Thursday 1 May 2008

Extreme Multi Drug Resistant TB

I am not afraid of HIV. I know that since Sheba and I are faithful to each other - and we take simple but effective steps known as universal precautions in the health care setting that we are safe from contracting HIV.

TB is an entirely different matter.
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It spreads in the air by droplets. It can be present in a closed room for upto 36 hours after a person has coughed in it.
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It is very common in our dear land of India. And very common among our friends with HIV.
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TB is often untreated, or poorly treated. The former leads to death. The latter to death as well - but in the mean time brings about multidrug resistant TB. Today's world has a 3 new letters that spell fear: XDR - extreme drug resistant TB - tuberculosis that is shown to be resistant to all the 4 or 5 basic medications used in TB treatment.
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We have a lady who has multidrug resistant TB. She may be our first known XDR case. Its our dear 'Mrs. Candy'. Today her culture and drug sensitivity reports came back. She is resistant to all 5 basic medications used to treat TB. She is still sputum positive despite twice having taken the full course of the meds.
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What can we do? To replace each drug will mean costs over over Rs. 200,000 per year. Plus the many potential side-effects and the rigorous monitoring that this entails. In South Africa, people with TB are put in hospitals - and not allowed to leave until they are sputum negative. Some of the hospitals have become jails. Mrs. Candy doesn't even have a home. For her a jail would be a kind of a blessing - with some meals and a set of walls around her.
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Please pray for Mrs. Candy. We are about to start her on the basic re-treatment course again - as we do not have other options at this point. We consulted our colleagues at SHALOM Delhi about a government scheme to put known MDR patients on second-line TB therapy for some months and then send them back to their homes to complete the 2 year treatment. Dr. Saira Paulose told us that everyone they sent to the place left against medical advice soon after going there - thus defaulting on their treatment. In discussing the matter with our colleague , Dr. Adam, he said that 20% of people on retreatment do manage to overcome the bacteria even in multi-drug resistant settings. Its not a high number, but its all we have for Mrs Candy at this point. That and the power of prayer.
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Pray for us too. If we inhale Mrs. Candy's XDR TB bacilli - and they manage to colonise us too - then we have the same set of treatment options open to us. Pray for each staff member who is exposed to these dangers everyday. We do what we do for love - because our Lord Jesus did it for us in the first place - but need strength and hope to carry on.
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Macrophages and tuberculosis bacteria. Macrophages are among the most important defense protection of the body. Tuberculosis bacteria however "hide" in the macrophages and are thus able to survive. (Image: MPI for Infection Biology/Volker Brinkmann) For more info, click: here

1 comment:

  1. I will most certainly pray for you and your patients. I believe that MDR and XDR TB are some of the most frightenings health concerns our world faces today. I sincerely appreciate what you are doing to help bring comfort and healing to those afflicted -- even at personal risk to yourself. Thank you for the love that you are showing others.

    Melissa

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