[Mb-civic] Drug-Resistant Cases Of TB in U.S. Increase - Washington Post

[William Swiggard]

Drug-Resistant Cases Of TB in U.S. Increase

By David Brown
The Washington Post
Friday, March 24, 2006; A10

The number of cases of multidrug-resistant tuberculosis is increasing in 
the United States, as is the fraction of those cases that is resistant 
to at least five antimicrobial drugs.

The Centers for Disease Control and Prevention reported that there were 
128 cases of multidrug-resistant TB in the United States in 2004, up 
from 113 the year before. This is the first increase in a decade.

In addition, the proportion of hard-to-treat cases that are "extensively 
drug resistant" rose from 3.9 percent in the 1993-1996 period to 4.5 
percent during 2001-2004.

"It is a modest increase, but it is a movement in the wrong direction," 
said Kenneth G. Castro, an assistant surgeon general and director of the 
tuberculosis program at the CDC, which released the data.

These findings appear to be driven by the growth of multidrug-resistant 
(MDR) TB overseas and in recent immigrants to the United States. .

Of the 2005 cases, 45 percent were in U.S.-born people, and the balance 
in foreign-born people. The most frequent native countries of the latter 
group were Mexico, the Philippines, Vietnam, India, and China.

Overall, tuberculosis continues to decline in this country. The 
per-capita rate of the lung infection last year was the lowest since the 
government began collecting data in 1953. There were slightly more than 
14,000 cases reported to health authorities, compared with about 24,000 
a decade earlier.

The incidence of TB has fallen steadily since 1993, when a seven-year 
rise of the disease finally got the attention of public health 
authorities who had considered it virtually eliminated.

That resurgence was marked by outbreaks of multidrug-resistant 
infections, particularly among prisoners. Castro said he and other 
officials hope the slight uptick in MDR cases now is not the harbinger 
of a new phase of growth in the ancient infection.

The report, timed for World TB Day today, also described the growth of 
"extensively drug-resistant" (XDR) TB, defined as microbes resistant to 
not only the two first-line drugs, but to three or more of the six 
classes of second-line drugs.

Laboratory studies from Latvia showed that 19 percent of drug-resistant 
cases fit the XDR definition, as did 15 percent of the drug-resistant 
cases in South Korea.

"Drug-resistant TB is growing, and that should worry us," said Marcos 
Espinal, a World Health Organization official who heads the Global 
Partnership to Stop TB.

On a telephone briefing organized by the anti-poverty activist 
organization, Results, he called for more money to fight the global TB 
epidemic, which is particularly severe in sub-Saharan Africa because of 
the disease's high incidence in people infected with the AIDS virus.

http://www.washingtonpost.com/wp-dyn/content/article/2006/03/23/AR2006032301522.html?nav=hcmodule
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