When Antibiotics don’t work: fathoming                    Totally Drug Resistant Tuberculosis

 

“The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily under dose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.” -Sir Alexander Fleming.

 

Nearly 70 years ago, when the mass production of the first antibiotic had just begun, its discoverer had warned us in his Nobel Lecture that the unbridled and indiscriminate use of these ‘magic bullets’ will spell doom. Over the years many groups of antibiotics have came into existence, and so has resistance. And now we are under the scourge of such bacteria, our own creation, that seek to make our antibiotics worthless. Totally Drug Resistant Mycobacterium tuberculosis is one such nemesis. It is the name given to the mutated form of the bacillus that shows wider resistance to antibiotics than the previously described Extensive Drug Resistant (XDR) form. Tuberculosis, long feared as ‘The White Plague’ and ‘The Captain of the Men of Death’, is the second most common cause of death from infectious diseases in the world (after HIV/AIDS).

 

TDR-TB was first reported in 2007 in Italy, then in Iran, with subsequent reports from South India in 2012, which caught the attention of the medical community worldwide, thanks to the media coverage. However, there is controversy regarding its naming and prevalence; and data about its prevalence is said to be sparse. It is also not yet recognized by the WHO, although the United Nations’ Special Program for Research and Training in Tropical Diseases has set up a Specimen TDR Tuberculosis Bank to archive specimens of TDR-TB. In vitro drug susceptibility testing (DST) for MDR TB (resistant to two of the major drugs: Rifampin and Isoniazid) and XDR TB (MDR resistant to quinolones and injectible anti-TB drugs) has been confirmed, but data on TDR is yet to be agreed on. Regardless of the controversy, it must be remembered that the current situation compounds the siege of the disease. It is a tell-tale of how the reckless use of the available resources will spell our doom.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

There is little doubt that TDR TB will be a serious problem eclipsing MDR TB, unless government agencies and doctors, guided by WHO take necessary steps. It has been noted that no new class of antibiotics has been discovered for decades, as pharmaceutical companies are busy creating the more-profitable drugs for heart diseases. In the post-antibiotic age, when no antibiotic will be effective, imagining our existence is a scary prospect. A simple throat infection we now tend to ignore might be fatal; once infected TB will be invariably cause death. Will we find be able to stop the mutations, or create new ways to control the bacillus or will it spell the doom for mankind? The future is hard to fathom.

 

 

 

 

    References:

• Sir Alexander Fleming. Banquet Speech. The Nobel Prize. 1945. Accessed on January 22nd , 2014 from: ww.nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-speech.html

• Global Tuberculosis Report 2013. WHO, Geneva, Switzerland. 2013.

• Udwadia ZF, Amale RA, Ajbani KK et al. Totally drug-resistant tuberculosis in India. Clin Infect Dis 2012; 54: 579–81.

 

 

   Post Credits- Basalathullah Mohammed, 2k11 Batch, Gandhi Medical College.

   Originally published in Lexicon- The online medical magazine & blog