Thread: Tuberculosis updates

New TB test quicker...

New Test Can Detect TB in Just Two Hours
03 September 2010 - A new medical test can detect tuberculosis in less than two hours. Health experts say it could revolutionize the way TB is diagnosed and treated, and also, save millions of lives.

This little girl has tuberculosis. Before the flooding in Pakistan forced her family out of their home, her father said she received medication for TB. Something she doesn't get in this camp. Crowded conditions are breeding grounds for this deadly disease, whether in Pakistan or in Haiti. Testing for TB can be slow. Patients take a sputum test, but doctors say it is not reliable. So a sample is also sent to a laboratory to be cultured. The culture develops slowly and requires highly trained technicians in order to make a diagnosis.

Dr. Gary Simon heads the division of infectious diseases at George Washington University. "Right now, it takes days to weeks to make a diagnosis and determine a resistance pattern," he said. Now, scientists say they have developed testing equipment that takes only 90 minutes to produce results and is more accurate than current tests. Dr. David Persing is with the California-based company (Cepheid) that makes the equipment. "A key part of the technology is that it doesn't require a skilled operator to perform the test," he said. Studies show the test is 98 percent accurate.

Dr. Anthony Fauci at the National Institutes of Health says it will play an important role in diagnosing TB in both developing nations and developed ones. "You have something that can be done quickly, on-site so that the person doesn't leave the clinic, because a lot of times they doesn't come back to the clinic, so you have them right there. You make the diagnosis and you also have a good head start on what type of drug to put them on. It is an enormous advantage over just doing a smear of the sputum," he said.

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1 hour TB test...

New hopes for 'one-hour TB test'
14 September 2010 : Scientists at the UK's Health Protection Agency say they have devised a new test which can detect the presence of the tuberculosis bacterium in one hour.

The test has been developed by the Health Protection Agency (HPA). Its developers claim the test can spot all strains of the disease and could reduce both the incidence and the consequences of the disease worldwide. According to the World Health Organization, in 2008, an estimated 1.3 million people died from TB worldwide.

Genetic signature

The standard identification test for TB involves taking mucus coughed up from the lungs and growing a bacterial culture in the laboratory. But it can take up to eight weeks to reach a diagnosis, by which time the individual might have infected many more people. Other more rapid tests exist which scan for an antigen found in many TB strains, but they may not detect all infections, say the HPA.

The new test focuses on a particular DNA region within the bacterium which the researchers says is present in all strains of the disease. Once a sample is taken, a scientific technique know as a "polymerase chain reaction" is used to amplify the volume of DNA available so that the genetic signature can be identified.

More http://www.bbc.co.uk/news/health-11297640

TB in Africa...

Overcrowded Prisons Serve as Incubators For Tuberculosis
02 November 2010 - Overcrowded prisons in Sub-Saharan Africa are proving to be dangerous incubators for tuberculosis say researchers at a recent conference in Cameroon.

The prisons of Sub-Saharan Africa are causing tuberculosis rates to rise in the region's prisons, according to University of Yaounde researcher Christopher Kuaban. "The reasons for this is that there is overcrowding, there is promiscuity; a lot of promiscuity, there is malnutrition. Like I said already, the health services are inexistent or not. There is poor ventilation of the cells, and you have very old prisons that were built in the colonial area when the populations were small. We have been going on now for 50 years, these prisons have not been increased in size," he said.

Kuaban added that the Newbell prison in Douala, which was constructed in 1930, is one example where the TB-infection rate continues to soar due to massive overcrowding. "And the number of persons put in detention or in prisons, put in these facilities is more than the capacity that was foreseen. The Doula central prison was built for 700 persons," he says, "now it houses about 3,200 to 3,500 persons." According to Kuaban, preventive measures that would stop the rise of tuberculosis include providing better healthcare, expanding and ventilating prisons and setting up comprehensive control programs. He adds that some prisons in Cameroon have begun to take preventative steps.

"Some prisons have started now, enrolling, when they are enrolling their inmates, they screen them at the gates for TB," Kuaban explains, "What is lacking still, we should do planned massive screening of all prisoners, sometime each year, at least once or twice each year." He says despite these new government measures to address the problem, implementation often remains slow due to lack of funding.

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Stopping TB outbreak in south Asia...

Tuberculosis War: Fighting the Spread
Dec. 17, 2010 - Few Resources and Poverty Fuel Tuberculosis in India and Cambodia but Experts Say the Epidemic Can Be Stopped

Deep in eastern Cambodia, near the Vietnam border, is a lush rural landscape that has been ravaged by war. The U.S. secretly bombed here during the Vietnam War, and later Vietnam invaded to put down the brutal Khmer Rouge regime and occupy Cambodia. Peace has finally come, but this quiet area dotted with rice paddies and rural workers is today the scene of a different kind of war: one to stop the spread of tuberculosis. TB is a deadly but curable disease that has taken hold in places like Cambodia, and throughout the developing world. The bacterium breeds where people live in poverty and in cramped quarters.

On the frontlines of this war is a top researcher from Harvard who has dedicated her career to taking care of refugees and children in Cambodia. Anne Goldfeld is a professor at Harvard's Immune Disease Institute. She also co-directs the Global Health Committee, along with her Cambodian medical partner, Sok Thim, a survivor of the Pol Pot regime that killed an estimated two million Cambodians in the 1970s.

This story is part of ABC News' "Be the Change: Save a Life" initiative, a year-long series of broadcast and digital coverage focusing on global health issues. Watch the kickoff on a special-edition of "20/20" tonight at 10 p.m. ET and for the full story on TB in Cambodia and India, watch "Nightline" tonight at 11:35 p.m. ET and World News Sunday at 6:30 p.m. ET. For complete coverage and information on how you can personally make a difference, go to SaveOne.net.

Working in the province of Svay Rieng, and in the capital of Phnom Penh, the two doctors have teamed up to provide early detection and long-term treatment for a population ravaged by TB, a disease considered all but eliminated in the West. At the small Svay Rieng hospital, three hours from Phnom Penh, Sok and Goldfeld examine several young children who exhibit possible symptoms of TB. They need to determine whether it is in fact, TB, and quickly. "She could develop meningitis and it could turn into coma," said Goldfeld of one young girl. "It could turn into disseminated TB ' -- tuberculosis that spreads beyond the lungs -- ' (and) she could die."

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Trainin' rats to help in the fight against TB...

Scientists Using Giant Rats to Diagnose TB
23 December 2010 - Scientists say they've found a method for detecting tuberculosis: an African rat. Researchers say the sniffing powers of the African pouched rat can help detect TB in sputum samples more efficiently and at a lower cost than lab technicians using microscopes.

Researchers at a non-profit medical research facility in Tanzania, called APOPO had a hunch about the African pouched rat. Knowing that the rodent has a keen sense of smell, APOPO researchers wondered if they could train the rats to detect the odor of the tuberculosis bacterium in infected samples of human sputum. The rodent, which weighs about a kilogram and gets its name from giant cheek pouches it stuffs full of food, is native to sub-Saharan Africa, where the tuberculosis infection rate is the highest in the world.

Investigators conducted a head-to-head comparison of the rats' ability to smell tuberculosis against the skills of laboratory technicians testing more than 10,500 sputum samples gathered from patients from five TB treatment centers in Tanzania. Using conventional microscopic analysis, technicians found that just over 13 percent of the sputum samples were positive for tuberculosis. The same samples were then analyzed by a group of 10 rats in a special sniffer cage, and the second-line screening by the animals picked up an additional 620 new TB-positive patients, a 44 percent increase over the tuberculosis detection rate by technicians. Alan Poling, a psychologist at Western Michigan University in Kalamazoo, led the study.

Poling is not prepared at this point to say that the pouched rats are better at detecting TB than trained technicians using microscopes. But he says the animals are a lot quicker. "They can test hundreds of samples a day," said Poling. "And we essentially get results immediately. A microscopist can do 20 to 40 samples a day, so it's very slow for microscopists. It's also not very accurate. They miss a lot of positivies." The rats work in a long, narrow stainless steel cage with ten small wells, or holes set into the floor. Each hole contains a sputum sample. The animals walk the length of the cage, sniffing each hole.

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Granny says its one o' dem end time plagues in Revelation inna Bible...

IRC Says 10 Million Might Die of Tuberculosis by 2015
March 25, 2011 - The International Federation of Red Cross and Red Crescent Societies warned Thursday that as many as 10 million people will die of Tuberculosis by 2015, unless the international community intervenes. The world's largest humanitarian and development network presented its report to mark World Tuberculosis Day.

Tuberculosis - preventable and curable

The International Federation of Red Cross and Red Crescent Societies (IFRC) says worldwide access to affordable, effective treatment and care is crucial to halt a global and often deadly Tuberculosis pandemic. In its latest report, "Towards a Tuberculosis-Free World," the IFRC warns that by 2015 more than 10 million people could die from an illness that experts say is preventable and curable. The report says that more than 80 percent of tuberculosis cases occur in Africa and Asia, with India and China alone accounting for a third of people suffering from the disease.

Challenges: multi-drug resistance, cost

Dr. Sonja Tanevska, Heath and Care Coordinator of the IFRC Europe Zone, says there is also concern about Eastern Europe and the Central Asian nations of the former Soviet Union. "Eastern Europe is unfortunately affected by the form of tuberculosis that is very difficult to treat. It is multi-drug resistant tuberculosis,” Dr. Tanevska said. “This is why Eastern Europe is very specific and it is very important for [the] fight [against] Tuberculosis." Dr. Tanevska says part of the problem is that many people diagnosed with tuberculosis in these former Communist nations do not complete their treatment because of the cost, which can range from $100 to $7,500. Dr. Tanevska says that each year, hundreds of thousands of people in Eastern Europe and Central Asia are infected with tuberculosis and that seven people in the region die of the illness every hour.

Yet, she explains, IFRC volunteers have been able to save the lives of thousands. "Our report has a story from Turkmenistan. One of our volunteers in our program, she had tuberculosis twice in her life -- once when she was a child and she was cured and a second time she got tuberculosis when she was 33 [years old]. She was devastated,” she explains. “And only Red Cross Red Crescent volunteers helped her to go through this difficult period. And they gave her psychological support and in many ways helped the family in general to go through this difficult period. And she is now one of the volunteers of Turkmenistan Red Crescent.”

Future needs

Prob'ly will work - until the germs get resistant to it...

Combination Pill Found Effective Against TB
April 15, 2011 : 4-in-1 tablet could reduce drug-resistance

A new study finds that combining four tuberculosis drugs into one pill could help fight drug-resistant strains of the disease. One of the main reasons those strains develop is because many TB patients don't take their medicines as instructed. The World Health Organization's recommended treatment for tuberculosis includes four drugs. Combined in one pill, they are easier to take. But there have been doubts about whether the four-in-one pill is as effective.

In this new research, WHO scientist Christian Lienhardt and colleagues studied how patients responded to the combination pill compared with the drugs in separate pills. TB patients were recruited in 11 countries in Latin America, Africa, and Asia, and divided into two groups. One got the combination pill, the other took the same drugs in individual pills.

Lienhardt's team used three different methods to measure whether different ways of taking the drugs were equally effective. The found the combination pill was slightly less effective. But that might be more than compensated for by the assurance that the patient taking the combination pill is getting all the medicine, not a partial dose that could kill the weaker strains while allowing the more drug-resistant TB bugs to survive. "It's important to be able to fight and prevent multi-drug resistance, which is really an emerging, and a very high concern for people who take care in the fight against tuberculosis," says Lienhardt. "And the best way to prevent resistance is to make sure that treatment is fully being taken."

The combination pills are already being used in some TB treatment programs, but other programs have avoided them because of concerns about their effectiveness compared with individual pills. The study was funded by the U.S. Agency for International Development (USAID) which, the authors say, had no role in the conduct of the study or its conclusions. The paper by Christian Lienhardt of the World Health Organization and his colleagues is published in the Journal of the American Medical Association, JAMA.

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Immigrants bringin' in TB...

TB screening 'missing most cases'
20 April 2011 - Current screening for TB in immigrants arriving in the UK is missing the majority of cases, say researchers.

Using new blood tests for checks would be better than chest X-rays, which detect only active infections, says an Imperial College London team which analysed more than 1,000 immigrants. Blood tests could prevent substantial numbers of cases, they write in The Lancet Infectious Diseases. The government said the research backed new guidance from health watchdog NICE.

Tuberculosis is caused by a bacterial infection, which attacks the lungs. It has risen dramatically in the UK over the past decade, partly because of an increase in cases among people who move to the country from overseas. Immigrants arriving in the UK from countries with a high incidence of TB are required to have a chest X-ray on arrival to check for TB. But this screening method can miss cases where the infection lies dormant in the lungs and does not cause symptoms.

Professor Ajit Lalvani, of Imperial College London, argues that new blood tests should be used to pick-up cases where people are carrying TB infection but will not develop it for several years. His research is based on an analysis of more than 1,000 immigrants at centres in London, Leeds and Blackburn.

He said: "By treating people at that early stage, we can prevent them from developing a serious illness and becoming infectious. "Crucially, this wider screening could substantially reduce TB incidence while remaining cost-effective. Our findings provide the missing evidence-base for the new national strategy to expand immigrant screening." NICE updated its guidelines on TB screening in March.

Latent infections

New combo treatment for DR-TB proven effective...

Effectiveness of Four-Drug TB Treatment Confirmed
April 25, 2011 - One of the biggest challenges in fighting tuberculosis comes from new drug-resistant strains of the disease. And one of the main reason those strains have developed is that TB patients often don't take their standard, 14-pill, course of medication as instructed. Now, as Vidushi Sinha reports, a new study finds that a simpler approach - combining four TB drugs into one pill - is just as effective in treating this global killer.

For about a decade now the World Health Organization has recommended treating tuberculosis by using a four-drug, fixed-dose combination of medication - which has the same amount of pharmaceutical ingredients as the 14 pills that have traditionally been used. But the logic of fewer pills - a simpler routine for sick patients - has not yet sunk in among many doctors. For a variety of reasons, health professionals treating TB have resisted prescribing fewer pills.

But a new study in the high-TB-incidence areas of Africa, Asia, and Latin America confirms that the four-drug combination of pills is just as effective as the 14-pill regimen. Dr. Christian Lienhardt conducted the the research in several countries comparing the new and old treatment regimens. "It is true everywhere in the world patients, don’t like to take too many pills and if you have to take 14 pills every day for 6 months - you have the choice for four, then I will prefer 4 and lot of people will prefer 4," said Dr. Lienhardt.

But Lienhardt says the four-pill treatment has been resisted because many care providers intuitively doubt it would be as effective. "There is a type of a common sense and mainly among the health staff that when you take the older drugs that you know each one of them had a very, very good activity and when you combine maybe there is a way to lose that activity," he said. "That is a type of common sense that might unfortunately take place mainly among the care providers rather than the patients."

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TB may someday be a thing of the past...

New simpler TB treatment may help stop spread
5/16/2011 - Simpler drug combo requires just 12 doses over 3 months, instead of yearlong therapy

U.S. health officials say they have found a far simpler therapy for people at risk of developing tuberculosis, addressing a key barrier to preventing the spread of the disease. Patients who took a combination of two drugs just 12 times over three months fared as well as those who received the standard treatment that requires 270 daily doses, according to a landmark U.S. government study released Monday.

"New, simpler ways to prevent TB disease are urgently needed, and this breakthrough represents one of the biggest developments in TB treatment in decades," Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, said in a statement. The far less onerous regimen involves taking rifapentine, an antibiotic sold by French drugmaker Sanofi under the brand name Priftin, along with isoniazid, an effective tuberculosis drug in use since the 1950s.

The study results, presented at a medical meeting on Monday, could mark a major advance in preventing TB in countries with low-to-medium incidence of the highly infectious disease, according to the CDC, which sponsored the study. While many people believe TB to be a largely conquered disease of the past, there were more than 11,000 cases reported in the United States last year, and it remains one of the world's leading infectious killers, according to the CDC.

The 10-year study included more than 8,000 patients with latent TB infection, meaning they have the tuberculosis bacteria in their bodies but no symptoms and are not contagious. More than 11 million Americans are positive for latent TB, the CDC said, with Asians, other minorities and foreign-born individuals disproportionately affected.

More http://www.msnbc.msn.com/id/43046725...ious_diseases/