Doctors Struggling to Fight 'Totally Drug-Resistant' Tuberculosis in South Africa

More lethal and harder to treat tuberculosis has been developing for years all around the world.

South African patients of the TB center in Khayelitsha, on the south-western coast of South Africa, wait to see doctors, March 23, 2009. Tuberculosis is a contagious lung disease that spreads through the air, including through coughing and sneezing.

Patients of the TB center in Khayelitsha, South Africa, wait to see doctors, March 23, 2009. Tuberculosis is a contagious lung disease that spreads through the air, including through coughing and sneezing.

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In a patient's fight against tuberculosis—the bacterial lung disease that kills more people annually than any infectious disease besides HIV— doctors have more than 10 drugs from which to choose. Most of those didn't work for Uvistra Naidoo, a South African doctor who contracted the disease in his clinic. For those who contract the disease now, maybe none of them will.

A new paper published earlier this week in the Centers for Disease Control and Prevention's Emerging Infectious Diseases journal warns that the first cases of "totally drug-resistant" tuberculosis have been found in South Africa and that the disease is "virtually untreatable."

Like many bacterial diseases, tuberculosis has been evolving to fend off many effective antibiotics, making it more difficult to treat. But even treatable forms of the disease are particularly tricky to cure; drug sensitive strains must be treated with a six-month course of antibiotics. Tougher cases require long-term hospitalization and a regimen of harsh drugs that can last years.

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Naidoo, then an avid runner, says he continued training for months with the disease, which affects more than 389,000 South Africans annually (about one fourth of Africa's cases), according to the World Health Organization. It wasn't until he went to visit his family in Durban (he had been working with TB patients in a pediatric clinic in Cape Town) that his family noticed he had lost more than 30 pounds.

"I had flu symptoms and chest pains, but I was still running so I didn't think anything was wrong," he says. But when he went in for an X-ray, doctors found that his entire right lung had filled with fluid. Within weeks, he was on his deathbed as his body wasn't responding to the most commonly prescribed antibiotics.

"One night I nearly passed away—it didn't look good," he says.

His father, also a physician, suggested that he may have had an emerging MDR, or a multi drug-resistant strain of TB. The emergence of MDR and its even more dangerous cousin, XDR (extremely drug-resistant TB), have pushed tuberculosis cure rates in the country from a high of 73 percent in 2008 down to 53 percent in 2010.

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Naidoo survived the night and doctors eventually found a treatment regimen that worked, but he was in and out of the hospital for three years, and the drugs' side effects were almost unbearable, he says. He developed Stevens-Johnson Syndrome, a complication that causes layers of skin to separate from each other and can be deadly. He regularly bled from his eyes. He fell into a deep depression.

"The TB doesn't feel like it's killing you, but the drugs do. I am a doctor and was informed that the drugs you take make you feel worse," he says. "My case was three years long. I don't think the average patient has that kind of patience."

At King George V hospital in Durban—one of South Africa's most popular TB clinics, which specifically treats XDR patients—the 200 beds are always full, and there's a four- to six-week waitlist for new patients.

William Bishai, of the Johns Hopkins Center for TB Research Laboratory and head of the KwaZulu-Natal Research Institute for Tuberculosis and HIV in South Africa, works with Naidoo and says his commitment to getting better is uncharacteristic in South Africa. TB is particularly easy to contract among people who have compromised immune systems due to HIV infection—a group that makes up about 12 percent of the country's population.

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"There's a co-infection problem with HIV—a lot of XDR patients also have HIV and have to take eight TB drugs in addition to their HIV retrovirals," he says. "The average uneducated person would be prone to giving up. There have been a number of suicides at King George V."

Partial treatment of TB is one of the most important causes of drug resistance, says Karin Weyer, coordinator of the World Health Organization's Stop TB department on drug resistance. Any time a patient stops treatment, surviving bacteria have already been exposed to some level of antibiotics and are more likely to be resistant if the patient relapses, she says.