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Totally Drug-Resistant TB Emerges In India 346

Posted by Soulskill
from the it's-all-darwin's-fault dept.
ananyo writes "Physicians in India have identified a form of incurable tuberculosis there, raising further concerns over increasing drug resistance to the disease (abstract). Although reports call this latest form a 'new entity,' researchers suggest that it is instead another development in a long-standing problem. The discovery makes India the third country in which a completely drug-resistant form of the disease has emerged, following cases documented in Italy in 2007 and Iran in 2009."
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Totally Drug-Resistant TB Emerges In India

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  • by ArcherB (796902) on Friday January 13, 2012 @02:47PM (#38689518) Journal

    We just haven't found a drug to fight it. And before people get on the anti-antibiotics bandwagon, if we didn't use antibiotics, then the simplest infection would be "Totally Drug-Resistant".

    Now if you want to speak of the "overuse" or preventative use of antibiotics, then go ahead.

    • Watch out Indonesia (Score:5, Interesting)

      by Toe, The (545098) on Friday January 13, 2012 @02:51PM (#38689582)

      Isn't the real story that it's in three countries, and that they are geographically disparate?

      Or... does the disease only affect countries that start with the letter I?

      • by Samantha Wright (1324923) on Friday January 13, 2012 @03:01PM (#38689758) Homepage Journal
        Nah, it happens all over the place, including in countries that start with "Russia". The antibiotic-resistant TB there is just not quite as bad. Unfortunately, it lives in the prison system.
        • Why unfortunately?
          It seems to me, if you had to have a incurable decease in your country you would want it to be quarantined, an to infect the people you like the least. A prison seems like the best place to have diseases, where else would you want it? In nurseries, in supermarkets?

          • by hedwards (940851)

            The problem is that prisoners get released or escape and they're typically packed in tightly enough that the disease can easily spread. If you're not really careful or quite lucky you end up in a situation where there are people who have done their time and can't be released because they're infected. Many of whom wouldn't have been infected if not for the conditions in the prison.

            If there's going to be an outbreak, I personally would rather it be somewhere that's actually set up to deal with such a thing or

          • by jd (1658)

            Supermarkets are probably a good place to have diseases. Much of the food is either tinned (so isolated from it) or will be washed, and in either case it will likely be cooked (killing most bacteria and deactivating most viruses). Meanwhile, most shoppers won't be exposed for any significant time, which means they stand a far better chance of building up resistance than to suffering any hardship. Ok, no place is "great" to have disease, but in terms of opportunities to strengthen health vs. impair it, I'd c

          • In addition to all the other responses, the prisoners have to be treated in hospitals. The disease can (and does) spread to the rest of the population from there.
      • by erroneus (253617)

        That just means the U.S. of A. is safe from this disease because none of the letters are "I."

    • by i kan reed (749298) on Friday January 13, 2012 @02:52PM (#38689596) Homepage Journal

      There's no such thing as an anti-antibiotics bandwagon. Does not exist.

      If you search for the phrase "ban antibiotics" you will ONLY find results for people opposed to agricultural antibiotic use on healthy animals. That's it.

      There are enough stupid movements to hate without having to invent new ones.

      • by Anonymous Coward on Friday January 13, 2012 @03:00PM (#38689736)
        Pssh, your anti-anti-anti ban movement isn't fooling anyone.
      • by tb()ne (625102) on Friday January 13, 2012 @03:04PM (#38689796)
        And yet for a Google search on "anti-antibiotics", the first page of results contains almost all links for mis/overuse of antibiotics in humans.
        • GP: "Now if you want to speak of the "overuse" or preventative use of antibiotics, then go ahead."

        • by Anonymous Coward on Friday January 13, 2012 @03:18PM (#38690014)

          They are *not* candy, some doctors prescribe them like they are and some patents demand them like they should be....

          All antibiotics by their very nature disrupt the balance of the non aggressive bacteria which your body tolerates to produce extra essential vitamins in the gut and to cloud out the explicitly pathogenic varieties in the skin and elsewhere. This means that they come with a risk of skin rashes, minor stomach upsets gas and other such issues, particularly heavy use may cause more serious issues on occasion. Because of these issues you should only take antibiotics for real infections or serious wounds not colds or coughs, unless you have particular risk factors.

          Despite these issues refusing them when you have a serious problem is madness, they are a powerful tool and a boon to our average lifespan and health that has not yet been equalled by any other single class of technology, wanting to cut unnecessary use to improve effectiveness and reduce risk is not the same as wanting to stop using them.

          • by tb()ne (625102)
            Well stated. I'd mod you up if I hadn't already posted (and you weren't AC). I wasn't arguing for or against antibiotics - just addressing the red herring in the parent post.
          • by SydShamino (547793) on Friday January 13, 2012 @04:06PM (#38690686)

            I was attacked in mid-December by a cat, which bit my left hand harder than I knew cats could - twice. (It was an indoor feral cat we care for, and we were moving, and I had to get him in a cage. And yes, eventually we both calmed down and got him moved.)

            Initially my hand swelled to twice its normal size, and then the wounds started to fester. This was within a day. Fortunately I went to the doctor the morning after it occurred, and by the time the wounds were filling with pus I was already ramping up 10 days of antibiotics. The infection was gone within three days (but of course I dutifully took the entire 10 day regimen). My hand still hurt a little but it's usable.

            In retrospect, I've been thinking that just 100 years ago I very well could have either lost my hand or died. Now my biggest concern was a few weeks of pain and inability to use my hand, and maybe one or two small scars.

            I am very grateful for the discovery and medical application of antibiotics, and I very much support restrictions with antibiotics to cases where they are mandatory. Doctors and patients abuse painkillers, so we restrict access to them and control their use closely so as to prevent the patients from hurting themselves. Doctors and patients abuse antibiotics, so why don't we restrict access to them and control their use closely so as to prevent patients from hurting all of humanity?

        • by hedwards (940851)

          Except those people aren't opposed to using antibiotics in cases of bacterial infection that warrants it, they're opposed to giving it to live stock just for the hell of it or giving it to people that likely have a viral infection.

          Nobody's anti-antibiotics even if some of us think that we need to progress beyond them to using something a little bit longer term like phages.

      • There's no such thing as an anti-antibiotics bandwagon. Does not exist.

        Sure there is. You've never heard of probiotics?

    • by arnodf (1310501)

      exactly what I was thinking, in india antibiotics are used as if it was water.When I was there last year, newspapers adviced against eating honey because it was completely saturated with antibiotics. (another food scandal at the time was chickpeas coloured green and sold as peas)

      • in india antibiotics are used as if it was water

        Yeah, I've heard about this. In particular, about them being given out like M&Ms, even for viral infections where the doctors knew damn well that they'd do nothing useful, but wanted to pander to the patients. That's not even the OP's "overuse", it's blatant and irresponsible misuse that was obviously going to cause major grief at some point- well, here we are.

        I've heard it said that such people had no other option, but since their only "option" didn't work, the doctors would have been more responsibl

        • Yeah, I've heard about this. In particular, about them being given out like M&Ms, even for viral infections where the doctors knew damn well that they'd do nothing useful, but wanted to pander to the patients. That's not even the OP's "overuse", it's blatant and irresponsible misuse that was obviously going to cause major grief at some point- well, here we are.

          And, to make things even worse, the standard from what I've seen among the Indians I have worked with is to take the antibiotics until starting t

    • by wolfsdaughter (1081205) on Friday January 13, 2012 @02:59PM (#38689712)

      The problem isn't using antibiotics to fight bacterial infections.

      The problem is incorrectly using antibiotics, much of which comes from IGNORANCE and POVERTY
      1) Ignorance: lack of education on how antibiotics work, and a frightening number of people stop taking the antibiotics as soon as they start feeling better - VERY BAD IDEA!

      2) Poverty: medicines are expensive, and so people who are tight on money will "share" drugs, with other people to save on costs. This goes hand in hand with ignorance about how the drugs work.

      The answer to this (and many other problems) is universal education and healthcare.

      • Re: (Score:3, Interesting)

        by timeOday (582209)
        Universal healthcare and education would have innumerable benefits, but it would not halt the evolution of pathogens. I did find a source claiming perhaps 50% of antibiotics are used incorrectly, which is not good. But the economic rise of several populous nations, and the growing world population, will increase antibiotics use by much more than that, as well it should, saving millions of lives in the process. The more people, the more pathogens, and the more medical researchers, and the faster the arms r
    • by David Greene (463) on Friday January 13, 2012 @03:04PM (#38689810)

      You misunderstand the problem. Antibiotics are not the problem. The overuse of antibiotics is the problem. I hear about this every single week from my wife, who is a provider. She constantly gets pressured by patients to prescribe antibiotics when they are clearly not necessary or justified. We have to change the culture of medical care here in the U.S.

      • Overusing antibiotics isn't a big problem if you take them properly.

        Problems arise when people use them for legitimate reasons, but don't follow your full course of treatment.

        It happens in the US, but it is a much greater problem in developing countries where people lack education and money to follow what the doctor prescribed. Why would they want to waste money taking pills once they feel better.

    • by Luckyo (1726890) on Friday January 13, 2012 @03:07PM (#38689848)

      This is a silly claim. There are antibiotics that can kill most of the resistant bacteria. We know many of them. Problem is, they also kill the host when host is human, typically by destroying kidneys or liver.

      It's not that we don't have the tools to kill these "super germs". We do. We just don't have the tools that kill the germs without killing the humans. Essentially we're paving the path for bacteria that adapt to antibiotics as a threat to their existence by remaining/becoming vulnerable to antibiotics that destroy various internal organs, and becoming resistant to those that do not.

    • Re: (Score:3, Interesting)

      by Anonymous Coward

      Except that new antibiotics aren't really being developed anymore. The last one in wide use, I forget which, was brought out some 20 years ago. The reason: high development cost, combined with fast bacterial adaptation mean that pharmaceutical companies aren't even able to recoup their investment before a drug falls out of use. Source: my infectology professor.
      Two possible solutions to this problem I see is raising the price of antibiotics or introducing government subsidies for development.

      • by DarkOx (621550)

        What I don't understand is why antibiotics can't be rotated in and out of use. If these bugs adapt in so few generations and have generations so quickly I'd think they'd lose adaptations for immunities that haven't been needed as quickly as they develop new ones.

        So why can't we just put penicillin on the shelf for 20 years, use amoxicillian, and then some others and by the time we go through the list penicillin would be highly effective again?

        • Re: (Score:3, Informative)

          by tgibbs (83782)

          Antibiotic rotation is an idea that sounds good but that doesn't seem to work well in practice. What seems to happen is that microorganisms evolve in such a way as to neutralize the cost of being resistant. Usually, the initial mutation reduces fitness in the absence of the antibiotic, but then there is selective pressure to accumulate compensatory mutations that eliminate that cost. Once that happens, there is no longer selective pressure to revert to sensitivity even if the use of that antibiotic is disco

    • It's also possible that a combination of existing drugs will kill it. AFAIK, that's how leprosy was cured.

      Of course, the more drugs you throw at a problem, the more likely the patient will have a bad reaction.
    • by LWATCDR (28044) on Friday January 13, 2012 @03:29PM (#38690168) Homepage Journal

      True enough.
      Actually there are a couple of means to attack this strain.
      1. We should sequence those strains and see if we can identify any weakness to exploit.
      2. Discover how their resistance works. For example strains that are resistant to say penicillin tend to make an enzyme that breaks down penicillin. So possibly one could make a drug that binds that enzyme and combine it with the antibiotic or change the antibiotic that the enzyme has no effect or even have the drug activated by the enzyme.
      3. Bacteriophages are an interesting but really under researched treatment in the West. The old USSR did a lot of research in to them and frankly we should start as well.

      Of course what is really scary are the folks that are no in "raw" milk. They are making claims that it can cure everything from cancer to Autism all the while providing an excellent vector for TB.

      • Re: (Score:3, Interesting)

        I definitely agree that we should do massive researching into phages. http://en.wikipedia.org/wiki/Bacteriophage [wikipedia.org]

        problem is that big pharma won't do much with phages because they're naturally occurring which i think means no patents - so as soon as one has FDA approval, anyone can produce it,

        I wish the government should give out grants to research phages - but big pharma would cry "unfair"

    • Re: (Score:2, Insightful)

      There are two drugs that are used for TB: isoniazid and rifampicin.

      From the article:

      "The fact that no new first-line TB drugs have been developed for half a century has probably contributed to the emergence of strains that are unresponsive to treatment, says Mitnick. “If you keep using the same drugs for that long, resistance is inevitable.”"

      “The pharmaceutical industry had scant interest in TB for decades,” says Richard Chaisson, director of the Center for TB Research at th
    • Well put!

    • by no-body (127863)

      Ah - you probably haven't had or don't know somebody who had a drug-resistant bug and had "just" to wait until a drug is found...

      We just haven't found a drug

      What a jerk you are!

  • Cough... (Score:4, Interesting)

    by wbr1 (2538558) on Friday January 13, 2012 @02:49PM (#38689542)
    And yet the food industry and the pharmaceutical industry would have us believe that the overuse of antibiotics is harmless ...cough.
  • by Iamthecheese (1264298) on Friday January 13, 2012 @02:50PM (#38689570)
    The only silver lining is that it's not even more deadly. At least we can learn about the effectiveness of quarantine methods in the modern era before something even more deadly shows up. Also each evolution that allows a bacteria to become resistant to a drug weakens the bacteria in all other cases.
    • by Samantha Wright (1324923) on Friday January 13, 2012 @03:00PM (#38689720) Homepage Journal
      I could ramble aimlessly about this general topic for a while, but instead to farm karma more efficiently I think I'll make an obscure, off topic point that I think is interesting by analogy: this directing of evolution also occurs at an environmental scale. Life may find ways to survive in the presence of all the chemicals we dump into the ecosystem, but it will be more vulnerable to other stressors as a result, including those through which it would normally survive. In combination with the on-going loss of diversity caused by more direct damage to the environment, life as we know it is pretty cornered.

      It's a little as if we're extremely incompetent first-year med students trying to eliminate a patient's symptoms (i.e. the planet's inherent imperfection for supporting modern life) and we're on the verge of unintentionally killing off the infection that's actually responsible. (Admittedly, this is a lousy analogy, but it's important to realise that it's happening.)
    • by shadowrat (1069614) on Friday January 13, 2012 @03:04PM (#38689806)

      Also each evolution that allows a bacteria to become resistant to a drug weakens the bacteria in all other cases.

      I had not understood this to be true. I keep hearing that strains of bacteria become resistant to all antibiotics. not just a queue of 3, then the next strain is resistant to a 4th antibiotic, but no longer resistant to the first. Evolution does seem to favor specialization, but traits are only lost if they hinder. I don't know exactly what the mechanism of resistance is, but i don't know that each kind of antibiotic requires some new organ to exist resulting in lumpy slow bacteria.

      • It's the energetic cost. Think of climbing Everest, an electric heater and generator+fuel might be very useful, but the weight you have to lug around is really prohibitive to doing it, so you only take what's necessary to survive up there.
        • There was this nice experiment in which viruses in a test tube with an artificial environment (with viral materials for wiral reproduction) eventually shed all the parts they needed to enter and use living cells, which made them reproduce faster and outpace their slower-reproducing, cell-infection-capable siblings...and then when they deprived them of said materials and reintroduced live cells, the "more evolved" viruses were out of luck.
  • by elrous0 (869638) * on Friday January 13, 2012 @02:55PM (#38689644)

    I was wondering why "Bob" kept coughing.

  • This will be unpopular....

    I understand that we are supposed to be a society of victimology, where it's more important that a single victim feel good about themselves than it is to save society, or the species, as a whole, but...

    Maybe it's time to go back to the pre-antibiotic known-working fixes for contagious diseases for which there is no cure, i.e.: sanitariums and leper colonies? At least that way, in two hundred years, there will still be people around to feel morally outraged at the excesses of their

    • by s_p_oneil (795792) on Friday January 13, 2012 @03:13PM (#38689938) Homepage

      It might be popular if it stood a chance of working...

      Wikipedia quote:
      One third of the world's population is thought to be infected with M. tuberculosis,[3][4] and new infections occur at a rate of about one per second.[3] In 2007 there were an estimated 13.7 million chronic active cases,[5] and in 2010 8.8 million new cases, and 1.45 million deaths, mostly in developing countries.[6] The absolute number of tuberculosis cases has been decreasing since 2006 and new cases since 2002.[6] In addition, more people in the developing world contract tuberculosis because their immune systems are more likely to be compromised due to higher rates of AIDS.[7] The distribution of tuberculosis is not uniform across the globe; about 80% of the population in many Asian and African countries test positive in tuberculin tests, while only 5–10% of the U.S. population test positive.[1]

      It sounds like many Asian and African countries need the opposite (a place for all the healthy people to go).

      • by h4rr4r (612664)

        Tuberculin tests are just that, they test for the antibody. So even people who are no longer infected, or were vaccinated will test positive.

    • by myrdos2 (989497)
      TB can be vaccinated against.
    • by Dogtanian (588974) on Friday January 13, 2012 @03:41PM (#38690374) Homepage
      I can't work out whether this is meant to be a joke or not, or whether the people who modded it up as "Funny" misinterpreted it as a joke, or whether they thought it wasn't a joke, but modded it up as "Funny" anyway to show how laughable they thought it was.... :-/
  • by Samantha Wright (1324923) on Friday January 13, 2012 @03:07PM (#38689862) Homepage Journal
    For those interested in exactly how prevalent this sort of thing is, be aware that drug resistant TB is in almost every country in the world; it's just really bad in those particular three countries. This journal article from 2006 [oxfordjournals.org] has maps showing the incidence rates per country.
    • by Mashiki (184564)

      I personally blame people for stopping the take on the antibiotics in the first place for dooming us all. Man are we seriously moving back to the days of 40 to 150 years ago when we're going to start seeing "Quarantine" signs on houses? Well it sure the hell might be a good idea at this point.

      My sister had TB when she was younger, picked it up as a candy striper [wikipedia.org]. The hospital didn't pick it up in the patient in time, new immigrant, no check protocols at the time. This is going back oh almost 20 years no

  • by LizardKing (5245) on Friday January 13, 2012 @03:15PM (#38689974)
    We've had drug resistant TB in the UK. That includes one case in Basingstoke, where a family friend works as a nurse. The patient is (or was, this was two years ago) an intravenous drug user.
  • Unless you choose to add silly requirements like "the patient must survive the treatment".

  • by Saishuuheiki (1657565) on Friday January 13, 2012 @03:54PM (#38690564)

    It was also mentioned on NPR that one of the patients with the drug-immune TB in India actually checked themselves out of the hospital and they can't find them.

    Here's to you our new "Patient Zero"

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