XDR-TB in South Africa : no time for denial or complacency.

Abstract

On September 1, 2006, the World Health Organisation (WHO) announced that a deadly new strain of extensively drug-resistant tuberculosis (XDR-TB) had been detected in Tugela Ferry (Figure 1), a rural town in the South African province of KwaZulu-Natal (KZN) [1], the epicentre of South Africa’s HIV/AIDS epidemic. Of the 544 patients studied in the area in 2005, 221 had multi-drug-resistant tuberculosis (MDR-TB), that is, Mycobacterium tuberculosis that is resistant to at least rifampicin and isoniazid. Of these 221 cases, 53 were identified as XDR-TB (see Table 1 and [2]), i.e., MDR-TB plus resistance to at least three of the six classes of second-line agents [3]. This reportedly represents almost one-sixth of all known XDR-TB cases reported worldwide [4]. Of the 53, 44 were tested for HIV and all were HIV infected. The median survival from the time of sputum specimen collection was 16 days for 52 of the 53 infected individuals, including six health workers and those reportedly taking antiretrovirals [2]. Such a fatality rate for XDR-TB, especially within such a relatively short period of time, is unprecedented anywhere in the world.