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First two XDR-TB patients die in Lesotho

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Original Post Date: 2007-07-31 Time: 00:00:00  Posted By: Jan

Submitted by Adriana Stuijt:

First XDR-TB patients die in Lesotho

July 29 2007 — by Adriana Stuijt [email protected]. The XDR TB epidemic is definitely spreading into neighbouring countries from South Africa now.

The definite proof has been provided by Dr Peter Saranchuk, the medical coordinator of Medecins Sans Frontieres (Doctors without Borders) in Morija, Lesotho.

He writes me today in a personal communication that at least two XDR-TB cases have now been identified as having died in Lesotho just recently.

This tiny landlocked mountain kingdom is surrounded by South Africa.

He writes that the two dead XDR-TB patients had both come home from South Africa and had died shortly thereafter.

One of the dead XDR patients, whose names have not been released, had been receiving treatment for multiple-drug-resistance in a South African TB-clinic and had gone actually reneged on his treatment regimen to go home to Lesotho — where he died shortly after arrival.

This unnamed patient had also died shortly after the Lesotho health service had obtained a sputum sample from him and had submitted it to a laboratory in South Africa for confirmation. He died long before the laboratory had actually confirmed the XDR-TB diagnosis. Lesotho does not have laboratory facilities which can diagnose XDR TB and it takes at least six weeks to get a confirmation.

Dr Sananchuk also writes that “he was sure that there are plenty of drug-resistant TB in Lesotho currently, most of which is going unrecognized.(180)´

The reasons include:

– frequent migration of people between South Africa and Lesotho

– limited ability to perform culture/DST of suspected DR TB cases here in Lesotho (so drug-resistant cases go unrecognized)

– long turn-around-time before culture/DST laboratory results are received (at least 6 weeks, so we need a more rapid diagnostic for DR TB)

– poor infection control measures at clinics and hospitals where people with active TB (including DR TB) are repeatedly seen…

– ongoing problems with ‘regular TB (180)´ management, which include adherence problems and excessive defaulter rates, therefore ‘breeding’ drug resistant tuberculosis…

Dr Saranchuk also wrote that ‘regarding mortality, HIV-infected people are much more likely to die from drug-resistant tuberculosis.

“We have confirmed four cases of MDR TB thus far in our health service (in Lesotho) — two HIV-negative people are improving on MDR treatment, and two HIV-positive people have died (including the case from South Africa mentioned above).

Source: email Dr Peter Sananchuk at Medecins Sans Frontiere in Lesotho: [email protected]