Tuberculosis patients are beyond a cure in South Africa, and are being discharged even though they are not cured. These patients have a strain of TB that is resistant to drug therapy, called XDR-TB. XDR stands for extensively drug resistant. The Lancet reported that 40 percent of these patients were let go from the hospital and lived, contagious, for an average of 19.8 months after discharge.
The reason for their dismissal from quarantined hospital rooms is that bed space in the hospital is desperately needed for other tuberculosis patients who can be cured. Max O’Donnell, MD and Neil Schluger, MD, at the Columbia University College of Physicians and Surgeons, stated that global TB control efforts have resulted in modest gains in the past decade, but drug resistance is a roadblock to the cure for this strain of TB.
Multi-drug resistant TB, or MDR-TB is not curable by taking the drugs isoniazid and rifampin. The World Health Organization (WHO) has listed that on three continents, an estimated 40,000+ individuals are infected with MDR-TB. Half of the infected individuals will not be able to respond to existing treatments, due to the severity of their illness. The next degree of this illness is the XDR-TB, which is also resistant to these drugs and also any fluoroquinolone and other few injectible drugs that are used to treat TB.
Researchers found after a few years patients were found incurable, only twelve patients had positive results. 78 had died, four had their treatments interrupted, and 11 were not cured and remained contagious although they received a year’s worth of drug treatments.
Researchers followed a patient with XDR-TB who was discharged after failing treatment and he went on to infect his brother, who also died. This is the nightmare scenario that physicians are predicting will kill far more.
Tuberculosis patients are beyond a cure in South Africa, with a median survival rate of 19.86 months. This is where the spread of the XDR-TB is taking place, when patients are released from hospitalization into the general population. Researchers who would like to study the resistant strain of tuberculosis, however, budgets for these types of studies have been cut. There is not a lot of hope that XDR-TB will be stamped out any time soon. In fact, the XDR-TB picture looks bleak.
Professor Keertan Dheda of the University of Capetown, stated that better home-based care and tuberculosis institutions were key in keeping the disease from spreading. Dheda also calls for a testing of more drugs to combat MDR-TB and XDR-TB.
Although nurses and physicians follow the discharged patients, making sure they understand how the XDR-TB spreads, the results are less than hopeful. After treatment, 74 percent of patients died, and may leave behind their deadly disease to their family members. When patients sneeze, cough or even spit, they can unknowingly transmit the germs to others in the home environment.
The only real response to the discharge of these patients, has come from a spokesperson, Yogan Pillay, from the Department of Health. He stated that they would begin delay of discharge to those households where any children under the age of five years lived. Pillay tried to reassure Cape Town residents that social workers go the homes of discharged TB patients and instruct the family in matters concerning the contagious nature of the illness.
Tuberculosis patients who are beyond a cure in South Africa are being discharged at an alarming rate and with the sure risk of infecting others closest to them.
By Lisa M Pickering