Tuberculosis research & treatment updates

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New TB treatment focuses on children...

New Tuberculosis Treatment Aimed at Children
December 02, 2015 — Researchers at the annual Union World Conference on Lung Health on Wednesday announced the debut of a child-friendly tuberculosis treatment – a move they hope will strike a serious blow in the fight against this often-deadly disease. It sickens at least 1 million children a year, according to the World Health Organization.

Dr. Mel Spigelman, president and CEO of the TB Alliance, an international nonprofit organization, told VOA the treatment is a major advance. "For the first time, we have appropriate treatment for the million children who have tuberculosis, with a formulation of drug that is easy for kids to take, that tastes good and that will hopefully make the disease much easier to treat," Spigelman said at the conference in Cape Town. Until now, children have been given cut-up adult pills, which they often reject because of the bad taste, the doctor said. The new medicine is dissolvable in water and comes in flavors like strawberry and raspberry – in precise doses.

Anwar, 4, gets treated for tuberculosis at the Kashi Vidyapith block hospital near Varanasi, India, Feb. 1, 2014. The country has the world’s highest incidence of TB. Researchers have unveiled an affordable, child-friendly medicine to combat the disease.​

The treatment was developed with the help of international aid groups including the World Health Organization and the U.S. Agency for International Development. Spigelman said that’s because major pharmaceutical companies have little financial incentive to develop medicine for TB, which is largely a disease of the poor. "TB is a disease that is intimately linked with socioeconomic status," he said. "It’s intimately linked with poverty, with crowding, with poor nutrition." The airborne respiratory illness remains one of the world’s biggest killers, despite the fact that nearly all cases can be cured, the WHO says. It reported 1.5 million TB deaths in 2014; of those, 140,000 were child victims.

Evidence of failures

Speigelman noted that TB also lacks high-profile champions. To illustrate his point, Speigelman referred to perhaps the most famous TB patient, Fantine, the fictional peasant-turned-prostitute in French author Victor Hugo’s 19th century novel, “Les Miserables.” But Dr. Lucica Ditiu, executive director of the Stop TB Partnership in Geneva, said TB is a very modern threat. She said the disease is on the rise, with the emergence of multiple drug-resistant strains.

Researchers are lauding a new tuberculosis treatment aimed at children. The medicine is affordable, flavorful and easy to swallow.​

"TB is coming back. And TB's coming up is a sign of global failure, because TB is a sign of poverty, and misery and lack of nutrition and lack of basic things and people living in bad conditions and being so desperate or unwell that health remains as the last of their priorities," she said. She urged international donors and leaders to do more and invest more to fight the disease.

New Tuberculosis Treatment Aimed at Children

 

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MR-TB on Obama's agenda...

White House releases plan to combat multidrug-resistant TB
Dec. 22, 2015 - The plan includes increased investment into research and development for treatment.

The Obama administration announced a plan to help combat multidrug-resistant tuberculosis in the United States and around the world, which it calls an advancement of previous plans to work with the World Health Organization to reduce overall cases and deaths caused by TB. While about 100 cases of MDR-TB are found in the United States each year, it affects nearly half a million people around the world annually. More than 9.5 million people develop active tuberculosis infections every year, according to the WHO, which recently reported TB passed AIDS as the leading global cause of death. "The National Action Plan is an effort to articulate a comprehensive strategy, and to mobilize political will and additional financial and in-kind commitments from bilateral and multilateral donor partners, private-sector partners, and governments of all affected countries," according to a White House press release.

Tuberculosis is a lung disease spread through the air from person to person. While there are less than 100 reported cases of multi-drug resistant TB in the United States, cases are increasing other places and the disease is leading global cause of death overall.​

Obama's National Action Plan is built on three goals: strengthening domestic capacity to combat MDR-TB; improving work with other countries to better combat MDR-TB; and accelerating research publicly and privately in the United States to better fight MDR-TB. Just under 10,000 cases of tuberculosis were reported in the United States in 2014, according to the Centers for Disease Control and Prevention, which represented a decrease from 2013, but was the smallest year-to-year decrease in a decade. Overall, TB has been declining in the United States for 20 years, and fell below 10,000 for the first time in 2012.

The 3- to 5-year plan is in line with the WHO's global strategy to reduce tuberculosis around the world, and comes weeks after the global organization announced the most recent statistics on the infectious lung disease. "The [WHO] report shows that TB control has had a tremendous impact in terms of lives saved and patients cured," WHO Director-General Margaret Chan said at the time. "These advances are heartening, but if the world is to end this epidemic, it needs to scale up services and, critically, invest in research."

White House releases plan to combat multidrug-resistant TB

 

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Drug combo to fight MDR-TB...

Drug Combo Could Advance Fight Against Multi-Drug-Resistant TB
December 30, 2015 - The U.S. Centers for Disease Control and Prevention, or CDC, estimates 10 million people became sick and 1.5 million died in 2014 as a result of multi-drug-resistant tuberculosis. Without an effective and aggressive treatment strategy, the number of cases could rise to 75 million worldwide by 2050.

A new study concludes that a combination of at least six drugs may be needed to combat the growing health menace.
Multi-drug-resistant tuberculosis bacteria. (Credit: U.S. Centers for Disease Control and Prevention)Multi-drug-resistant tuberculosis bacteria. (Credit: U.S. Centers for Disease Control and Prevention) "If we don't act promptly, if we don't act now, then the problem of drug-resistant TB will just get worse," said Peter Cegielski, team leader for Drug-Resistant TB and Infection Control in the global TB branch at the CDC.

A doctor examines chest X-rays at a tuberculosis clinic in Cape Town, South Africa​

Cegielski says that when a person is infected with multi-drug-resistant — or MDR — TB, the bacterium that causes the disease does not respond to two gold-standard drugs for treating the illness: isoniazid and rifampicin. So doctors turn to a cocktail of many more-expensive but less-effective drugs. How many drugs should be in that cocktail was the focus of a study led by Cegielski.

Multi-drug-resistant tuberculosis bacteria​

Six over five

Currently, the World Health Organization recommends that five drugs be administered simultaneously. But the study, conducted at 26 sites in nine countries, found that using six drugs could provide a necessary boost in efforts to defeat MDR-TB. Participating countries included Russia, South Africa, Taiwan and Estonia. Among the 1,100 adult patients in the study with MDR-TB, those who received six potentially effective drugs saw a 36 percent greater likelihood of responding to treatment compared with those who received five or fewer drugs. The findings were published in the journal PLoS Medicine.

An inmate sits in the multi-drug-resistant tuberculosis ward in a prison hospital in Russia.​

Conducting pre-treatment testing also helped to determine which drugs were most likely to be effective against resistant TB infections, according to Cegielski. "So, it was clear from this work that more testing for drug resistance, and especially testing for the full range of drug resistance, would be important so that physicians can choose the most effective drugs based on those laboratory results," he said. The WHO is now encouraging doctors around the world to do drug-sensitivity testing prior to treating their MDR-TB patients, Cegielski said. Meanwhile, the Obama administration unveiled an action plan to bring resources to bear in the prompt identification and treatment of patients infected with multi-drug-resistant tuberculosis.

Drug Combo Could Advance Fight Against Multi-Drug-Resistant TB

 

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New, simple TB blood test...

Simple Blood Test Diagnoses People With Active TB
February 19, 2016 - Test is easier than current methods for detecting the lung disease, and has potential to find and treat many more people, researchers say

Each year, 9.6 million people become infected with tuberculosis; 1.5 million of them die. The rest silently carry the bacterium in a latent state, with the constant threat that it could become active TB. It's estimated that one-third of the world's population is infected with TB, and the active cases are difficult to diagnose. Purvesh Khatri, a computational immunologist who analyzes data on TB infections, says there are limitations to the current diagnostic test that uses sputum, which is coughed up from a person's respiratory tract.

A physician examines an X-ray picture of a tuberculosis patient.​

While the test is highly accurate, it is hard to perform on some people. "The problem is that it requires sputum, and the children cannot cough up sputum," Khatri said. In addition, the traditional test can't distinguish patients with active TB from those who have recovered from tuberculosis and those who have received the BCG tuberculosis vaccine. Also, it can be hard to detect TB in those infected with the virus that causes AIDS.

New test

So, in 2014, the World Health Organization challenged researchers to develop a simple blood test to easily diagnose and sort out those who have latent disease from those who have active TB. Khatri and his colleagues at Stanford University in California have done just that, creating a highly accurate blood test that could be performed in resource-poor countries where new infections are common. When someone becomes infected with active TB, it sets off a chain reaction of activity in hundreds of genes.

The blood test developed by Khatri and colleagues identifies three genes that respond in a consistent pattern when the disease becomes active. In a study published in the journal Lancet Respiratory Medicine, the Stanford scientists report the results of the test in 1,400 blood samples. The test correctly diagnosed 86 percent of samples from children with active TB, and the test was accurate in 99 percent of cases where there was no active disease.

New possibilities

Khatri says the blood test may also be used in another way. "We may be able to use this same [genetic] signature [to see] whether the patient is responding to treatment or not," he said. Researchers next plan to conduct a clinical trial in Brazil to see how well the blood test works in the real world with people who have been exposed to tuberculosis.

Simple Blood Test Diagnoses People With Active TB

 

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Shorter treatment 'will help tackle' TB...

Shorter treatment 'will help tackle' drug-resistant TB
Thu, 12 May 2016 - New guidelines from the World Health Organization aim to speed up the treatment of multi-drug resistant tuberculosis (MDR-TB).

The advice from the World Health Organization (WHO) should reduce treatment to around nine months. Currently, it can take as long as two years - and many patients fail to complete what can be a burdensome course. Doctors urged countries to implement the guidelines quickly. Conventional treatment can involve thousands of pills and daily injections. Deafness is one of the main side-effects. Cure rates are as low as 50% because patients abandon treatment, leading to further problems with resistance. The WHO is also recommending a faster test for MDR-TB, which gives results within two days - compared with the current three months.

Tuberculosis lungs x-ray​

It hailed the guidelines as a "critical step forward". Around 5% of TB cases are thought to have resistance to the two most effective drugs. This translates into 480,000 cases worldwide - and 190,000 deaths from this form of TB every year. Many patients are not being identified. The shorter treatment plan costs less than $1,000 per patient - compared with conventional treatment which costs $2,400 for the medicines alone. The International Union against TB and Lung Disease and Medecins Sans Frontieres have been involved in trials of the new treatment method in Bangladesh and nine African countries, which have influenced the WHO's decision. The Union hailed today's advice as "an historic moment".

Cases 'driven underground'

Its senior vice president, Dr I D Rusen, told me: "When we first saw evidence about the shorter regimen, back in 2007, it was almost too good to be true. "Then further results which were consistent were presented at our conference late last year. Next year we'll have more evidence from a head-to-head trial comparing the two treatment methods. "The shorter treatment plan uses different doses of existing drugs which were previously used for leprosy. "So we hope there will be time for production to scale up, while countries get systems in place for the new guidelines, although it's possible there could be some supply issues."

David Lister, an MSF TB Doctor working in Uzbekistan, co-ordinated one of the studies and described the huge difference it made. He said: "The prospect of two years of TB treatment drives parents to hide their children from treatment, teenagers to abandon their ambitions and adults to decide between providing for their family or getting healthy. "The fear of relentless suffering due to side-effects manages to outweigh any hopes of cure and returning to a normal life. "But when I say, 'it's only nine months' they say, 'I can do that'."

Shorter treatment 'will help tackle' drug-resistant TB - BBC News

 

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Faster protocol to speed TB treatment...

Researchers Streamline TB Testing to Speed Treatment
May 25, 2016 | New protocol identifies more tuberculosis patients, and is easy to implement in poor rural areas worldwide. Researchers have developed a two-pronged, streamlined approach to diagnosing tuberculosis aimed at treated patients more promptly.

Diagnosing the fatal lung disease is difficult using conventional means such as a microscope, in which the presence of the TB bacterium is easily missed in sputum samples. Instead, researchers are using the latest technology to streamline the diagnosis process. According to the World Health Organization, tuberculosis causes more deaths globally than any other infectious disease. Nearly 10 million people are diagnosed with TB each year, and the disease kills approximately 1.5 million people, mostly in low- and moderate-income countries. AIDS patients are at high risk of becoming infected with tuberculosis.

A physician examines an X-ray picture of a tuberculosis patient.​

Experts believe many people infected with TB aren’t diagnosed until they become ill or die. “A major area of research interest for us is looking at how we can improve diagnosis to make sure that patients aren’t missed by the system,” said Priya Shete, a TB researcher at the University of California in San Francisco. “And the goal of catching those patients is to ensure not only timely diagnosis, but timely treatment initiation to try to minimize bad tuberculosis outcomes and also to prevent ... further transmission of the disease.”

Trial program

Shete and her colleagues led a trial program at four health centers in Uganda that aimed to catch more tuberculosis cases. A total of 822 patients suspected of being infected with TB were referred for testing. Of those, 12 percent were ultimately diagnosed with the disease. Seventy-five percent of that total was diagnosed the same day with fluorescence microscopy, a more sensitive form of testing than is conventionally done. Sputum samples of the participants who tested negative were sent to a regional laboratory for an even more sensitive analysis using GeneXpert, which identifies DNA sequences specific to TB. Those results showed that two dozen people who originally tested negative for the bacterium were infected.

Same-day treatment was administered to the 98 patients diagnosed in the first round of testing, while antibiotics were administered six days later to a majority of the patients who were determined to have TB using the genetics test. About 20 percent of the infected patients were lost to follow-up. The bottom line, Shete says, is many more patients were identified using the two-prong approach than with the traditional testing method. “You know, at the end of the day, it meant that we got 82 percent of patients, by any means, on therapy, and I think [that shows] the feasibility of some of these types of interventions in even remote, rural settings.” Researchers now plan to repeat the testing system at 20 clinics in Uganda. Shete says future work will examine whether TB diagnosis and treatment numbers can be improved by reorganizing health centers to include a staff dedicated to fighting tuberculosis.

Researchers Streamline TB Testing to Speed Treatment

 

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New tests for TB and counterfeit drugs...

Experimental TB Test Gives Results in an Hour
August 22, 2016 - A new TB test has been developed that can tell doctors within one hour whether someone has tuberculosis. The test is in the experimental stages, but scientists say it has the potential to make a big difference in developing countries hit hard by TB.

TB is a potentially deadly disease that strikes 10 million people each year. Two million of them die of the disease, according to experts. There are antibiotics to treat TB, but it can take up to three weeks to get a diagnosis, which delays treatment. The test that is often used in resource-poor countries is the Ziehl-Neelsen, or ZN, test. Developed in the 1880s, it is an 11-step process that begins when technicians put a sample of sputum on a microscope slide, then dye and rinse it multiple times. That alone can take several hours. In addition, it is often difficult to definitively detect the presence of the bacterium under the microscope. Meanwhile, the same sputum sample may be sent away to grow the TB pathogen in a dish. But mycobacterium grows slowly, taking as many as three weeks to yield a result.

New test, quick results

However, an experimental TB test has the potential to show clinicians what they need to know within one hour. Carolyn Bertozzi, a biological chemist at Stanford University in California, helped develop the rapid TB sputum test, which she said fills a treatment void in developing countries, where patients often disappear before they are diagnosed. "So, it's a real public health problem to not have an accurate test that, first of all, is more specific for TB, will tell you whether the TB are alive, and can be performed in a period of time where you can keep somebody in the clinic so you can act on the diagnosis while they are still there," Bertozzi said.

How it works

The rapid test uses sugar molecules found in the cell walls of the TB bacteria. Investigators tag modified versions of the sugar molecule with a fluorescent dye, which the live pathogens take up and integrate into their cell walls. Under the microscope, only the live mycobacteria, which cause tuberculosis, glow green. The test also could be used to check sputum samples to see whether someone being treated for TB is responding to the antibiotics, Bertozzi said.

A doctor examines a boy with tuberculosis at the hospital of Doctors Without Borders in Malakal, South Sudan​

There's still more work to be done before the test becomes a reality. For now, Bertozzi sees it as a way to confirm a diagnosis using a microscope for a first-pass look for the TB microorganism. "I'm excited about it because it is so simple,” she said. “It is low-tech, but it kind of fulfills a niche in technology that doesn't exist right now in the world of either TB basic science or TB diagnosis." Field trials of the experimental test began in June in South Africa. A number of charitable organizations, including the Gates Foundation, have shown an interest. The work is being presented this week at the annual meeting of the American Chemical Society in Philadelphia, Pennsylvania, the world's largest scientific society.

Experimental TB Test Gives Results in an Hour

See also:

Paper-based Test Identifies Bogus and Poor Quality Drugs
August 22, 2016 - Counterfeit and substandard medications are a serious problem in the developing world, potentially harming patients who desperately need medical treatment.

Some of these drugs — including the antibiotics ciprofloxacin and ceftriaxone — have been deemed essential by the World Health Organization for the treatment of infections. However, chemists in developing countries often do not have expensive instruments to determine whether a pill is genuine. Now, a simple paper-based test may be the answer. Instead of a $30,000 machine, a $1 paper card can test a drug in three minutes to determine whether the medication is inactive or of substandard quality. The tests come in 20-card packets.

A team of researchers has developed a simple, inexpensive, paper-based device to test medicine for quality and authenticity.​

Chemist Marya Lieberman of the University of Notre Dame in Indiana helped develop the inexpensive test. "Really, this touches on issues of basic fairness and justice,” Lieberman said. “If people are paying for medicine, they deserve to get medicine.” Lieberman said the card can be used to test a wide variety of medications. "This card is designed to test antibiotics and tuberculosis medications, but it also works for some other drugs,” she said. “For example, for some diabetes medications and heart medications."

How it works

To see whether a drug is genuine, researchers crush a pill and rub the resulting powder across 12 lanes on the card. Each lane contains a test for a separate ingredient. The card is then dipped in water. Chemicals on the card react to the powder and turn a certain color, which is compared to a color pattern from high quality pills from a drug manufacturer. The process sorts out active from inactive ingredients, as well as harmful ingredients such as heavy metals.

Sometimes medications break down if they are stored improperly in hot temperatures. In one experiment, researchers subjected the antibiotic ceftriaxone to high temperatures and then used the card to color test the ingredients. When compared to the color chromatic pattern provided by the manufacturer, scientists saw the active ingredient in the antibiotic was different from the properly stored drug. The researchers also tested antibiotics from western Kenya and Uganda, and found between 10 to 30 percent of the medications were of poor quality.

Range of benefits

 

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Dat's why Granny don't want Hillary coughin' on her - she don't wanna get the TB...

Evidence of TB Found in People Who Are 'Cured'
20 Sept.`16 - Researchers are perplexed following the discovery that tuberculosis may not be completely gone in those who are deemed “cured.” A recent study found evidence of the bacterium that causes TB remains in the lungs after treatment.

A study of 99 HIV-negative individuals in Cape Town, South Africa, who had been treated for pulmonary tuberculosis with a rigorous antibiotic regimen, had their lungs imaged before during and after treatment. Investigators at Stellenbosch University used a CT scan, a more detailed form of x-ray, and PET scans that glow bright to reveal the presence of lung abnormalities. Imaging in 76 of those patients thought to be cured showed continued inflammation in the lungs and lesions similar to those of untreated patients. One year after treatment, 50 patients showed similar lung involvement, although most of the lesions had decreased in size. Sixteen patients with some abnormalities picked up in the scans were otherwise free of lesions.

Researchers also detected genetic material in the saliva and mucus of 34 patients, an indication that live bacteria remained in their lungs. “Oh yeah, we certainly were,” said Clifton Barry describing the surprised reaction of researchers. Barry is a senior scientist at the U.S. National Institutes of Health Tuberculosis Research Section. He co-authored the study published in the journal Nature Medicine. “We were quite surprised to see the residual findings at the end of treatment... and the evidence of presence of active live bacteria in patients we called cured of tuberculosis,” Barry added.

A physician examines an X-ray picture of a tuberculosis patient.​

Barry said investigators don’t know what the implications are, but they wonder whether such patients could relapse and, if so, whether a second infection could become resistant to antibiotics. A six-month course of antibiotics has been the gold standard in treating patients, who afterwards usually show no symptoms of TB. Said Barry, “I think the question is, “Is that really enough?” And do we need to think about potentially looking more carefully at patients at the end of treatment and evaluating in a different algorithm how we treat individual patients.”

One-third of the world’s population is infected with tuberculosis. The U.S. Centers for Disease Control and Prevention says 9.5 million people become sick and 1.5 million die. Not only might TB patients need to be monitored closely after treatment, researchers say the study points up that new strategies may be needed for dealing with tuberculosis. These may include doing genetics tests to determine the bacterium’s genotype, or severity and traits, so treatment regimens may be tailored to individuals infected with TB, replacing a one-size fits all approach to curing tuberculosis.

Evidence of TB Found in People Who Are 'Cured'

 

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Children's TB drug launched in Kenya...

TB drug designed for children launched in Kenya
Tue, 27 Sep 2016 - Kenya launches the world's first child-friendly drug, raising hopes for thousands affected by the world's deadliest infectious disease.

The new pill is a combination of three drugs used to treat tuberculosis, mixed in the right dosage, and is fruit-flavoured to appeal to children. Until now, the global TB Alliance says pills designed for adults have been split to get the dosage for children. Every year, about a million children fall ill with TB, which is the world's deadliest infectious disease. In 2014, an estimated 140,000 children died of TB, according to global figures from the World Health Organization (WHO). Kenya is the first country to roll out the new drug nationally, with more countries expected to follow over the next three years.

Experts say the new treatment will be more effective because the components have been measured accurately and the pill is not bitter-tasting. What is it like to live in a TB hotspot? Anne Soy, BBC Africa health correspondent: At Majengo slum in Kenya's capital, Nairobi, a dark corridor leads to Helen Chebet's one-roomed home, where she lives with her family of six. The mud-walled building, reinforced with rusty iron sheets, has very few windows and the only source of natural light in the space she rents comes from a tiny transparent panel installed in the roof. Living conditions like these, crowded and with poor ventilation, are cited as contributing factors to the transmission of tuberculosis.

African boy stands next to medicine tray​

This year, both Ms Chebet and her two youngest children were diagnosed with tuberculosis, after several failed attempts to treat for other possible infections. Her 15-month-old daughter Chepkoech was put on a six-month course of antibiotics, which required her to take six tablets a day. Ms Chebet tried to hide the drug in the toddler's food, but her strategy did not work. "One particular drug was difficult to split and dissolve in water... I had to grind it," Ms Chebet says adding that Chepkoech could only stand the bitter-tasting drugs for the first two months.

The new drug dissolves easily in water, making it easier to take every day for the six-month treatment period. "Caregivers can easily give up knowing how difficult it is to give children such medicine," Kenya's head of TB programmes Dr Enos Masini told the BBC. It is not only Kenya, which begins rolling out the drug for free from 1 October, where TB sufferers are expected to benefit. More than 20 countries have expressed interest in introducing the pill, says Dr Cherise Scott from the TB Alliance, the global non-governmental organisation that spearheaded the production of the new drug. "The new child-friendly pill will boost survival," Dr Scott adds. Africa has the highest prevalence of TB of any continent. The global TB death rate has dropped by almost a half between 1990 and 2015, the WHO says.

Tuberculosis symptoms

 

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People can catch TB from animals...

Animal TB threatens human health say vets and doctors
Fri, 30 Sep 2016 - Animal tuberculosis, which is spread through contaminated food, is a greater threat to human health than previously realised, leading doctors and vets warn.

The disease can be more serious and harder to treat than conventional, human tuberculosis. The world has committed to being free of tuberculosis by 2035. But bodies including the World Health Organization (WHO) say animal TB has been neglected for decades. Raw or unpasteurised milk is one of the most common sources of the infection. But animal tuberculosis - officially known as zoonotic tuberculosis - also affects those in close contact with infected animals including vets, farmers and butchers.

Dr Francisco Olea-Popelka, from the Union Against Tuberculosis and Lung Disease, said zoonotic tuberculosis was "far more common than previously recognised". The best estimates suggest there are around 121,000 new cases of animal TB each year. The figure is tiny compared to human TB, which is the biggest lethal infection in the world. But Dr Olea-Popelka told the BBC News website: "I think we should care." "This is a well-known problem and has been neglected for decades, it is a disease that is preventable, treatable and curable and yet still today we have hundreds of thousands of people suffering from it. "Ten thousand die every year from this disease, that's a lot of cases compared to many other diseases, why not care?" he added.

He is part of a group - including the WHO, the UN Food and Agriculture Organization and the Stop TB Partnership - that has published a call to action in the Lancet Infectious Diseases medical journal. One of the biggest issues the report raises is the unknown scale of the problem. Studies in Mexico suggest 28% of all tuberculosis cases are down to zoonotic TB but a study in India put the figure at 9% and one in children in California suggested a figure of 45%. Dr Paula Fujiwara, from the International Union Against Tuberculosis and Lung Disease, added: "With approximately nine million individuals contracting TB globally each year, even relatively low percentages of zoonotic TB lead to large numbers of people suffering from this form of the disease." "People living with zoonotic TB require specialized care, but in the vast majority of cases, they are not even adequately diagnosed," she added.

Animal TB is caused by Mycobacterium bovis, which is a different infection to human TB caused by Mycobacterium tuberculosis. M. bovis is inherently resistant to one of the key drugs used to treat human TB - pyrazinamide. And Dr Olea-Popelka added: "Once you get zoonotic TB it is often extrapulmonary TB, meaning it is not only in the lungs, but in other organs; that complicates the diagnosis and makes it more difficult to treat." How to tackle animal tuberculosis will be one of the themes of the Union World Conference on Lung Health taking place later this month.

Dr Olea-Popelka said the key strategies for preventing zoonotic were:

* milk pasteurisation
* farmers, butchers, vets and zookeepers protecting themselves from inhaling bacteria
* and preventing the infection in animals in the first place

Each is easier said than done.

Animal TB threatens human health say vets and doctors - BBC News

 

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DR-TB Higher than Thought in West Africa...

Drug-Resistant TB Higher than Thought in West Africa
November 03, 2016 - Researchers have found the number of multidrug-resistant tuberculosis cases in West Africa is greater than thought.

Officially, the World Health Organization estimates the incidence of new cases of so-called MDR-TB in the African region is 2 percent, and 17 percent among people who were treated for TB more than once. But investigators on the ground in eight West African countries came up with higher numbers. They report that 6 percent of new cases and 35 percent of retreatment cases are drug-resistant to more than one medication. An analysis of almost 974 sputum samples from TB patients carried out by the West-African Network of Excellence for TB, AIDS and Malaria (WANETAM), found that 39 percent were resistant to at least one first-line antibiotic used to treat tuberculosis. Additionally, bacterial isolates in 22 percent of the samples did not respond to two or more anti-TB drugs.

A doctor examines chest X-rays at a tuberculosis clinic in Gugulethu, Cape Town, South Africa.​

The findings are published in the online journal BMC Medicine. WANETAM'S Martin Antonio, with the medical research council unit in Gambia, said the statistics are particularly worrying for the region's 245 million inhabitants who live in one of the poorest corners in the world. "The higher the rates in the community," he explained, "the more likely it is to be spread. And we really need to catch that." Researchers also detected the presence of what is called pre-extensively drug-resistant TB in sputum samples at all study sites in Burkina Faso, Gambia, Ghana, Guinea-Bissau, Mali, Nigeria, Senegal and Togo. These are on the verge of developing into extensively drug-resistant bacteria, which respond to neither first- or second-line drugs.

A doctor examines a child with tuberculosis as her mother holds her at the hospital of Doctors Without Borders (MSF)​

The highest proportion of pre-extensive drug resistance was seen in Ghana, in 35 percent of MDR samples. Multidrug-resistant bacteria were most prevalent among patients who'd been treated for TB before in Bamako, Mali, and Lagos, Nigeria. They were four times more likely to be resistant compared to new cases. If the spread of MDR-TB continues at its current pace, according to Antonio, "it means the treatment options for those patients is highly limited. It means more patients may actually die from TB because they may be untreatable." He is calling for West African governments to put aggressive, community-wide TB containment efforts in place as soon as possible to prevent a worsening of the tuberculosis epidemic. That includes beefing up laboratories to conduct rapid testing and treatment of TB, more personnel to make sure patients take their drugs properly, and actively following those who are treated more than once for TB.

Drug-Resistant TB Higher than Thought in West Africa

 

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New Blood Test For Detecting TB Risk in Children...

Blood Test Called Highly Effective in Detecting TB Risk in Children
February 21, 2017 - A simple blood test is highly effective at identifying children infected with tuberculosis so they can be treated before it progresses to a life-threatening disease, according to research by scientists who say it is often difficult to diagnose TB in children.

One of the biggest challenges in the global war on TB is identifying people early so they can be treated before the disease becomes full-blown and potentially fatal. Finding TB in young children, in particular, poses a hurdle because youngsters often can’t produce a sputum sample necessary to diagnose the disease. The other problem, according to infectious disease specialist Jason Andrews of Stanford University, is children’s infections often settle in their kidney, spine or brain. Unlike TB infections in the lungs, a sputum test cannot diagnose infection in other organs.

'Vast majority can be cured'

“If you find them early and treat them, the vast majority — close to 100 percent — can be cured,” Andrews said. “For the preventive therapy [in children with latent infection], a single antibiotic can be given that has very good ability to prevent against going on to develop active disease." Andrews and his colleagues conducted a study on the use of a blood test to diagnose children at risk of developing TB and found it highly effective. While the test, called QuantiFERON, is sometimes used in adults, the World Health Organization (WHO) does not recommend it for children. The researchers analyzed the data from a clinical trial of an experimental TB vaccine trial in South Africa, just outside Cape Town. The vaccine turned out to be a flop, but investigators were curious about how well the blood test performed in diagnosing latent TB in young children — those at highest risk of developing an active infection.

2,500 children tested

The study involved approximately 2,500 healthy, HIV-negative babies and children. At the start, none was infected with the TB bacterium. The test was repeated one year later, to check for the development of an infection. At that point, 172 of the children tested positive for TB, and 30 were already being treated. Researchers then looked at data on the other 142 kids who had not yet developed active disease.

Testing them at the two-year mark, they found that those children with the highest levels of a blood biomarker called interferon gamma had a 40-fold increase in the risk of developing active tuberculosis. “When we saw the data in children, we were just astounded by the exceptional predictive value that it had,” Andrews said. The study was published in the journal The Lancet Respiratory Medicine. Based on the findings, Andrews would like to see the WHO change its recommendation to include the use of the blood test in children.

Powerful killer

See also:

Lab on a Paper Card Can Test Drugs for Purity
February 22, 2017 — Whether it’s brake fluid in Nigerian teething syrup, melamine in Chinese baby formula, or talcum powder in Kenyan antibiotics, contaminated food and medicine is a deadly problem. But a group of scientists, led by Notre Dame chemistry professor Marya Lieberman, hopes to eliminate the problem for millions of people in developing nations by offering a simple solution.=

A ‘lab on paper’

The PAD - or Paper Analytical Device - project began six years ago as a collaboration between Notre Dame and St. Mary's College. The simple invention replaces expensive machinery that might not be available in developing countries. Each of the 12 lines on the paper card is laced with a different chemical. When medicine is smeared across the lines and the card is soaked in water, a color change indicates whether the drug is safe. Drugs can be tested at any stage of the distribution process.

While not all alterations are deadly in and of themselves, not getting the right medicine or the correct dosage can still have fatal consequences for severely ill patients. “One in ten children who go to the hospital with pneumonia in Kenya don’t make it out,” Lieberman notes. “That’s because there is kind of a golden hour for patients to recover. If they don’t get the needed medicine in the correct dose, bacteria take over and they won’t make it.” During a trip to Kenya last year, her team discovered amoxicillin caplets cut by half with talcum powder. In that case, they devised a simple water test to check for purity. But most contamination cases need a more comprehensive test to discover errors.

A world of contaminants

In addition to testing pharmaceuticals, Lieberman’s team is developing cards to test lead, iodine, and even urine. Notre Dame graduate student Jamie Luther is working on a card to identify contaminants in milk. "There are tests that are published for people at home to mix chemicals to test their own milk,” she says. “I thought to myself, that’s so cumbersome. People shouldn’t be handling acids in their home. They shouldn’t mix dangerous chemicals with their hands." In order to discover the most common contaminants, Lieberman’s team works with 18 universities throughout the U.S. The labs use High Performance Liquid Chromatography (HPLC) machines to test drugs gathered from pharmacies throughout the developing world.

Notre Dame graduate student Nicholas Myers never considered what a big problem altered pharmaceuticals were before he started working on the project. "I just took it for granted that chemical analysis could happen anywhere,” Myers admitted. “I didn’t know the extent to which low and middle income countries did not have the capacity to do chemical testing." Veripad, a New York startup company is developing a complimentary smartphone app to help read and evaluate the cards. Because less experienced testers may not fully understand color results, and some may be color blind, the app takes away the guesswork. Testers can take a photo with their phones and get almost instantaneous results.

Lieberman says if there’s one thing this project has taught her, it’s that it’s sometimes necessary to look at a problem from a new angle to find the best answer. "If we can’t increase the capacity of analytical labs in the developing world,” she observes, “maybe we can come up with a way to bring that technology in a portable form that will be usable in the field." The World Health Organization says a functioning health care system should have 343 pharmaceuticals on hand. So far, Lieberman’s team has developed PADs to identify 60 different drugs and eventually hopes to have tests for them all.

Lab on a Paper Card Can Test Drugs for Purity

 

[irosie91]

for the record-------this stuff is really really BIG----TB in very young children is a DISASTER---frequently----progresses like a Tsunammi

 

[anotherlife]

Whilst we don't want tuberculosis in children, tuberculosis used to be the old fashioned population control. How long does it take for tuberculosis to kill an adult? And how long for a child? Lots of famous 19th century artists lived with tuberculosis, most famously the musician Chopin, who lived with tuberculosis for39 years. Hardly a killer desease.

 

[waltky]

Who knew that the answer to TB could be right under our feet?...

A Bacterium Found in Soil Could Fight Tuberculosis
March 06, 2017 - Scientists are developing an antibiotic from a microorganism found in soil to fight the tuberculosis bacterium. As TB becomes increasingly resistant to existing antibiotics, soil could hold the key to new drugs against this global killer.

Tuberculosis is treatable with antibiotics, but in thousands of cases, antibiotic misuse has caused the disease to become non-responsive to the drugs. According to the World Health Organization, there are 10.4 million new cases of tuberculosis every year, killing 1.8 million people. In 2015, it was estimated that 480,000 infections were not responsive to two major drugs commonly used to treat TB. A quarter-million patients died reportedly of drug-resistant infections. An international team of researchers has been hunting for new sources of antibiotics in nature to treat deadly illnesses like TB. Investigators have hit upon a species of bacteria in a large family called Streptomyces found in soil.

Making synthetic compounds

In the laboratory, they’ve extracted compounds from Streptomyces that target a specific enzyme called MraY in mycobacterium, the pathogen that causes TB. The compounds effectively kill mycobacterium. Using synthetic chemistry, the researchers were able to recreate these compounds, turning them into more potent versions of the originals. Structural biology professor David Roper of England's University of Warwick is part of the team that includes scientists in the United States and Australia sleuthing for novel agents to treat disease.

A doctor points to an X-ray showing a pair of lungs infected with tuberculosis on board a mobile X-ray unit screening for TB in London​

In the case of the Streptomyces microorganism, Roper said researchers have extracted compounds that target how mycobacterium makes its cell walls. He likens them to bones in the human body. “If you knock out our skeletons, you’re not going to be a very competent human being, are you? And the same is true for the biosynthesis of the bacterial cell wall. It’s exactly the same principle that penicillin inhibits, although that’s a different enzyme and other antibiotics like vancomycin for example. So, the biosynthesis of the bacterial cell wall is a good target for antibiotics,” said Roper.

Finding the right tools

The work was published in the journal Nature Communications. In the soil, Roper said the bacteria use the compounds to kill other microorganisms near them, giving them a survival advantage. “One of the reasons for looking at natural product compounds in general is that these things have been derived from nature, therefore they’ve gone through many millennia years of evolution in the first place, and they’ve been retained by nature so they must have, as it were, long-standing efficacy.” The challenge has been growing soil bacteria like Streptomyces in the lab with available tools so they can be made into drugs. The team is looking for ways to do that and they are beginning to find the right tools.

There is no timetable for turning soil bacteria into drugs against diseases like TB, just that it will take time. As new drugs from soil bacteria become available, Roper doesn’t rule out the possibility that TB eventually may become resistant to them too. Researchers, however, have learned from experience with tuberculosis that antibiotics must be used with great care to preserve their effectiveness.

A Bacterium Found in Soil Could Fight Tuberculosis

 

[yiostheoy]

Whilst we don't want tuberculosis in children, tuberculosis used to be the old fashioned population control. How long does it take for tuberculosis to kill an adult? And how long for a child? Lots of famous 19th century artists lived with tuberculosis, most famously the musician Chopin, who lived with tuberculosis for39 years. Hardly a killer desease.

My dad caught TB in WW2 Germany during his American occupation of that country.

He had to spend a year in an Army hospital stateside to get over it.

My mom told me it was a very hard disease to get over.

He was in the prime of his life at the time -- late 20's.

I can only imagine how deadly it would be for children or the elderly.

 

[yiostheoy]

Anytime you hear anybody around you coughing, the worst case is that they have TB and you just caught it too.

Coughing comes from cold viruses, flu viruses, bacterial pneumonia, viral pneumonia, smoking, dust, coal dust, cancer, and TB.

Smoking, dust, coal dust, and cancer are the only ones that are not contagious.

All the others are.

When I hear someone coughing I make a swift basketball spin move to get away from their germ cloud.

 

[irosie91]

Whilst we don't want tuberculosis in children, tuberculosis used to be the old fashioned population control. How long does it take for tuberculosis to kill an adult? And how long for a child? Lots of famous 19th century artists lived with tuberculosis, most famously the musician Chopin, who lived with tuberculosis for39 years. Hardly a killer desease.

My dad caught TB in WW2 Germany during his American occupation of that country.

He had to spend a year in an Army hospital stateside to get over it.

My mom told me it was a very hard disease to get over.

He was in the prime of his life at the time -- late 20's.

I can only imagine how deadly it would be for children or the elderly.

the progress of TB is HIGHLY variable. In fact-----it can remit spontaneously

 

[yiostheoy]

Whilst we don't want tuberculosis in children, tuberculosis used to be the old fashioned population control. How long does it take for tuberculosis to kill an adult? And how long for a child? Lots of famous 19th century artists lived with tuberculosis, most famously the musician Chopin, who lived with tuberculosis for39 years. Hardly a killer desease.

My dad caught TB in WW2 Germany during his American occupation of that country.

He had to spend a year in an Army hospital stateside to get over it.

My mom told me it was a very hard disease to get over.

He was in the prime of his life at the time -- late 20's.

I can only imagine how deadly it would be for children or the elderly.

the progress of TB is HIGHLY variable. In fact-----it can remit spontaneously

Yup and all his life that is what everyone in the family was afraid of.

 

[irosie91]

Whilst we don't want tuberculosis in children, tuberculosis used to be the old fashioned population control. How long does it take for tuberculosis to kill an adult? And how long for a child? Lots of famous 19th century artists lived with tuberculosis, most famously the musician Chopin, who lived with tuberculosis for39 years. Hardly a killer desease.

My dad caught TB in WW2 Germany during his American occupation of that country.

He had to spend a year in an Army hospital stateside to get over it.

My mom told me it was a very hard disease to get over.

He was in the prime of his life at the time -- late 20's.

I can only imagine how deadly it would be for children or the elderly.

the progress of TB is HIGHLY variable. In fact-----it can remit spontaneously

Yup and all his life that is what everyone in the family was afraid of.

oh-----well---since world war II----there have been MANY new antibiotics used
to fight TB-------sheeeeeesh-----sorry your people were so wrecked------the damned
little microbe mutates and adapts ----right now --there are new developing resistant
strains