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Monday, 26 April 2010


Saturday, 24 April 2010


Operations will be halted in the coming months at the Chao Center for Industrial Pharmacy and Contract Manufacturing at the Purdue Research Park in West Lafayette.
The facility has not become self-sustaining during its five years of operation, according to Joseph Hornett, senior vice president, treasurer and chief operating officer of the Purdue Research Foundation, which owns and manages the research park.
The Chao Center is a pharmaceutical manufacturing facility that produces and distributes legacy and small-volume drugs.
The facility will continue manufacturing and distributing the multidrug-resistant tuberculosis drug Seromycin and other life-saving legacy drugs until new manufacturers are found.

AIDS funding

A few weeks ago, the Boston Globe published an article on the U.S. government’s decision to flatline AIDS funding in countries that are currently receiving money through the President’s Emergency Plan for AIDS Relief (PEPFAR). This flagship program has put 2.4 million people on treatment, restoring life and hope for millions.
Globally, more than four million people are currently receiving treatment, with support of PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNITAID, national governments, and other donors. But there are at least six million people who need treatment now, who are still unable to get it.
Instead of scaling up, now the Obama Administration is saying enough is enough. It is telling the health providers that it funds that they can only put new people on AIDS treatment if some of the people they are already treating die.
The Boston Globe article quotes Eric Goosby, the U.S. Global AIDS Coordinator, as saying “People are struggling to find resources to honor the commitments we have made… We’re not at a cap point yet. If it gets worse, we’ll have another discussion.”

Contagious diseases of air passengers not reported

Hundreds of people at major U.S. airports each year are severely ill with symptoms of potentially contagious diseases, yet few are reported to health officials as intended under U.S. regulations and international guidelines, a USA TODAY review of ambulance records and federal data shows.
To detect diseases such as pandemic flu, tuberculosis and measles, federal regulations require airlines to notify health officials of passenger illnesses involving diarrhea or fever plus rash, swollen glands or jaundice. The International Civil Aviation Organization, a United Nations agency, also includes persistent vomiting or coughing in its guidelines.
Concerns about fliers spreading dangerous diseases have been fueled by the 2003 SARS outbreak, high-profile tuberculosis patients and the H1N1 flu pandemic.

Canada: First Nations tbc statistics obscured

Federal MPs on the House of Commons health committee got an earful Tuesday morning from an army of First Nations chiefs, doctors and public health experts who said Ottawa's plan to combat TB is failing First Nations people.
Data on outbreaks and infection rates are spotty and kept secret under the guise of patient confidentiality. Jurisdictional squabbles between the federal and provincial governments stymie treatment and prevention programs on reserves. A nearly 20-year-old national plan to combat the disease is only slowly being reviewed. There are no national standards on monitoring and controlling TB and it's tricky to do simple things like fly in a mobile X-ray unit to help confirm a diagnosis in a remote community.
Kimberley Barker, a doctor and adviser to the Assembly of First Nations, said Ottawa has so little control over its regional operations that there's little accountability on TB spending.
That bleak assessment follows a Winnipeg Free Press investigation that found some Manitoba communities have recorded some of the highest TB rates in the world since the 1970s.
Places like Lac Brochet have recorded 636 cases per 100,000 people, a fact Chief Joseph Dantouze reminded the Commons health committee of Tuesday.Read more:

Florida: Eleven tbc cases in Tampa High School

TAMPA - Five months after one confirmed case of tuberculosis turned up at Plant City High School, health officials have discovered 11 new cases and are testing for more.
The Hillsborough
County Health Department tested 23 people Tuesday at the school, district spokeswoman Linda Cobbe said.
"Nobody had any symptoms," she said, but they may have had prolonged contact with others who tested positive.

Tuesday, 20 April 2010

The problems posed by HIV co-morbidity

The human immunodeficiency virus (HIV) epidemic has led to an increase in the incidence of tuberculosis globally, particularly in sub-Saharan Africa. Coinfection with HIV leads to difficulties in both the diagnosis and treatment of tuberculosis. Because of the poor performance of sputum smear microscopy in HIV-infected patients, more sensitive tests-such as liquid culture systems, nucleic acid amplification assays, and detection of mycobacterial products in various body fluids-are being investigated. The treatment of coinfected patients requires antituberculosis and antiretroviral drugs to be administered concomitantly; challenges include pill burden and patient compliance, drug interactions, overlapping toxic effects, and immune reconstitution syndrome. Both multidrug-resistant and extensively drug-resistant tuberculosis can spread rapidly among an immunocompromised population, with resulting high mortality rates. Current guidelines recommend starting antiretroviral treatment within a few weeks of antituberculosis therapy for patients with CD4 cell counts <350>

Fluoroquinolones as first line therapy

Fluoroquinolone antibiotics are relatively new drugs in anti-tuberculosis (TB) treatment, with the potential to become the first new class of drugs to be recommended for routine treatment since rifamycins in the 1960s. Later generation fluoroquinolones, including levofloxacin, gatifloxacin, and moxifloxacin have been found to be safe and well-tolerated in observational studies and phase 2 clinical trials, except for a risk of severe dysglycemias with gatifloxacin. These drugs currently are used as second-line agents in treatment of TB cases with drug resistance and drug intolerance, and empirically in treatment of infected contacts of patients with multi-drug resistant TB. Widespread use of fluoroquinolones for treatment of community acquired pneumonia and other bacterial infections is leading to the emergence and spread of strains of Mycobacterium tuberculosis that are fluoroquinolone-resistant, putting at risk the potential effectiveness of these drugs against TB. Clinical trials are under way to determine whether fluoroquinolone-based treatment regimens can shorten the duration of TB therapy. The ultimate contributions of fluoroquinolones to TB control remain to be determined.

Importance of Microscopy

Smear examination for the detection of Acid fast bacilli continues to be the gold standard in Diagnosis of Tuberculosis. In spite of several inadequacies, Microscopy for AFB detection is economical, specific and the man power can be trained easily. The detection of AFB in sputum smears helps for higher case detection, and contains the spread of Tuberculosis in the Society.
The smear will become Postive when one has bacilli more than 5,000 – 10, 000 / 1 ml of sputum. Multiple smear examinations, at least three morning specimens are advised and appropriate collection of specimens will increase yield to > 43 %. If efforts were taken in educating patients for 1- 2 minutes in methods to collect the sputum, will yield higher results. Sputum induction procedures are helpful. Today’s emphasis to identify AFB, in smears is more demanding with associated HIV/AIDS, as few bacilli are excreted. Concentration of specimens and digestion of thick and mucous associate specimens with Sodium hypochlorite, Sodium hydroxide, N-acetyl –cystine – Sodium hydroxide will increase rate of detection to > 18 % in sensitivity and incremental yield of 9 %( positve after treatment with above chemicals – positives with direct Ziehl Nelson’s straining ) Sodium hypochlorite is beneficial in HIV positive patients as it is Mycobactericidal and also kills human Immunodeficiency virus, but not suitable for culturing specimens.
Need for Florescent Microscopy
The developing world should explore the Fluorescence microscopy, which will improve the sensitivity of Microscopy in patient who excrete few bacilli as in association HIV infection, The role of Ziehl Neelsen’s method of staining and conventional Microcopy is losing the sensitivity with ever increasing work load, technicians opting to see few fields, monotonous nature of work, the lack of accountability, and inter Institutional quality control protocols. Many systematic reviews indicated use of Florescent Microscopy will increase 10% higher sensitivity and 9 % in incremental yield when compared with Z.N method of staining. About 15 times as many fields of view can be scanned by Fluorescent Microscopy as by conventional Microscopy in the same period. The developing countries face crunch to buy Fluorescent microscopes and to maintain the regular availability of florescent dyes. It is utmost important to develop centralized and dedicated centers for Microscopy to have control on peripheral laboratories. Negative smears by conventional Microscopy needs further attention with optimal microscopy, concentration methods to detect AFB to reduce early mortality among the infected and to contain the spread in society.
Culturing for Mycobacterial Isolation
Sputum culturing remains a gold standard for diagnosing Mycobacterial infections. A Postive grwoth can be demonstrated with few bacilli to as low as 10 – 100 of viable bacilli per I ml of sputum. Cultures show growth of AFB even when patients where on treatment and negative by smear examination. A simple measure with decontamination of specimens and inoculation of at least 150 – 200 µl of concentrate on culture medium will increase the success in culturing. In spite of best decontamination procedures, 1 – 4 % of the isolates are false Postive. The greatest limitation of culturing on Lowenstein – Jensen medium and other equivalent medium is long periods (2 – 12 weeks) for isolation of bacteria.
Advances in Diagnostic Methodologies.
1. Mycobacterial growth in Incubator tube MGIT (Mycobacterium Growth Indicator Tube) is one new culturing method, costlier to install and automated system. Economic limitations and timely availability of reagents (closed system committed to the manufactures.) continue to hamper the growth of technolology in developing world
2.. Recent success with MODS ( the Microscopic Observation of drug susceptibility Assay ) developed in Peru gained the success as affordable, and primary drug resistance can be performed with simple efforts, But inverted microscope is essential to read the results at frequent intervals. Contamination or hazard to technical personnel is minimal. Even the district laboratories can report resistance to Isoniazid and Rifampicin In spite of several controlled studies on MODS assay is poor to discriminate between, M.tuberculosis from Non Tuberculosis Mycobacterium. The success of MODS is a great breakthrough in detection of MDR strains provided the prevalence of NTM prevalence is low MODS assay can identify patients with TB in approximately on third of time required for culturing on L J medium.
Emerging and Rapid Diagnostic methods.-
1 Fast plaque with phage amplification technology, tested in areas with high rates of HIV infection, had contradicting results, needs more understanding.
2. Quanti – Feron TB test – Done on Blood specimens, based on the principle of ELISA and enzyme linked immunospot. With higher production of Interferon γ (Inf-γ) by cells in response to Mycobacterium tuberculosis, than to the other environmental Mycobacterium in particular to Mycobacterium avium complex. The testing results correlated with Tuberculin skin test reactivity, but still hampered in BCG vaccinated.
3 Elispot – Tested by Elisa methodology detects Interferon γ produced by T lymphocytes in response to latent Tuberculosis
Infection. Elispot gained more clinical acceptability and advantageous, being negative in majority of BCG vaccinated individuals
Both the above testing methods were limited to high end laboratories and cost of testing remained the major limitation in many developing countries. More helpful to diagnose the latent Tuberculosis Infections.
Molecular Technology:
The fast gains of Polymerase technologies by amplification of DNA (PCR) are limited to controlled studies interpreted in relation to clinical context and performance of the laboratory .Rapidly changing molecular technologies, out dating earlier hardware, other equipment and patented primers, added to limitations in the Developing world. Mainly used as restricted research tool, and unaffordable to the needy poor.
Many extra pulmonary tuberculosis cases were benefited with Molecular technology.
Future Goals in Control of Tuberculosis ;
Stop TB partnership, Global Plan for 2006 to 2015 call for strengthening of network to facilitate detect all TB cases including smear negative tuberculosis. The Emphasis should focus on Sputum concentration methods, promoting the use of Fluorescent Microscopy. Helping the smaller laboratories to initiate culturing, and antibiotic sensitivity testing. The present affordable option may remain with utilizing the methodology of MODS .The Developing world wishes to utilize this upcoming technology for practical, and simple way to detect the MDR tuberculosis even at district Laboratories
. Yet there is no fool proof, sensitive and specific test, which is inexpensive and rapid method for Diagnosing the Tuberculosis.
Great challenges include detection and controlling of MDR TB. Strengthening the Smear Microscopy, and more aggressive provisions for enforcing the Fluorescent microscopy, may reduce the incidence of spread of tuberculosis. We have to watch the Impact of X-MDR in the Indian continent. The undergraduate and postgraduate Medical students should be taught with more emphasis on control of drug resistant tuberculosis The best options with implementation of International standards for tuberculosis care with initiation of Major global health participation may bring hope to reduce the incidence of Tuberculosis by 2015.

US: statistics

In the United States, TB is much less common than it used to be. Of the some 13,000 new cases of active disease each year in the United States, over half occur in persons born outside of the country. Tuberculosis is very common in the developing world. It has been estimated that as much as a third of the world's population is infected with M. tuberculosis, and worldwide about 1.6 million people die of TB every year. TB and HIV are closely associated; people with HIV are much more likely to develop active disease if they are infected with the bacteria that cause TB.


The main focus of the work of Farmabrasilis has been the development of the immunomodulator P-MAPA. Although this compound was originally intended for cancer treatment and has been shown to have anti-tumour activity, P-MAPA also modulates the production of interferon-gamma and interleukin-10, known to be key substances in the body’s defences against TB, malaria and other infectious diseases. This had led Farmabrasilis to put forward a new approach to treating patients with these conditions - including those co-infected with HIV - which would involve attempting to re-establish patients’ immunocompetence by adjuvant immunotherapy with P-MAPA.
Farmabrasilis welcomes contact with other individuals and organizations interested in the further development of the proposed approach.
Tests carried out by Tuberculosis Antimicrobial Acquisition and Coordinating Facility (TAACF) under contract signed by Farmabrasilis and US NIAID has shown that P-MAPA is active against M. tuberculosis in vivo

Chicago history of sanitarium

In January 1964, fifteen-year-old Kathleen Felters from Chicago’s Lawndale neighborhood on the West Side was admitted to the Municipal Tuberculosis Sanitarium at 5601 N. Pulaski on Chicago’s Far North Side. She was transferred to the sanitarium by bus from Cook County Hospital, accompanied by a nurse.
At the time Kathleen weighed 97 pounds and had just undergone a pulmonary lobectomy, which in her case meant the right lower lobe of her lung was removed. She had had TB for six months before she was taken to Cook County.
Kathleen wasn’t the first in her family to reside at the sanitarium. In all, at least ten members of her family suffered from TB. From the 1940s to the 1960s six were admitted: her father, who died of TB at the sanitarium in March 1957; her grandfather; her uncle’s wife; two of her uncle’s siblings; and her uncle’s niece, who died as an infant from TB.

Finland, vaccination, immigrants

The end of vaccinations for tuberculosis did not bring about an increase in cases of actual tuberculosis among children. The disease still exists in Africa and Russia, and many immigrant children are still vaccinated in Finland. Terhi Kilpi of the National Institute for Health and Welfare emphasises, however, that immigration does not pose an additional risk for tuberculosis among Finns.
“This has been seen very well in Sweden. Tuberculosis among the population has become increasingly rare, even though the country has taken in immigrants for decades. It should also be noted that young children with tuberculosis do not infect others,” Kilpi explains.
Finland stopped routinely vaccinating children against tuberculosis in 2006 because it was found to cause more harm than good, with bone infections as a possible side effect

California: San Diego/Tijuana statistics

Once a disease thought to have been eradicated across most of the developed world, today the incidence of tuberculosis (TB) is again on the rise. As the most heavily trafficked land border crossing in the world with close to 60 million crossings a year and an unparalleled level of bidirectional border crossers, the San Diego-Tijuana border region is particularly vulnerable to infectious diseases such as TB. The incidence of TB in San Diego remains one of the highest in the nation and was double the U.S. national average in 2007. The incidence of TB in Tijuana is over 2.8 times the Mexican national average.
The report identified several concrete steps that could be taken by the government, business and the philanthropic sector to reduce the incidence of TB in the San Diego-Tijuana border region by investing in laboratory diagnostics, prevention, infection control, expanded surveillance and expanded cooperation of area employers in TB health education, diagnosis and treatment. In the case of laboratory diagnostics no such services currently exist in Baja California yet could be provided for less than $213,000 a year permitting the state to accurately identify, detect and diagnose tuberculosis cases using cultures and drug susceptibility testing.
Additional key findings:
Over 600 cases of pulmonary TB were confirmed and reported annually in Tijuana in 2006 and 2007 with an overall rate of 46 per 100,000 inhabitants, which is substantially higher than rates in neighboring Mexican states.
Since 2000 there has been an average of over 300 new TB cases per year in San Diego County, of which nearly 40 percent were born in Mexico according to the San Diego County Health & Human Services Agency.
The estimated cost of TB in San Diego is a minimum of $21.3 million annually for an average of 300 cases. This includes approximately $12.7 million in lost earnings for patients due to their disease.

Monday, 19 April 2010

Georgia: Illegal Immigrants with Tbc

Last month, 50 students and teachers at Lilburn Middle School in Gwinnett County, Ga., a suburb of Atlanta , tested positive for tuberculosis exposure, and four have been confirmed to have an active case of TB.. While that news may be shocking to most, it is nothing new. In October 2009, about 200 students at the county’s Norcross High School underwent testing, after TB was discovered at the school. Of course, Atlanta is a known ‘sanctuary city’ for illegal aliens.It is often said that the flood of illegal immigrants into this country is reaching 'epidemic proportions.' While that statement is true, it is just as true that the illegal immigrants pouring over the U.S./Mexican border are endangering this country with actual epidemics. Tuberculosis, hepatitis, dengue fever, chagas, and even leprosy are being imported into the U.S. inside the bodies of illegal aliens. A virtual 'hot-zone' of disease can be found in this nations border states. Illegal immigrants have set up so-called ;colonias’ just inside the states of New Mexico, Texas, and Arizona. The shanty towns are comprised mostly of cardboard shacks and huts made with cast-off building materials. They have no sanitation, and are surrounded by mounds of garbage. The estimated 185,000 illegals share their makeshift towns with armies of rats. Of course, diseases only common to Central and South America run rampant in these places.

Sunday, 18 April 2010

Badger spreads bovine Tbc

On Queen guitarist Brian May's blog, the hottest topic isn't his searing solo on "We Will Rock You" or the operatic ambition of "Bohemian Rhapsody." It's the badger "genocide" Mr. May fears is headed to the Welsh countryside.Mr. May is part of a large badger-loving community trying to block government plans to kill up to 1,000 of the furry creatures in coming months. Farmers blame the animals for spreading tuberculosis to cattle. A group called Badger Trust has spent close to £100,000 ($154,000) on a legal battle to try to stop the planned killing.A plan to kill up to 1000 badgers in Wales has British rock star Brian May up in arms. WSJ's Jeanne Whalen reports.In March, Mr. May joined badger activists in Wales at a Swansea courthouse, where Badger Trust's wigged lawyers tried to convince a judge that the planned cull is illegal. "What was at stake? Badgers, yes, but much more; the whole question of how we treat the other animals on our planet was in microcosm represented here," Mr. May later wrote on his blog, Brian's Soapbox.Badgers, whose tunneling in gardens bothers some people, too, have long spread bovine TB to cattle, by urinating on fields where they graze, and by salivating on feed. But periodic culls haven't stopped the TB. Meanwhile, the badger-extermination campaign has helped create a devoted band of protesters. The U.K. has at least 60 badger-protection groups.

Fiji: grant to aid prophylaxis and treatment

THE treatment of about 650 tuberculosis patients over the next five years will be carried out by the National TB Program via a $20million grant from the Global Fund.The project will involve the distribution of TB prophylaxis to more than 750 children.The Ministry of Health will manage and co-ordinate the grant.The recipients include the Red Cross Society, Fiji Nursing Association and the Fiji School of Medicine, Fiji National University, National TB Program, National Reference Laboratory, Fiji Pharmaceutical and Biomedical Services Centre and the Health Information Unit.The Global Fund will support the ministry to reduce the burden of TB in Fiji.The funds will be distributed in two phases starting this month and ending in June 2012.The Health Ministry will upgrade laboratory systems in the main divisional facilities, support the National TB program and strengthen the pharmaceutical inventory.The health sector believes the grant will allow the State to decentralise the role of government health services for TB, allowing more private practitioner and civil society organisation participation. The grant aims to bring about effective community outreach programmes.

Kentucky: Sanatorium in Louisville

Right in the heartland of the United States, in Louisville, Kentucky, lays the Waverly Hills Sanatorium. It originally opened in 1910 as two-story hospital to accommodate 40 to 50 tuberculosis patients, but the building we see today was built in 1926 and has always been dedicated to the treatment of tuberculosis patients, a fairly common disease back in the early 20th Century.Many people lost their lives at the sanatorium. It is estimated that as many as 63,000 could have died inside the walls of this concrete building, but that’s only a legend. Some researchers say the true number of deaths is about 8,000, pretty far from the alleged 63,000.

Saturday, 17 April 2010

Ethiopia: active case finding

Active case finding is to find, diagnose, and treat and follow up tuberculosis patients in the local communities.
To find out the efficacy of community-based case finding, we did a community randomized trial and cost-effectiveness analysis in south Ethiopia. The trial Ethiopia aimed to evaluate if community health workers could improved smear-positive case detection and treatment success rates (
Datiko and Lindtjørn, 2009 and Datiko and Lindtjørn, 2010).
The study showed that involving of health extension workers (HEWs) in sputum collection and treatment improved smear-positive case detection and treatment success rate, possibly because of an improved service access. This finding has policy implications and could be applied in settings with low health service coverage and a shortage of health workers.
Recently, National TB Control Programme in Ethiopia started to decentralize case finding and treatment to local communities (in Ethiopia called kebeles) using community based-treatment by health extension workers.

UK: prison death from tbc

A MAN has died from tuberculosis while being held in Cardiff Prison, the Western Mail has learned.
Tests will now be carried out on those inmates and staff who were in close contact with the unnamed man, who died on April 2.
The Western Mail understands the man was in his 30s and was an illegal immigrant from Cameroon.