Eliminate the TB scourge
Cape Town — IT’S 1 a.m. A young mother approaches me during my hospital shift. She asks if her 2-year-old son will survive the night. He has been given a diagnosis of severe tuberculous , months after her husband was found to have drug-resistant . We suspect the child acquired the infection from his father.
The mother was tormented by guilt and worried about her child’s future. The disease usually affects the lungs, but it can also strike the brain, kidneys and other parts of the body. How do I tell the mother that the fluid in her baby’s brain is terribly elevated and we need to drill holes into his skull to release the pressure? How do I tell her that, if he survives, he will probably have some brain damage and that the prospects that he’ll be able to lead an independent life are questionable?
For me, these moments are both a harsh reality and all too personal.
On Feb. 22, 2011, I was declared cured of a severe form of drug-resistant TB, which I contracted during my medical internship. It took three years, one week and one day for me to be released from the shackles of 23 tablets a day with additional intravenous medications.
I saw the fearful looks in my family’s eyes, wondering if I would make it through many a night. The fear was indistinguishable from what I see in the families of TB patients I treat today. Doctors and nurses resuscitated my ailing body, afflicted by almost every side effect known from the toxic drugs used to combat TB: Diffusely bleeding skin lesions. Liver inflammation. Severe limb pain and near immobility. . and thoughts of suicide.
Since being cured, I have been forever changed. Odd as it may sound, I refer to TB as my greatest mentor in my work as a clinician and researcher against this scourge. But as I don my stethoscope each day, I also worry that this disease, caused by bacteria that can be spread through the air, will revisit my body.
Ninety-five years ago, Benjamin Weill-Hallé and Raymond Turpin administered the first live-attenuated TB vaccine to a human at the Charité hospital in Paris. This Bacille Calmette-Guérin vaccine is still the standard of preventive care, yet it has unpredictable results and gives only some protection to young children against the most severe forms of the disease. And yet, in the past century, no one has figured out how to make a better vaccine.
In terms of curing the disease, in the 1940s the microbiologist Selman Waksman, working with a graduate student, Albert Schatz, at Rutgers University, helped begin the anti-TB drug revolution. Waksman received a for the discovery of streptomycin, the first effective in treating TB. Some 70 years after the discovery, most advances in TB medicine still come from recycling drugs developed in Waksman’s era that can damage the body as they attack the TB bacteria.
Today we have an ineffective TB vaccine, insufficient diagnostic tools, TB drugs with pernicious side effects, a growing problem of bacterial resistance to current treatments, and an inexplicable lack of urgency, even though one-third of the planet’s population is infected by TB, according to the Centers for Disease Control and Prevention. Some 9.6 million people worldwide became ill with the disease in 2014, and 1.5 million people died. Where is the reflection of this reality in research priorities and overlying policies?
Since the era of Hippocrates, “consumption” has plagued the human race, taking an estimated one billion lives. But only two new drugs have been approved for treatment of multidrug-resistant TB in more than 40 years.
This is in sharp contrast to other devastating diseases. The recent Ebola outbreak in West Africa, for example, prompted a swift response. Doctors fighting Ebola now have vaccine candidates, emergency research funding and the attention of policy makers. But TB control and prevention have not been embraced in this way despite the disease’s extraordinary global impact and cost.
For this reason, I was heartened last December by the release of the Obama administration’s plan to develop a comprehensive strategy to combat multidrug-resistant TB. The world urgently needs President Obama’s leadership on this. But his global health budget request for the coming year would cut TB aid funding by 19 percent.
TB nearly killed me. I understand the stakes from all sides of the issue. Talk is cheap. Drug-resistant TB can and must be confronted — but researchers and health care experts need the money to develop new vaccines and drugs.
As air fills my now-scarred lungs, I remain hopeful for the day when TB will be a disease of the past. With a global commitment, we can make that happen.
Source: The New York Times
