Earliest Drug-Resistant Tuberculosis Strains Were First Detected in Italy

drug-resistant-tb-tdr-slide

Contrary to what was previously believed, the earliest cases of the Totally Drug-Resistant Tuberculosis (TDR-TB) were not the current 12 known cases reported in Mumbai or the 15 cases in Iran from 2009, but rather two middle-aged women from Italy, who died several years after first contracting the disease.

The patients were younger than 50, born in Italy and from middle class families. They had no great risk from TB infection. They were both treated at the E.Morelli Hospital, which is a giant TB sanatorium in Sondalo, in the north of Milan. They were diagnosed by local doctors, and treated repeatedly with the normal TB drugs, until someone realized that something strange was going on. The TB infection had eaten away part of their lungs, leaving empty dead zones.

infected-lung-dead-zonesThe first woman caught a multi-drug resistant TB from her mother and passed it on to her 14-year old daughter, who isn’t the second woman in this case. The daughter was eventually cured, but her mother was treated at three different hospitals with 17 different antibiotics for 422 days and took TB drugs for 94 months before it killed her in 2003.

The other woman’s treatment took 625 days and also involved 17 different drugs. She had been on a drug regimen for 60 months before dying. Both women died in 2003, but one had been under treatment for 5 years while the other had been in treatment for 8. In both cases, the drug susceptibility tests show that the resistance to new drugs was acquired over time. The first case was mismanaged, and then the patient was admitted to a reference hospital when the TB was already resistant to most of the available drugs. In the second, management and adherence to the prescribed regimen wasn’t optimal prior to the admission to the E.Morelli hospital.

Maryn McKenna states that there might be something molecular going on in these epidemic strains of TB which makes them more likely to become drug-resistant, the paper emphasizes that blame should rest on poor health and bad antibiotic use.

[via Wired Superbug, images via PHIL CDC and Granuloma]

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