MDR and XDR: TB Kills

Tuberculosis: a 19th and early 20th century disease of wilting women and men in sanitariums, living in isolation while they take the fresh air cure and hope that their endless coughing will subside, leaving them with weakened lung function if they manage to survive the brutal infection. At least, that’s the perception of much of the West, that tuberculosis is a historic disease and one of limited importance and concern now, when ample medications are available to treat it and aggressive treatment of tuberculosis has all but eradicated it from existence, putting it far down the scale of concerns for doctors and patients alike. Tuberculosis is something you read about in books, not something that could actually happen to you, or people like you.

In fact, nothing could be further from the truth. Meet multi-drug-resistant tuberculosis (MDR TB) and extensively drug-resistant tuberculosis (XDR TB), which are found in some parts of the Global South as well as parts of Russia, often hand-in-hand with high HIV rates, as the bacterium exploits weakened immune systems to settle in and make a home for itself. Tuberculosis isn’t just alive and well, it’s active and even more deadly than ever before, with higher stakes in a global world where it can easily leap from patient to patient, and nation to nation.

MDR TB resists multiple antibiotics used to treat the infection, forcing doctors to try a complicated drug regimen that may last six months or more as they try to fight the infection. Like other drug-resistant infections, it presents a dual challenge. One, doctors have to find the right cocktail to actually treat the infection and help the patient get better. Two, the patient actually needs to stick with the medication, which is a challenge when the treatment period is so extensive, and when the drugs involved can have serious side effects, sometimes making patients extremely sick.

Patients on courses of medication for MDR TB may need to live on isolation wards or in specified tuberculosis hospitals to avoid spreading the infection, something that could be particularly dangerous because of the drug resistance it has developed. MDR TB treatment can be, thus, isolating and miserable, and in some hospitals, administrators have trouble finding personnel willing to work as nurses, cleaners, and other support staff, because people fear contracting cases of MDR TB in the course of their work. This can put patients in danger by creating an unhealthy and inconsistent environment, which is the last thing you want when you’re treating aggressive, constantly mutating bacteria that take advantage of any shifts in their surroundings to become more resistant to treatment.

XDR TB operates on a whole different level, resisting such a wide array of drugs that it can be effectively untreatable, though patients may be tried on extremely toxic, experimental, or dangerous drugs to see if one or more has a chance at knocking out the infection. Patients with XDR TB can get very sick, and many also struggle with underlying infections like HIV that have weakened their immune systems and make it even more difficult for them to fight off the tuberculosis on their own — something many people with reasonably healthy immune systems do routinely without even being aware of it.

Tuberculosis, when it’s addressed at all, is sometimes cast as a problem of the Global South, something that crops up in parts of Africa in particular, although it’s also a growing issue in Russia, where HIV/AIDS and tuberculosis are combining in a brutal attack on many Russians, especially in low-income areas. Tuberculosis is also cropping up in other low-income areas around the world, illustrating how infectious disease and poverty can be very closely linked. Low-income people are less likely to have the resources to access preventative tools, screening, diagnosis, and treatment, and their communities tend to be more crowded, with poorer sanitation, creating an ideal setting for bacteria to grow and spread.

Without reliable access to what should be basic human rights like clean water, comfortable housing, and healthy food, communities can fall prey to infectious organisms like this pernicious bacterium. Drug regimens are expensive to adhere to, and aren’t always an option, no matter how hard patients are willing to work on getting better. Even in areas where NGOs are active with getting treatment to patients who need it, they can’t be everywhere, and they can’t address all of the barriers between diagnosis and treatment, let alone the challenges involved in helping patients remain on treatment until the infection is fully resolved — if it can be, which isn’t always the case with XDR TB.

Why should this matter to people in the West, who may not be directly affected by it? On a fundamental human rights basis, it should matter, because people falling ill of infectious diseases anywhere in the world is an issue that should be confronted. It’s also a serious public health issue, as MDR and XDR TB know no borders, and they will merrily cross over into the West, including into affluent communities, via a variety of pathways. Every single bacterium might not make the trip, but that doesn’t matter, as long as just a few do, carrying their unique load of resistant mutations along with them. That means that drug-resistant forms of the disease can spread around the world if they aren’t stopped wherever they flare up.

Furthermore, many drug companies aren’t making investment in antibiotics a priority. This holds true not just for tuberculosis drugs, but also for infections with bacteria like staph, responsible for the infamous MRSA infections which can be deadly in some cases. Antibiotics aren’t profitable in many parts of the West when compared to drugs like statins, and thus they’ve fallen off the development radar — in part because the West has collectively decided that drug-resistant infections are, in perhaps a singularly appropriate use of the slang term, a ‘third world problem’ and thus nothing to do with us.

But it is something to do with us. It’s something to do with us because human beings matter no matter who and where they are, and it’s something to do with us because drug resistance spreads wherever it will, including into the hearts of our own homes and hospitals, and it’s happy to wait there as long as it needs to in order to find susceptible hosts.

Photo: Microbe World, Flickr.