Extreme Drug Resistant Tuberculosis
Did you know that 1 in 3 people in the world are infected with tuberculosis? I have come to believe in this statistic as we currently have 7 patients on my ward alone with active TB. Multiple patients have pulmonary (lung) TB and we also have two patients with TB meningitis. I have discovered that TB is on par with HIV in Africa.
We had a fireside chat (there is no fire, but we sit around and discuss an interesting topic) tonight about XDR TB. The distinction of XDR TB is drug resistance to INH, rifampacin, quinolone, and an injectable agent. The thing about TB is that you need to treat with 4-5 drugs to cure the disease. If you are resistant to >4 drugs there is a very low probability of survival. The mortality rate for XDR TB is 50-80%.
The moral issue comes in what do you do with a patient who has XDR TB?? There was a patient that was hospitalized at Moi University for 9 months with XDR TB. She was brought against her will to the hospital and placed in isolation to undergo her treatment. Her family lived 3 hours away and was unable to afford the trip to visit her. She died in isolation after 9 months of therapy.
This situation at first appears shocking and inhumane but you have to think about public health. What if there is an outbreak of XDR TB? It would be devastating. What do you do with these people?
The testing for XDR TB is not readily available in Kenya. So it is highly likely there are many people out there with resistance. If the testing does become available what are we going to do when we find these patients?
If you have any comments on this issue I would love to here them. I don't think there is a right answer to this difficult problem. I think one thing we focus on is PREVENTION! We have to prevent patients from getting TB/XDR TB in the first place.