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| Constant companion, future scourge |
| By Jim Montalto, News Editor |
| Published: 06/11/2007 |
Just when you thought tuberculosis (TB) has had enough coverage in media outlets and medical journals, the emergence of highly drug resistant strains of Mycobacterium tuberculosis in South Africa and the former Soviet Union, has brought the disease back into the limelight. Extensively drug resistant TB, also known as XDR TB is resistant to the more popular therapies used to battle TB, including isoniazid, rifampin, fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or
capreomycin).TB and XDR TB can be spread by poor access to health care, crowding, the HIV epidemic, and injection drug abuse, all factors corrections professionals face every day. In their article, “TB in Correction: Constant Companion and Future Scourge, ” doctors Renee Ridzon, Senior Program Officer at the Bill and Melinda Gates Foundation, and Anne S. De Groot, Associate Professor of Medicine (Adjunct), The Warren Alpert Medical School of Brown University, say the emergence of XDR TB is a phenomenon occurring primarily due to poor TB control and inadequate TB disease management. They also attribute XDR TB’s presence to incorrect drug prescribing practices by providers, poor quality or erratic supply of drugs, and patient non-adherence. As a result, the folks at the Infectious Diseases in Corrections Report decided to cover several aspects of XDR TB and multidrug-resistant TB (MDR TB) in their June issue. IDCR begins May’s newsletter with somewhat grim, yet not surprising, news. “While XDR TB is still not common (of 17,690 M. tuberculosis isolates obtained world-wide in 2003- 2004, 20% were from patients with multidrug resistant (MDR) TB [i.e., resistant to isoniazid and rifampicin] and 2% were from patients with XDR TB), the emergence of XDR TB in prison settings in the former Soviet Union, and the spread of XDR to the outside communities to which inmates and correctional officers belong, illustrates once again the important role that front-line professionals such as correctional health providers have to play in protecting the health of their charges and communities.” IDCR then goes on to discuss TB treatment and prevention in correctional facilities. Fortunately, only , 4 percent of MDR TB cases met the criteria for XDR TB in the U.S. compared to Latvia, which has one of the highest rates of MDR TB, and has 19 percent of its MDR TB cases meeting the XDR TB criteria. Ridzon and De Groot go on to say that “in 2006, the prevalence of TB in the U.S. was 4.6 per 100,000. Although the TB case rates are much lower in the U.S. than rates elsewhere in the world, the rate of decline in TB prevalence has slowed in recent years, in part due to the persistence of TB among foreign-born populations and delayed diagnosis and treatment among members of racial and ethnic minority groups.” An overview of TB in U.S. correctional systems is covered as are examples of outbreaks in states like Florida, Kansas and South Carolina. Controlling TB also gets thorough coverage. Diagnostic tests, more accurate testing, protecting staff and proper treatment are all urged and leads to the conclusion that “Good public health practices inside will lead to improved public health outside.” Two case studies on the treating TB in correctional settings serves as a helpful and practical follow up to IDCR’sMay issue. To read the entire report go to www.idcronline.org Related resources: Centers for Disease Control and Prevention fact sheets on XDR TB |
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