New Strain of Tuberculosis Resistant to Most Available Drugs

MOSCOW — A virulent strain of tuberculosis resistant to most available drugs is surfacing around the world. Concerns of a pandemic that could devastate efforts to contain TB and be fatal to people with immune-deficiency diseases such as HIV-AIDS.

Extensively drug-resistant TB, or XDR-TB, has been detected in 37 countries. It arises when the bacterium that causes TB mutates because antibiotics used to combat it are carelessly administered by poorly trained doctors or because patients don’t take their full course of medication. Rather than being killed by the drugs, the microbe builds up resistance.

At least 50 percent of those who contract this strain of TB die. The disease is transmitted through coughing, spitting or even speaking, so health officials have imposed sometimes extreme restrictions on infected people to prevent exposure to the public.

In the United States, 13,767 TB cases were recorded in 2006, the lowest rate of infection since reporting began in 1953. A retrospective analysis by the CDC found 49 cases of the new strain in the country since 1993.

Even in the antibiotics age, TB has remained a scourge in poorer countries and communities. Today, one in three people globally is estimated to be infected with dormant TB, according to the World Health Organization (WHO). Most will never get sick, but in one in 10 cases the bacterium becomes active when the host’s immune system is compromised. Worldwide, an estimated 1.7 million people die every year of the disease.

Two events last year alerted the medical community to a frightening new version of the disease. The Centers for Disease Control and Prevention, drawing on a survey of TB labs on six continents, reported that the prevalence of the super strain of TB increased from 3 percent of patients to 11 percent between 2000 and 2004. It reached 15 percent in South Korea and 19 percent in Latvia. There are no statistics yet about the new strain in Russia, China or Africa, areas with major TB populations .

The CDC survey was followed by a report from Yale University researchers that the superbug had raged through a rural hospital in South Africa in 2005 and early 2006, killing 52 of 53 who contracted it, including six health care workers. The victims, apparently infected by airborne transmission of the virus, died on average just 16 days after diagnosis; most of them also had HIV.

Robert Daniels, a 27-year-old dual Russian-U.S. citizen, underwent months of treatment for TB in Russia, where he often led a homeless existence. After telling people he was feeling better, he flew from Moscow to New York on Jan. 14 last year, then on to Phoenix.

In fact, his disease had not disappeared. The microbe causing it had mutated, apparently helped by his failure to complete a drug regimen in Russia. Weeks after arriving in Phoenix, Daniels was again coughing, feeling weak and losing weight.

Doctors in Phoenix diagnosed his illness as the new resistant strain of TB. Daniels again failed to follow doctors’ orders, authorities say. So health officials got a court order, and he was locked up in the prison wing of a Phoenix hospital, where he has spent the past nine months in hermetically sealed isolation.

Patient attitudes and behavior are a serious problem. Daniels did not follow treatment properly and is a risk to the general public, but he doesn’t get it:

“It’s not right,” Daniels said in a telephone interview about his isolation. “I’m not a criminal.”