XDR TB: now more cases than bird flu

Keith Alcorn
Published: 27 October 2006

South Africa has now detected 284 cases of Extensively Drug Resistant (XDR) tuberculosis (TB) in the province of Kwazulu Natal alone, a spokesperson for the South African Medical Research Council told reporters this week, exceeding the 256 cumulative cases of avian influenza worldwide reported by the World Health Organization up to October 16th.

Up to 20 potential cases await confirmation in the Eastern Cape province alone, where 14 deaths in patients receiving treatment for multi-drug-resistant TB are being described as XDR TB. Cases have now been reported in all South African provinces, Dr Karin Weyer told a regional summit on XDR TB earlier this month.

XDR TB is defined as a form of TB that is resistant to at least three of the six classes of drugs that can be used in second-line treatment. XDR TB has proved rapidly fatal in many of the patients observed in South Africa, with all but one of the first 53 cases described resulting in death within three weeks of diagnosis.

One of the few drugs thought to be effective against XDR TB, capreomycin, has been donated to the South African government by manufacturer Eli Lilly. South African manufacturer Aspen Pharmacare is urgently working to develop a manufacturing facility capable of making injectable capreomycin.

South Africa’s parliament was told earlier this week that health departments will be encouraged to seek court orders for the quarantine of patients with XDR TB if patients do not cooperate in reporting for treatment and observing infection control measures. One patient in Gauteng has already been detained after she discharged herself from medical care.

However Dr Gerrit Coetzee, head of the TB reference laboratory at the National Health Laboratory Service, said there was an urgent need to curb the spread of infection by introducing far more stringent infection control procedures in all healthcare facilities.