Posted by: Dr Pano Kroko | December 12, 2013

Natural Enemies – Tuberculosis in Europe – Again

Bird Flu for Christmas ?

What about TB ?

Early last week, the city of Hong Kong confirmed its first case of H7N9, the newest form of avian influenza that first emerged in February this year.

So far, the World Health Organization (WHO) has confirmed 137 infections and 45 deaths (a concerning 33% mortality rate) and has described the new strain as “unusually dangerous” and “one of the most lethal” viruses they have faced in recent years.

The good news is that the majority of these cases occurred in the months of March and April and the rate of infection has remained fairly low since then.

The bad news is that the first evidence of human-to-human transmission was documented in August. In other words, the virus has mutated one step closer to a potential pandemic.

Fortunately, we’ve yet to see a highly contagious version of the virus, and Asia has done an excellent job containing it so far. Hong Kong officials were able to isolate the latest incident by tracking down and clearing 17 people who came in contact with the infected patient.

Genetic mutations are primarily random so the chances of increased transmission are low. While anything is possible, the most likely scenario is that a vaccine will be created before H7N9 is able to have a significant impact on the human population.

It’s natural to be worried, but the truth is that fears of worldwide epidemic are highly overblown. Mainstream media likes to jump on the issue because it’s exciting enough to grab your attention, but there’s no need to duct tape your doors and start walking around with a surgical mask just yet.

Now pandemics are nothing to take lightly — the bubonic plague wiped out as much as 60% of Europe’s population in the 14th century. However, people had no knowledge of contagious disease at the time and this was the primary reason it was able to spread so rapidly.

Today we have a highly educated population and organizations following strict procedures to shut down almost any potential medical threat. Human knowledge is a far greater weapon than natural mutations, and we can feel relatively safe from natural pandemics as a result.

Unfortunately this doesn’t mean viruses aren’t a greater threat today than they were 600 years ago.  In fact, it can be argued that viruses are a greater threat now than ever before…

Because the tables have turned and while human medical knowledge and innovation have long been our greatest weapons against contagious diseases, those weapons could soon be turned against ourselves.

In January 2012, research on H5N1, another deadly form of avian flu, was halted in response to public outrage. A group of researchers were able to successfully create a more contagious version of the virus between mammals, causing obvious reason for concern.

After 5 months of evaluation, WHO released a statement warning that “…any unintended release of the modified H5N1 viruses for laboratories conducting such research would have the potential for serious global consequences.”

The organization went on to say that even the release of the information in these studies alone was a threat to biosafety and biosecurity.

After a year of moratorium and in the face of strict opposition from leading minds in the medical community these researchers have once again begun to work on increasing the contagiousness of the H5N1 virus.

Now the intentions of these scientists are not malicious — they simply want to know more about the disease. However, the implications are incredibly threatening to the global community regardless.

While it wasn’t stated by WHO directly, it’s clear through their response that these results could potentially be replicated by anyone with foul intentions if they were to gain access to the research materials.

Now consider another illness:

TB2

Am talking about Tuberculosis.

Now with TB things are a lot worse too:

Tuberculosis (TB) is an infectious disease that is caused by a bacterium called Mycobacterium tuberculosis.

TB primarily affects the lungs, but it can also affect organs in the central nervous system, lymphatic system, and circulatory system among others

Increasing resistance to tuberculosis drugs around the world is a “ticking time bomb”, says the World Health Organization (WHO).

It estimates almost 500,000 people around the world have a type of TB which is resistant to at least two of the main types of drugs used to treat the disease.

But most are not diagnosed and are walking around spreading these more deadly strains.

More than half the cases are in China, Russia and India with Africa as always leading the way. Yet now countries which previously had reported eradicating this disease — are now experiencing a serious flare up. Take Greece for example that now has more new Tuberculosis cases than at any time since the onset of the second world war and the devastating Axis powers occupation that denied access to proper nutrition because the grains and foodstuff production of the country was taken by the German Army [Wermacht] and this resulted in a wide spread famine. And now Greece is again at the epicentre of a new TB epidemic. The worse to be seen in Europe in many decades. Ad this is because of the population’s malnutrition, resulting from the Austerity Economic Policies enforced upon the citizens as if living under another form of occupation of the country…

Unfortunately the WHO says that the overall number of people developing the disease is falling, although 8.6 million people were diagnosed with TB last year, and more than a million people died from the disease. Now thousands are set to die in SE Europe and in Greece in particular because of denial towards the existence of the illness.

And to add insult to injury — what is known as an extensively drug-resistant form of TB (XDR-TB) is now spreading also in the disadvantaged areas of Athens Greece and other economically blighted places hard hit by the Sovereign debt crisis and the cut down of Social and health services due to austerity.

The giant problem with TB (XDR-TB) is that it is not responding to most of the main drugs used to treat the disease. And is worth knowing that acute pneumonic TuBerculosis, resistant to antibiotics,  has a rather concerning 57% mortality rate — once it gets lodged in the lungs. that means that One out of every Two people infected with this strain of acute pneumonic TB of the lungs, are quickly lost to the epidemic.

Analysis of lobar pneumonic tuberculosis: To heighten the awareness of lobar pneumonic tuberculosis, or tuberculous pneumonia or acute pneumonic tuberculosis.
Symptoms: All the patients with acute onsets have a continuous high fever, and their WBC was not found higher than 10 x 10(9)/L. All of the patients’ chest radiographs showed a consolidation in one or two lobars, and in 30% of the patients pleural effusions were found. Significant roent genographic changes could occur in short duration. All the patients were not sensitive to common antibiotics, and the shadow could enlarge in short time. Exudative foci could be absorbed shortly after antituberculosis chemotherapy, and no cavitation was found. An early transbroncho-lung biopsy (TBLB) and (or) brushing smear may be advantageous to early diagnosis and treatment of this illness.

Dr Ruth McNerny of TB Alert had this to say: ”We’re just silently watching this epidemic unfold and spread before our eyes”

Many innocent children and older adults have caught the disease and  died from TB in the last few years in Greece whose Ministry of Health denies the existence of the disease in Greece in a show of silly Ostrich mentality.

People fed well and living  in healthy ways are being fairly resistant to the virus. But Greece now is undergoing it’s worst economic malaise since the great depression of 1929…

And above all else — TB is an economic disease.

Greece in may of 2013 was taken out of the context of the European Union and Eurozone economies and was reclassified with a far lower status fitting it’s reduced circumstances — as an Emerging Economy, albeit with a contracting and shrinking economy…

Welcome to Athens, Africa in 2013, in Greece. In essence the current Governments have physically moved Greece to Africa without shifting the geographic and tectonic plates. An amazing feat of magic was performed in front of our very own eyes.

Athenian Tuberculosis is now taking it’s toll on the most vulnerable population, because many weakened and infected individuals and especially children, have died because the two main drugs used to treat the condition are increasingly useless in fighting this most virulent bacterial infection.

I always will remember one of two beautiful twin sisters — the one who died from the disease and the lament of the other one who survived.

She was just six years old and represents fully what wrong with the Health System of Greece today and in my mind should be the public face of the TB epidemic and an inspiration for those who fight against it.

We all know that Tuberculosis is an airborne disease. It’s very contagious and can spread from person to person by breathing in an infected person’s germs.

The cramped and crowded living and working conditions in the centre of Athens, the public transport network, the public markets, the subway systems, and close quarters, create the perfect environment for the fast spread of airborne TB and other similar diseases.

People are living closely and there’s not much food or heat or hygienic conditions for the refugees and the economically disadvantaged.And thus they all get sick together…

And there is nobody to turn to except for our small NGO screening and administering drugs to the often times disillusioned people. And even when we reach the people on time — we still have to fight an uphill battle because of lack of trust on the antibiotics available.

And as it often happens — many times the infected individuals aren’t given or aren’t taking, the full course of antibiotic treatment when they first develop TB, and that makes their infection resistant to the two main types of TB drugs.

No one in Athens has been able to get the right drugs from government schemes, because the government denies the existence of the disease afraid of hurting it’s vaunted Tourism industry and if they identify an illegal alien with TB — they simply ship them with Express Priority, back to their home country. Of course this makes our work harder because the people are scared to even come for screening….

The rampant misuse of antibiotics is another cause of the drug failure and the further development of the bacteria infected patients towards resistance.

Avoidance is another root cause of failure because the total treatment against TB includes painful injections every day and lasts around two years.

Still even if you follow up the strict regime — once TB2 hits the lungs, people have a fifty fifty chance of survival at best.

Add to it that this enhanced antibiotic treatment costs upwards of $10,000 per patient in the space of the two years.

Whereas the standard TB treatment costs around $50.

Drug-resistant TB or otherwise known as Multidrug-resistant TB (MDR TB) is caused by an organism that is resistant to at least isoniazid and rifampin, the two most potent TB drugs.  Extensively drug resistant TB (XDR TB) is a rare type of MDR TB that is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs, such as amikacin, kanamycin, or capreomycin.

There are several drugs used to treat TB, but when two of the primary drugs that are essential to treating TB – rifampicin and isoniazid – are no longer killing the TB bacteria, then the patient has drug-resistant TB.

The WHO says out of the estimated 2,000 drug-resistant cases in Greece, in 2012, only 700 were diagnosed. Our concern at People’s Health International – our NGO –  is this simple question: What will happen if progressively multi-drug resistant TB takes over from normal tuberculosis in the Greek Society ?

The World Health Organization has no answers.

The Greek Government doesn’t even bother to ask the questions… cause they prefer to not know. Plausible deniability and all such…

Am sure You understand.

We have a huge dilemma here and a giant fail:

Our small NGO People’s Health International teams, are the only ones in Greece that have intimate working knowledge of the disease. And although we’ve been working against this difficult illness for almost 3 years now — we have a great need of help.

Our work is both mountainous & monumental, and still we find new obstacles every day…

For example: There are absolutely NO doctors in Greek hospitals who are properly medically qualified for TB treatment, and yet they are attempting at treating drug-resistant TB in a haphazard fashion.

They clearly don’t have the knowledge to treat the condition, yet they prescribe a cocktail of drugs — usually causing the adverse effect: Resistance to antibiotics.

Some undiagnosed patients are even going to pharmacies without prescription and buying drugs over the counter. So we are seeing a rampant misuse of antibiotics. And in Greece self medicating is the norm with pharmacies in every corner — and you get the result of an epidemic of major proportions in the making.

World Health Organization TB programme, describes the situation as a public health crisis.

What could happen is progressively multi-drug resistant TB takes over from normal tuberculosis ?

If this happens not only would millions of patients potentially die of this form of TB, but if I look at it from an economic perspective the cost of dealing with millions of potential cases is enormous…

The fact that 80% of multi-drug resistant TB cases around the world are not being treated is a “ticking time bomb”.

TB is Killing you slowly.

Dr Ruth Mcnerny, senior lecturer at the London School of Medicine, who works with TB charity TB Alert, says: “We’re just silently watching this epidemic unfold and spread before our eyes.
TB treatment in developing and emerging economy countries is haphazard, because normal TB treatment takes at least six months to treat and costs around $50. Whereas multidrug-resistant TB treatment can take at least two years and costs around $2,500.  Extensively drug-resistant TB can cost many thousands of dollars to treat. Estimated 450,000 cases globally. TB is very clever because it kills you very slowly. And while it’s killing you very slowly you’re walking around spreading it.

The issue of TB is if you get someone on treatment, they’ll become non-infectious quite quickly.

But if the treatment’s not working because it is a drug-resistant strain, then they stay infected and they stay spreading drug-resistant TB.

The treatment for drug-resistant TB is very, very difficult and at some stage it becomes impossible.

Our NGO People’s Health International [ PHI-NGO ] is taking every step so that every TB affected person we can find in Athens Greece, gets the proper treatment as soon as possible.

Yet we need serious help from a major Health Organization like WHO because Greece is in an advanced state of the Tuberculosis Crisis.

And we need to educate the Public in order to be able to react:  Early diagnosis is the key. However to self diagnose is impossible and when you have symptoms now with the onset of winter in Greece it’s good to seek a proper lung Xray screening because the basic Mantoux skin test is now completely unreliable. The Mantoux tuberculin skin test (TST) or the TB blood test can be used to test for M. tuberculosis infection, yet additional tests are required to confirm TB disease.

Here are the basic Tuberculosis symptoms:

  • A persistent cough, usually for more than three weeks
  • Night sweats for weeks or months
  • Weight loss
  • Fatigue
  • High temperature
  • Shortness of breath

The work of PHI-NGO is to also see that the disease doesn’t spread. We are trying to make people aware about the precautions and treatment, so that the patients get the treatment and TB managed and under control in Greece soon, because many thousands of people are under imminent threat from the high risk of catching this particularly deadly form of TB.

Diagnosis of Tuberculosis Disease: When Should You Suspect Tuberculosis ?

TB is a disease caused by Mycobacterium tuberculosis. TB disease should be suspected in persons who have the following symptoms:

  • Unexplained weight loss
  • Loss of appetite
  • Night sweats
  • Fever
  • Fatigue

If TB disease is in the lungs (pulmonary), symptoms may include:

  • Coughing for 3 weeks
  • Hemoptysis (coughing up blood)
  • Chest pain

If TB disease is in other parts of the body (extrapulmonary), symptoms will depend on the area affected.

How Do You Evaluate Persons Suspected of Having TB Disease?

A complete medical evaluation for TB includes the following:

1. Medical History

Clinicians should ask about the patient’s history of TB exposure, infection, or disease. It is also important to consider demographic factors (e.g., country of origin, age, ethnic or racial group, occupation) that may increase the patient’s risk for exposure to TB or to drug-resistant TB. Also, clinicians should determine whether the patient has medical conditions, especially HIV infection, that increase the risk of latent TB infection progressing to TB disease.

2. Physical Examination

A physical exam can provide valuable information about the patient’s overall condition and other factors that may affect how TB is treated, such as HIV infection or other illnesses.

3. Test for TB Infection

The Mantoux tuberculin skin test (TST) or the TB blood test can be used to test for M. tuberculosis infection. Additional tests are required to confirm TB disease. The Mantoux tuberculin skin test is performed by injecting a small amount of fluid called tuberculin into the skin in the lower part of the arm. The test is read within 48 to 72 hours by a trained health care worker, who looks for a reaction (induration) on the arm.

The TB blood test measures the patient’s immune system reaction to M. tuberculosis.

4. Chest Radiograph

A posterior-anterior chest radiograph is used to detect chest abnormalities. Lesions may appear anywhere in the lungs and may differ in size, shape, density, and cavitation. These abnormalities may suggest TB, but cannot be used to definitively diagnose TB. However, a chest radiograph may be used to rule out the possibility of pulmonary TB in a person who has had a positive reaction to a TST or TB blood test and no symptoms of disease.

5. Diagnostic Microbiology

The presence of acid-fast-bacilli (AFB) on a sputum smear or other specimen often indicates TB disease. Acid-fast microscopy is easy and quick, but it does not confirm a diagnosis of TB because some acid-fast-bacilli are not M. tuberculosis. Therefore, a culture is done on all initial samples to confirm the diagnosis. (However, a positive culture is not always necessary to begin or continue treatment for TB.) A positive culture for M. tuberculosis confirms the diagnosis of TB disease. Culture examinations should be completed on all specimens, regardless of AFB smear results. Laboratories should report positive results on smears and cultures within 24 hours by telephone or fax to the primary health care provider and to the state or local TB control program, as required by law.

6. Drug Resistance

For all patients, the initial M. tuberculosis isolate should be tested for drug resistance. It is crucial to identify drug resistance as early as possible to ensure effective treatment. Drug susceptibility patterns should be repeated for patients who do not respond adequately to treatment or who have positive culture results despite 3 months of therapy. Susceptibility results from laboratories should be promptly reported to the primary health care provider and the state or local TB control program.

I just hope this writing serves as an educational primer for the TB practitioners, Doctors and lay people alike to be able to serve and protect one’s patients, family and self from this deadliest of hosts.

Hope this Winter there is not particularly harsh and that an epidemic TB outbreak in Athens doesn’t happen…

Yet I work devoutly and pray stoutly each and every day for that salvation…

But we all know that we need to do much much more…

Yours,

Pano

PS:

Visited today with someone high up from the Greek Ministry of Health  and had these dark thoughts to share because I saw their level of insouciance about Ethics and how they don’t care to do the right thing because all they wanted was to hush things up. I was mad, alarmed, and naturally became really concerned…

Contagion and epidemic proportions TB outbreak isn’t a science fiction scenario anymore. In Greece today where two thirds of the people live under diminished and weakened nutritional conditions, the threat is very real and especially now that the weather has turned really cold.

What we see happening with viral and bacterial evolutionary adaptation & modification along with antibiotic resistance today is a dangerously similar scenario to that of an atomic bomb ticking in our midst…

Mr Prime Minister — Take Heed


Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Categories

Follow

Get every new post delivered to your Inbox.

Join 3,250 other followers

%d bloggers like this: