- The XDR TB epidemic is definitely spreading into neighbouring
countries from South Africa now.
- The definite 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 as having died
in Lesotho just recently.
- This tiny landlocked mountain kingdom is surrounded by
- He writes that the two dead XDR-TB patients had both
come home from South Africa and had 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 actually reneged on his treatment regimen to go home to Lesotho
-- where he died shortly after arrival.
- This unnamed patient had also 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. He died long before
the laboratory had actually confirmed the XDR-TB diagnosis. Lesotho does
not have laboratory facilities which can diagnose XDR TB and it takes at
least six weeks to get a confirmation.
- 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
- * limited ability to perform culture/DST of suspected
DR TB cases here in Lesotho (so drug-resistant ca! ses go u nrecognized)
- * 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
- * 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).