Completely drug-resistant strain of TB reported in India

[Costa Fiero]

This wasn't what was supposed to happen.

The experiment would have quickly destroyed Pakistan, ending that miserable country swiftly and without resorting to nuclear weapons. It would have been contained to only that area, and we would have done the whole world a favor. After immunizing ourselves, we would have promptly threatened the world with our biological superweapon, and showed those bloody Yanks not to yell at us over the phone again...

But things got out of hand.

I received news from one of the lead scientists that they were missing a vial.

Indian Bureaucrats had taken one, and sold it to God knows who or what.

But then we found the first cases, in Iran. Then they came back home to India.

We attacked the virus within our borders, but found that it was adapting quickly. The virus was sentient, quickly multiplying, growing stronger, simply absorbing whatever we threw at it.

It spread out of India. It went to Bangladesh, Pakistan, Nepal, China, USA, UK....

A million dead in the first day. Twenty million dead in the first week. A billion dead within a year.

Then the dead began to return. The corpses simply stood back up as they rotted, and began attacking again, laying siege to Amritsar, which has become a refugee center for the uninfected and the few immune.

It's up to us to hold the line now. And now we will fight. We will repent for our sins, our mistakes...we will destroy the

INFECTION.
(Coming to theaters and IMAX whenever the fuck we feel like. We have the unkillable TB, you gonna question us?)

Yes, yes, that's all well and good. But does it have awesome dancing?

[Forster Keys]

Damn. This is what happens when you sell high level antibiotics over the counter. Hope it doesn't blow up it into something monstrous.

[New England and The Maritimes]

Damn. This is what happens when you sell high level antibiotics over the counter. Hope it doesn't blow up it into something monstrous.

Life isn't still around because it gets fucked up by the first new bacteria it comes across. There's been a 3.5 billion year arms race between infectee and infector, parasite and host, predator and prey. We're all designed to adapt, or else we'd still be clumps of amines in primitive pools.

[Nationstatelandsville]

India has clearly done something to offend Franklin Delano Roosevelt's ghost.

[Mike the Progressive]

Well since we are all going to die, NSG, I just want you to know: You're all a bunch of socialists. I apologize for nothing, no regrets, yadda, yadda, yadda.

Thank you, good night and good luck.

[New Sapienta]

This wasn't what was supposed to happen.

The experiment would have quickly destroyed Pakistan, ending that miserable country swiftly and without resorting to nuclear weapons. It would have been contained to only that area, and we would have done the whole world a favor. After immunizing ourselves, we would have promptly threatened the world with our biological superweapon, and showed those bloody Yanks not to yell at us over the phone again...

But things got out of hand.

I received news from one of the lead scientists that they were missing a vial.

Indian Bureaucrats had taken one, and sold it to God knows who or what.

But then we found the first cases, in Iran. Then they came back home to India.

We attacked the virus within our borders, but found that it was adapting quickly. The virus was sentient, quickly multiplying, growing stronger, simply absorbing whatever we threw at it.

It spread out of India. It went to Bangladesh, Pakistan, Nepal, China, USA, UK....

A million dead in the first day. Twenty million dead in the first week. A billion dead within a year.

Then the dead began to return. The corpses simply stood back up as they rotted, and began attacking again, laying siege to Amritsar, which has become a refugee center for the uninfected and the few immune.

It's up to us to hold the line now. And now we will fight. We will repent for our sins, our mistakes...we will destroy the

INFECTION.
(Coming to theaters and IMAX whenever the fuck we feel like. We have the unkillable TB, you gonna question us?)

Nice mass effect reference.

[Rio Cana]

The answer, Nanotech.

Read this titled "Case study: South Africa uses nanotech against TB"
http://www.scidev.net/en/features/case- ... -tb-1.html

Downside is if the govt. use decides to use the Nanotechs to control people.

[DaWoad]

The answer, Nanotech.

Read this titled "Case study: South Africa uses nanotech against TB"
http://www.scidev.net/en/features/case- ... -tb-1.html

Downside is if the govt. use decides to use the Nanotechs to control people.

which would be great at preventing antibiotic resistance. Absolutely useless however at treating already resistant strains (also mind control).

[Rio Cana]

The answer, Nanotech.

Read this titled "Case study: South Africa uses nanotech against TB"
http://www.scidev.net/en/features/case- ... -tb-1.html

Downside is if the govt. use decides to use the Nanotechs to control people.

which would be great at preventing antibiotic resistance. Absolutely useless however at treating already resistant strains (also mind control).

They could unleash armies of Nanobots to find and destroy TB via some kind of small electrical charge.

[DaWoad]

which would be great at preventing antibiotic resistance. Absolutely useless however at treating already resistant strains (also mind control).

They could unleash armies of Nanobots to find and destroy TB via some kind of small electrical charge.

1) nobody has the tech to do that
2) the tech to do that would be ridiculously complex.

[Greed and Death]

They could unleash armies of Nanobots to find and destroy TB via some kind of small electrical charge.

1) nobody has the tech to do that
2) the tech to do that would be ridiculously complex.

That leaves Phage therapy.
http://en.wikipedia.org/wiki/Phage_therapy

[DaWoad]

1) nobody has the tech to do that
2) the tech to do that would be ridiculously complex.

That leaves Phage therapy.
http://en.wikipedia.org/wiki/Phage_therapy

that could actually work. A modified phage that binds to TB surface proteins only would be perfect (assuming the mutation rate stayed relatively low) build in some sort of telomer-esque system to drastically limit the number of potential reproductions of the phage and you're good to go.

[The Rich Port]

My goddamn cosmic comrades better fucking handle this shit.

TB is not a fucking fun way to die, and Vishnu might take away some karma for being dipshits.

[Greed and Death]

That leaves Phage therapy.
http://en.wikipedia.org/wiki/Phage_therapy

that could actually work. A modified phage that binds to TB surface proteins only would be perfect (assuming the mutation rate stayed relatively low) build in some sort of telomer-esque system to drastically limit the number of potential reproductions of the phage and you're good to go.

A phage can be made that only attacks specif strains of TB.
The main problem is the patients immune system eventually attacks the phage.

[Simon Cowell of the RR]

Don't ya'll worry.

I'll repopulate earth for ya.

That was my job...
Everyone has been talking about a superplague, now we have one. Second thoughts?

[DaWoad]

that could actually work. A modified phage that binds to TB surface proteins only would be perfect (assuming the mutation rate stayed relatively low) build in some sort of telomer-esque system to drastically limit the number of potential reproductions of the phage and you're good to go.

A phage can be made that only attacks specif strains of TB.
The main problem is the patients immune system eventually attacks the phage.

i can see how that could be a problem. Even if the phage wiped out the infection (or weakened it enough) you could have serious problems occur from the immune response. hmmm . . .you could tailor the phage to each individual but that might be to expensive . . .

[Trotskylvania]

Well, this is a bad way to start the year.

Over the past 48 hours, news has broken in India of the existence of at least 12 patients infected with tuberculosis that has become resistant to all the drugs used against the disease. Physicians in Mumbai are calling the strain TDR, for Totally Drug-Resistant. In other words, it is untreatable as far as they know.

News of some of the cases was published Dec. 21 in an ahead-of-print letter to the journal Clinical Infectious Diseases, which just about everyone missed, including me. (But not, thankfully, the hyper-alert global-health blogger Crawford Kilian, to whom I hat-tip.) That letter describes the discovery and treatment of four cases of TDR-TB since last October. On Saturday, the Times of India disclosed that there are actually 12 known cases just in one hospital, the P. D. Hinduja National Hospital and Medical Research Centre; in the article, Hinduja’s Dr. Amita Athawale admits, “The cases we clinically isolate are just the tip of the iceberg.” And as a followup, the Hindustan Times reported yesterday that most hospitals in the city — by extension, most Indian cities — don’t have the facilities to identify the TDR strain, making it more likely that unrecognized cases can go on to infect others.

Why this is bad news: TB is already one of the world’s worst killers, up there with malaria and HIV/AIDS, accounting for 9.4 million cases and 1.7 million deaths in 2009, according to the WHO. At the best of times, TB treatment is difficult, requiring at least 6 months of pill combinations that have unpleasant side effects and must be taken long after the patient begins to feel well.

Because of the mismatch between treatment and symptoms, people often don’t take their full course of drugs — and from that (and some other factors I’ll talk about in a minute) we get multi-drug resistant and extensively drug-resistant, MDR and XDR, TB. MDR is resistant to the first-choice drugs, requiring that patients instead be treated with a larger cocktail of “second-line” agents, which are less effective, have more side effects, and take much longer to effect a cure, sometimes 2 years or more. XDR is resistant to the three first-line drugs and several of the nine or so drugs usually recognized as being second choice.

As of last spring, according to the WHO, there were about 440,000 cases of MDR-TB per year, accounting for 150,000 deaths, and 25,000 cases of XDR. At the time, the WHO predicted there would be 2 million MDR or XDR cases in the word by 2012.

That was before TDR-TB.

The first cases, as it turns out, were not these Indian ones, but an equally under-reported cluster of 15 patients in Iran in 2009. They were embedded in a larger outbreak of 146 cases of MDR-TB, and what most worried the physicians who saw them was that the drug resistance was occurring in immigrants and cross-border migrants as well as Iranians: Half of the patients were Iranian, and the rest Afghan, Azerbaijani and Iraqi. The Iranian team raised the possibility at the time that rates of TDR were higher than they knew, especially in border areas where there would be little diagnostic capacity or even basic medical care.

The Indian cases disclosed before Christmas demonstrate what happens when TB patients don’t get good medical care. The letter to CID describes the course of four of the 12 patients; all four saw two to four doctors during their illness, and at least three got multiple, partial courses of the wrong antibiotics. The authors say this is not unusual:

The vast majority of these unfortunate patients seek care from private physicians in a desperate attempt to find a cure for their tuberculosis. This sector of private-sector physicians in India is among the largest in the world and these physicians are unregulated both in terms of prescribing practice and qualifications. A study that we conducted in Mumbai showed that only 5 of 106 private practitioners practicing in a crowded area called Dharavi could prescribe a correct prescription for a hypothetical patient with MDR tuberculosis. The majority of prescriptions were inappropriate and would only have served to further amplify resistance, converting MDR tuberculosis to XDR tuberculosis and TDR tuberculosis.

As their comment suggests, the other TB challenge is diagnosis, especially of resistant strains, and here again the news is not good. The WHO said last spring that only two-thirds of countries with resistant TB epidemics have the lab capacity to detect the resistant strains. As a result, only one MDR patient out of every 10 even gets into treatment, and when they do, cure rates range from 82 percent down to 25 percent. That’s for MDR. None of the TDR patients have been recorded cured, and at least one of the known Indian patients has died.

Meanwhile, health authorities estimate that one patient with active TB can infect up to 15 others. And thus resistant TB spreads: XDR-TB was first identified just in 2006, and it has since been found in 69 countries around the world.

Cite: Zarir F et al. Totally Drug-Resistant Tuberculosis in India. Clin Infect Dis. advance access Dec. 21, 2011. doi: 10.1093/cid/cir889.

This is really not a good thing for India's healthcare system, if not the whole world's. Antibiotic resistance is increasing amongst many diseases throughout the developed and undeveloped world, caused by a combination of poor treatment practices and the simple nature of many bacteria species' ability to rebound and adapt after unsuccessful treatments. In my mind, this is one of the greatest public health challenges of the 21st century, and one that goes terribly unnoticed by the general populace. We should be doing much more to help countries like India in helping to establish modern and efficient healthcare systems, because ultimately the consequences of their system's failures will not stay within their borders for long, in this globalized day and age.

On that note, what say you, NSG? Should we do more about the emerging phenomena of antibiotic resistance? Should we, as in the industrialized Western nations, do more to assist poor countries like India in combating infectious diseases like TB? And if not, what, if anything, should be done about the emergence of new and dangerous strains like TDR-TB?

[Gauthier]

This wasn't what was supposed to happen.

The experiment would have quickly destroyed Pakistan, ending that miserable country swiftly and without resorting to nuclear weapons. It would have been contained to only that area, and we would have done the whole world a favor. After immunizing ourselves, we would have promptly threatened the world with our biological superweapon, and showed those bloody Yanks not to yell at us over the phone again...

But things got out of hand.

I received news from one of the lead scientists that they were missing a vial.

Indian Bureaucrats had taken one, and sold it to God knows who or what.

But then we found the first cases, in Iran. Then they came back home to India.

We attacked the virus within our borders, but found that it was adapting quickly. The virus was sentient, quickly multiplying, growing stronger, simply absorbing whatever we threw at it.

It spread out of India. It went to Bangladesh, Pakistan, Nepal, China, USA, UK....

A million dead in the first day. Twenty million dead in the first week. A billion dead within a year.

Then the dead began to return. The corpses simply stood back up as they rotted, and began attacking again, laying siege to Amritsar, which has become a refugee center for the uninfected and the few immune.

It's up to us to hold the line now. And now we will fight. We will repent for our sins, our mistakes...we will destroy the

INFECTION.
(Coming to theaters and IMAX whenever the fuck we feel like. We have the unkillable TB, you gonna question us?)

Yes, yes, that's all well and good. But does it have awesome dancing?

Can zombies do anything besides Thriller?