppeltinfizierte
02.12.2008 - Medizinauskunft

Gruß
Birgitt

Ein völlig neuer Wirkstoff gegen Tuberkulose wurde am Leibniz-Institut für Naturstoff-Forschung und Infektionsbiologie - Hans-Knöll-Institut (HKI) - in Jena entwickelt. Er ist auch bei multiresistenten Erregern der Infektionskrankheit wirksam. Das amerikanische Pharmaunternehmen Inverness Medical Innovations hat sich eine Exklusivlizenz gesichert und entwickelt auf Grundlage des Wirkstoffs ein Medikament. Ein wesentlicher Teil der Entwicklungsarbeit wird vom Jenaer Tochterunternehmen Clondiag GmbH durchgeführt ...

Neuer Tuberkulose-Wirkstoff aus dem Hans-Knöll-Institut
26.02.2009 - Informationsdienst Wissenschaft

Gruß
Birgitt

Die aus der Antibiotikatherapie anderer Infektionen vertraute Kombination aus einem Beta-Laktam-Antibiotikum und einem Beta-Laktamase-Hemmer zeigt laut Science (2009; 323: 1215-1218) eine starke In-vitro-Wirkung gegen extrem resistente Tuberkulose-Bakterien. Klinische Studien sind bereits geplant. Beta-Laktam-Antibiotika werden bei der Tuberkulose bisher nicht eingesetzt. Den Grund für die Wirkungslosigkeit erkannten die Forscher bei der Analyse des Genoms von Mycobacterium tuberculosis. Es enthält die Information für eine hochaktive Beta-Laktamase, die dem Erreger der Tuberkulose eine natürliche Resistenz verschafft ...

Tuberkulose: Altes Antibiotikum hilft bei neuen Resistenzen
27.02.2009 - Deutsches Ärzteblatt

Gruß
Birgitt

Die Tröpfcheninfektionskrankheit Tuberkulose bleibt eines der größten Gesundheitsprobleme in Namibia. Zudem bereitet ein neuer TB-Strang Sorgen, da er gegen Arzneimittel resistent ist. Die Regierung ruft deshalb die Öffentlichkeit auf, den Kampf gegen TB zu unterstützen ...

Neuer TB-Strang bereitet Sorgen - Welt-Tuberkulose-Tag gefeiert – Regierung sucht Unterstützung
25.03.2009 - AZ online

Gruß
Birgitt

Treatment of tuberculosis involves taking tablets daily for at least six months. TB patients must take all their medications as prescribed, failing which they may not recover and dangerous drug-resistant TB strains may develop. That is why it is considered ideal for TB patients to come to a treatment facility to take their tablets in the presence of a health worker -- at least in the early, intensive phase of the treatment.

Not everyone can travel daily to a health facility, however. The closest treatment facility may be too far away. Or the person may not be well enough. The WHO Stop TB Strategy therefore encourages alternative arrangements for supporting TB patients as they take their treatment. A friend, neighbour or community leader who has been educated about the process and demonstrated commitment can take on this role with help from health services. A variety of groups in many countries are developing their own approaches to community TB care.

This photo story showcases one such initiative in rural Kibaha in the United Republic of Tanzania. Members of the Upendo Disadvantaged Group – all of whom have been cured of TB - support and care for TB patients in their community.

Cured patients help in TB treatment in Tanzania
24.07.2009 - WHO

Gruß
Birgitt

Each year in Algeria about 20,000 new cases of tuberculosis are counted, reports Liberté, the Algerian pneumology society, specifying that in the past decade the number of individuals suffering from the disease has increased by 20%. About 25,000 cases are currently present in the country, continued the same source, of which 10,000 are highly contagious. The national programme for the fight against tuberculosis has allowed the number of deaths to be reduced, but has not been able to eradicate the disease.

HEALTH: ALGERIA, 20,000 NEW CASES OF TUBERCULOSIS EACH YEAR
13.10.2009 - ANSAmed

Gruß
Birgitt

Jedes Jahr erkranken weltweit mehr als neun Millionen Menschen an Tuberkulose. Carl Nathan, Professor am Weill Medical College der Cornell Universität New York, gehört zu den renommiertesten Tuberkuloseforschern der Welt. Am heutigen Freitag wird er mit dem Robert-Koch-Preis ausgezeichnet ...

Tuberkulose extrem resistent wie vor 100 Jahren
29.10.2009 - Welt

Gruß
Birgitt

Tuberkulose ist seit 50 Jahren heilbar. Trotzdem steigen die Zahlen der Infizierten weltweit. Besonders Indien, China und Afrika sind betroffen, obwohl genügend Medikamente zur Verfügung stünden ...

Tuberkulose - das unterschätzte Risiko
11.11.2009 - Deutsche Welle

Gruß
Birgitt

In some areas of the world, one in four people with tuberculosis (TB) becomes ill with a form of the disease that can no longer be treated with standard drugs regimens, a World Health Organization (WHO) report says.

For example, 28% of all people newly diagnosed with TB in one region of north western Russia had the multidrug-resistant form of the disease (MDR-TB) in 2008. This is the highest level ever reported to WHO. Previously, the highest recorded level was 22% in Baku City, Azerbaijan, in 2007.

In the new WHO's Multidrug and Extensively Drug-Resistant Tuberculosis: 2010 Global Report on Surveillance and Response, it is estimated that 440 000 people had MDR-TB worldwide in 2008 and that a third of them died. In sheer numbers, Asia bears the brunt of the epidemic. Almost 50% of MDR-TB cases worldwide are estimated to occur in China and India. In Africa, estimates show 69 000 cases emerged, the vast majority of which went undiagnosed ...

Drug-resistant tuberculosis now at record levels
18.03.2010 - WHO

Gruß
Birgitt