Monday, January 30, 2017

Forget Zika: The White Plague is back

The headlines in the US often are about exotic flashy but small epidemics like Zika and Ebola, not those that kill a lot more people, like Malaria or Measles.

Indeed, the traditional isolation techniques of Africa would have stopped Ebola's spread ( put the sick person in a hut, place food and water at the door, and when the hut starts smelling, burn it down.) This worked traditionally until Christian compassion made hospitals the norm.

But a potential epidemic that has been smouldering around for at least 30 years is now back in the news:

Drug resistant TB in South Africa, and is complicated by those who have HIV...

NYTIMES article reports they are finding cases, not just in those who had been treated in the past (often not completing treatment so the germs got resistant) but now it is spreading person to person.

XDR-TB has been reported in 117 countries, according to the World Health Organization. Most cases are isolated, but thousands of hidden cases are likely to exist because it takes multiple lab tests to detect each one.
The worst known outbreak is in South Africa, in the rural Zulu-dominated mountains behind Durban, where H.I.V. is also extremely common.
In 2006, researchers there reported an alarming finding: 52 out of 53 patients with both H.I.V. and XDR-TB had died, and half died within a month of getting a diagnosis.

to make things worse, few doctors in the US are able to recognize a case. Those of us who work with the AmerIndians are supposed to be aware we see "relapse" of cases, but X rays of TB scars make it hard to diagnose. I remember one case in New Mexico where I noted her scar edges seemed thicker... a bronchoscopy did reveal active TB, and the nurses were angry at me because it meant all of them had to be monitored for infection. Nowadays, PET CT scans etc. will make this easier for docs, but they are expensive in poor countries.

five to ten percent of inactive (and/or treated) TB cases will relapse: This is a problem if you were exposed as a kid and then developed Diabetes, cancer, HIV or immune problems. When I was in the IHS, we kept an eye on our diabetics, but debated whether or not to give prophylactic INH that lowers the risk but can cause liver damage.

The docs are debating how to treat it.

I suspect going back to the good old days of isolation and/or sanitariums is not a good idea. They closed most of the hospitals for this 50 years ago.

But other isolation might work... including masks, which is what we see here, not just on the street in flu season but when you go to some of the large clinics in Manila that treat TB etc. you see adults and kids walking around wearing surgical masks, to stop them from spreading infection. As in this photo of Jesus visiting the pediatric ward..
Joey Velasco

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