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A new but rare multi-drug resistant strain of tuberculosis is on the 

rise in the country, medical experts have revealed. The disease is 

highly contagious. The alarm bells were sounded over the weekend by 

10 Ugandan nurses, who have just completed a refresher course in 

Nairobi, Kenya, on how to handle patients with the 

multidrug-resistant chronic disease. The nurses said the most 

affected districts are Kampala, Gulu, Hoima, Soroti, Kabale, Mbarara, 

Mbale, and Arua.



At a press conference in Entebbe, the nurses under their umbrella 

organisation, the Uganda National Association for Nurses and 

Midwives, said medical reports suggest that the disease, currently on 

the increase in Uganda, has metamorphosed from the globally known TB 

-- an infectious disease that attacks the lungs, to a drug-resistant version.



Ms Janet Obuni, a nurse who led the team, said the disease is on the 

increase in Uganda because TB patients are misusing drug regimes 

meant to cure the lung illness, making them ineffective in treating 

the disease, "hence the emergence of multidrug-resistant tuberculosis 

(MDR-TB) which is becoming a serious global public health concern." 

"For this TB to be contained, the nurses need to be trained on how to 

handle it before it spreads," Ms Obuni said.



A nurse from Soroti Hospital, Ms Mary Asio, told reporters that she 

is currently handling 3 patients suffering from the disease, one of 

whom has failed to respond to TB treatment 4 times. "We have nothing 

to do now because he has received the treatment for 32 months yet it 

is supposed to be for 8 months," Ms Asio said, adding that doctors 

are now worried that the patient "may infect his family members." The 

nurses, however, provided no statistical data to back up their claims 

of the disease increase.



The WHO (World Health Organization) has described the 

multidrug-resistant TB when the TB bacteria are resistant to at least 

isoniazid and rifampicin, the 2 most powerful anti-TB drugs.



Dr Sam Zaramba, the director general of health services in the 

Ministry of Health confirmed the occurrence of the strain in a 

telephone interview. Without going into specifics he said a number of 

cases had been registered at "some treatment centres," adding that 

the government had responded by sending the team of nurses to Kenya 

for training on how to handle patients. The MDR-TB is much more 

difficult and costly to treat than drug susceptible TB, with a single 

patient requiring between USD 10 000-20 000, (UGX 17.6m-UGX 35.2m) 

according to medical reports from cases being handled in neighbouring Kenya.



Back home [in Kenya], TB drugs are given free to patients in all 

government hospitals, but patients reportedly fear to swallow them 

because they claim that they have side effects such as burns on the 

body. But patients can avoid the side effects of the drugs by feeding 

on a balanced diet, said Dr Clare Ojoru, the officer in charge of the 

TB ward at Mulago. She, however, added that "because there is laxity 

in patients to take their drugs, the multiresistant TB is on increase."



The nurses appealed to the government to provide them with protective 

gear so that "we don't acquire the disease", and called for a routine 

screening especially in schools around the country, to quickly 

identify any new cases. Early this year [2007], the WHO country 

office called for a declaration of TB as a national emergency in 

efforts to combat the disease.





--

Gustaf Rydevik, M.Sc.





our attention. Whether the strains that are causing tuberculosis 

unresponsive to medical therapy in Uganda are MDR (resistant to 

isoniazid and rifampin) or XDR (resistant to isoniazid, rifampin, 

fluoroquinolones, and at least one of the 3 injectable 

anti-tuberculosis drugs capreomycin, kanamycin, and amikacin) will 

depend on results of drug susceptibility testing. From the news 

releases, it is unknown if drug susceptibility testing has actually 

been performed in these cases.





"Drug susceptibility testing (DST) to the first-line antituberculosis 

drugs should be performed in specialized reference laboratories that 

participate in an ongoing, rigorous quality assurance program. DST 

for first-line drugs is currently recommended for all patients with a 

failed treatment, especially those who have failed a standardized 

retreatment regimen, and chronic cases are the highest 

priority...Patients who develop tuberculosis and are known to have 

been in close contact with persons known to have MDR tuberculosis 

also should have DST performed on an initial isolate. Although HIV 

infection has not been conclusively shown to be an independent risk 

factor for drug resistance, MDR tuberculosis outbreaks in HIV 

settings and high mortality rates in persons with MDR tuberculosis 

and HIV infection justify routine DST in all HIV-infected 

tuberculosis patients, resources permitting."



WHO estimates that of the 424 000 cases of MDR-TB that occur 

annually, 17 percent are actually XDR 

According to the WHO, however, "few national TB programmes have 

capacity for drug-susceptibility testing (DST) for the 1st-line drugs 

and even fewer have the capacity to test for 2nd-line drug resistance."



Other issues raised by the news release are the availability of fully 

potent 2nd-line drugs, availability of personal protective equipment 

(such as, disposable class N95 face masks) for healthcare 

professionals, as well as knowledge about tuberculosis and actual 

practice of optimal patient care of tuberculosis patients among 

healthcare professionals in developing countries. In regard to the 

last issue, a recent study documented inadequate knowledge and 

practice concerning tuberculosis among recent Pakistani medical 



[Information on actual sensitivity testing on the drug resistant 

cases mentioned in the above newswire would be greatly appreciated. - Mod.MPP]



Tuberculosis, XDR - worldwide (02) 20070623.2034

Tuberculosis, XDR, airplane exposure - multicountry (03) 20070601.1778

Tuberculosis, XDR, airplane exposure - multicountry (USA, France, 

Canada, Czech Rep.) 20070529.1738

Tuberculosis, XDR, 2003-2006 - Europe (Germany, Italy) 20070403.1132

Tuberculosis, XDR, 1993-2006 - USA 20070322.1005

Tuberculosis, XDR - South Africa (06) 20070319.0959

Tuberculosis, XDR, 1991-2003 - Spain 20070302.0738

Tuberculosis, XDR - South Africa (05) 20070228.0717

Tuberculosis, XDR - South Africa (04) 20070220.0638

Tuberculosis, XDR - South Africa (03) 20070209.0504

Tuberculosis, XDR - worldwide 20070205.0456

Tuberculosis, XDR - South Africa (02) 20070128.0375

...................................ml/mj/mpp