- LESOTHO -- The XDR TB epidemic
is definitely spreading into neighbouring countries from South Africa
now. The proof has been provided by Dr Peter Saranchuk, the medical coordinator
of Medecins Sans Frontieres (Doctors without Borders) in Morija, Lesotho.
He writes me today in a personal communication that at least two XDR-
TB cases have now been identified in Lesotho. This tiny landlocked mountain
kingdom is surrounded by South Africa.
-
- He writes that the two dead XDR-TB patients had both
come come home from South Africa and died shortly thereafter. One of the
dead XDR patients, whose names have not been released, had been receiving
treatment for multiple-drug-resistance in a South African TB-clinic and
had gone home to die in Lesotho.
-
- This unnamed patient had died shortly after the Lesotho
health service had obtained a sputum sample from him and had submitted
it to a laboratory in South Africa for confirmation -- and who had died
long before the laboratory had actually confirmed the XDR-TB diagnosis.
Lesotho does not have laboratory facilities which can diagnose XDR TB.
-
- Dr Sananchuk also writes that "he was sure that
there are plenty of drug-resistant TB in Lesotho currently, most of which
is going unrecognized.´
-
- The reasons include:
-
- - frequent migration of people between South Africa and
Lesotho
-
- - limited ability to perform culture/DST of suspected
DR TB cases here in Lesotho (so drug-resistant cases go unrecognized)
-
- - long turn-around-time before culture/DST laboratory
results are received (at least 6 weeks, so we need a more rapid diagnostic
for DR TB)
-
- - poor infection control measures at clinics and hospitals
where people with active TB (including DR TB) are repeatedly seen...
-
- - ongoing problems with 'regular TB ´ management,
which include adherence problems and excessive defaulter rates, therefore
'breeding' drug resistant tuberculosis...
-
- Dr Saranchuk also wrote that 'regarding mortality, HIV-infected
people are much more likely to die from drug-resistant tuberculosis.
"We have confirmed four cases of MDR TB thus far in our health service
(in Lesotho) -- two HIV-negative people are improving on MDR treatment,
and two HIV-positive people have died (including the case from South Africa
mentioned above).
-
- Source: email Dr Peter Sananchuk at Medecins Sans Frontiere
in Lesotho: msf-morija.med@leo.co.ls?
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