the tuberculosis epidemic is gaining ground

A consultation in a hospital in Uzbekistan.
A consultation in a hospital in Uzbekistan. Photo credits: Imke LASS / REDUX-REA
Of the 9 million new cases each year, 400000 resistant to many antibiotics and some to treatment.

Are we on the brink of a global epidemic of tuberculosis known as "XDR" due to a mycobacterium that is resistant to all known TB? The World Health Organization (WHO) estimates that there are now 9 million new cases of tuberculosis every year proved, and among these cases are multidrug approximately 400000. In other words, TB infects who can not be destroyed by the usual TB (isoniazid and rifampicin) that make up the treatment of "front lines".

Worse: experts from WHO are now convinced that nearly 27000 patients are victims each year from infection with a tubercle bacillus "trim" naturally invincible by all known antibiotics TB. And this is only an approximation, since many African countries had no means to collect such statistics!

A study commissioned by the WHO and released this week reinforces this fear: an analysis of 90000 new cases in 81 countries selected and monitored between 2002 and 2006 confirms, if necessary, all projections epidemiologists. The resistance rates reached records in Russia, Central Asia and Eastern Europe: to Baku, the capital of Azerbaijan, 22.3% of cases are resistant to standard therapy. In Moldova, it is 19% of the subjects which contain a sick bacillus resistant, and in several regions of Ukraine and Russia rates exceed 15%. But in the last survey in 2000, the world record was held by Kazakhstan with 14%: it is widely beaten today. It must not be forgotten in this grim Mongolia winners of the Interior and the region of Heilongjiang, China, with resistance lowest (7.5%), but very real.

"Fire Storm"

While a normal treatment lasts only six to eight months for a bacillus sensitive, it may be extended to two years in the event of resistance. Costs soar, according to the journal Science, between 3 and 100 times the normal price. But funding is inadequate to stem this trend: of the $ 4.8 billion deemed necessary by WHO, it lacks 2.5 billion. 27000 ultra cases are present in 45 of 81 countries surveyed, and would represent the tip of the iceberg of an iceberg.

Gerald Friedland, from Yale University, believes that the two epidemics of AIDS and tuberculosis can create a "fire storm" in South Africa. That threat was announced for some time: in August 2006 (see box), researchers announced the first epidemic of drug-resistant tuberculosis had reached the community of Zulu Tugela Ferry, South Africa (in KwaZulu-Natal). It has affected 217 people with a mortality rate of 84%, and since then, the bacterial strain has infected the nine South African provinces. And molecular biologists have taken thousands of samples frozen samples of diseased Oldest: DNA showed that the resistant strain was present as early as 2001 in Natal and 9% of cases classified as resistant were in fact already resistant to all antibiotics !