Ask Emily

26 01 2012

I’ve just read that there’s a kind of tuberculosis making a comeback that doesn’t respond to any known TB drugs. How does that happen and can anything be done to treat it or stop its spread?

Tuberculosis (TB) is a bacterial infection, usually of the lungs, although it can invade other tissues.

A healthy person may be infected but not show symptoms, but someone with an active infection may have a cough with blood in the sputum, night sweats, weight loss, and fever. The bacteria spread through coughs or sneezes.

As with seemingly all infections we treat with antibiotics, the TB bacterium has evolved to evade the arsenal of medications we throw at it.

While many cases still resolve after the long-term antibiotic treatment required (6 months or more), often people with the infection begin to feel better or get tired of the unpleasant side effects and will cease the therapy.

As with other similar situations with antibiotics, this premature cessation of therapy can give resistant bacteria the upper hand. The outcome is different grades of TB infection, based on the level of resistance. TB that resists most but not all drugs is multidrug-resistant. TB that resists all but drugs of last resort is extensively drug-resistant, and TB that responds to no antibiotics at all is totally drug-resistant (TDR).

That last form of TB strikes fear into the hearts of epidemiologists and public health officials because it is an infectious disease nightmare.

For a series of reasons ranging from an inability of low-resource countries to test for and detect TB to a lapse in treatment adherence because of poor healthcare management and patient follow-up, the most resistant forms of TB often emerge in areas poorly equipped to control it. Thus, when a report surfaced in January 2012 that a research team had identified 12 cases of TDR TB in India, on the heels of 15 identified cases in Iran in 2006, the worldwide response was, essentially, anxiety and fear.

The fear is that if this TDR form of TB gains a stronger foothold in overcrowded conditions where people walk ill and undiagnosed, it would be a plane flight away from toeholds anywhere else in the world. While humanity dealt with incurable and fatal TB for millennia before antibiotics started to fight back in the 1940s, this resurgence at a time when technology can take a disease around the world in a matter of hours adds a whole new dimension to the threat.

There is, of course, already the threat on the ground in India, where one of the cases is a 13-year-old girl and another of the people in the cohort has died from the disease. But lest anyone think that in their comfortable home in the West they are sheltered from threat, the news the day I wrote this contained reports of a student with TB in Fort Wayne, Indiana, which precipitated notification to 100 students who may have come in contact with their classmate. Another student in Westlake, Ohio, also had been diagnosed with TB, precipitating community action to make people aware of symptoms and prevention of spread.

The communities in these cases benefited from a public health surveillance program that moved into action once each diagnosis was made. But in India, the result has led to public health chaos, with officials arguing over whether or not some of the cases truly were TDR TB. That does not change the fact that TDR TB has already been identified in Iran, or the economic and healthcare gaps that will only continue to contribute to the likelihood of its spread.

Do you have a question for Emily? Send it to:

By Emily Willingham

Video courtesy of IBNLive

Share the Work to Reach the Goal

16 04 2010
A t-shirt advertising open source software.

Credit: Skype user “magerleagues"

If a piece of software or computer program is “open source,” that means that anybody can access the program’s code, make updates, and share it with others. Firefox is a well-known program that’s open source.

Nobody “owns” the program, and maintenance of these programs, which are usually free to consumers, is handled by a community of enthusiasts around the world.

Scientists, inspired by this hive-minded work style, have begun imitating the approach in their own research. Networked together by technology, researchers from around the world combine their efforts in pursuit of a common goal, as in the Human Genome Project and the Tropical Disease Initiative.

The Open Source Drug Discovery Foundation, a project spearheaded by India’s Council of Scientific and Industrial Research, is using this same approach to combat neglected diseases including malaria, leishmaniasis, and target number one―tuberculosis― which affect millions around the world.

The leaders of OSDD say that finding relief for people suffering from such diseases is up to them, because drug companies won’t put big money into this kind of research, since it would be difficult to recoup their investment.

So, how does it work? Members of the project donate their time and contribute their findings online. They hold discussions and pose questions. They share ideas. And it’s not just a group of established scientists—students are participating in the process as well. And everyone is focusing on a different aspect of the research: some are analyzing the genome of the bacteria that causes TB, while others might be researching existing patents for TB medicines.

Members are given credit for their contributions and are free to use the information in their own works and writings.

Project Director Zakir Thomas says that solving problems as a united group is “immensely motivational.” The fight against tuberculosis is a personal fight for many of the participants from India, where tuberculosis is a huge problem.

But, not everyone is sold on the project’s open source approach. Problems have appeared. How will the government provide the enormous amounts of money required to produce a drug and deliver it to the people who need it? Why would a company sponsor a clinical trial for a drug to which they would not have the rights? Many of the drug manufacturing companies in India specialize in producing generic drugs, not creating new ones.

Time will tell if India’s government will come through with the funding and a company will sponsor the clinical trials. If this process succeeds, it could fundamentally alter how scientists in the rest of the world research neglected diseases. And, who knows, perhaps all diseases.

Let’s hope it catches on.