Tuberculosis’ deadly return to Europe

Feature article appeared in the EUobserver on 15 February, 2010.

Vladimir appears as an unwrapped mummy, a skeleton of a man whose paper skin pulls taught over his Siberian bones. Top off, in stocking feet and navy Adidas track bottoms, he lies on his side as a nurse sponges the wounds left from the surgery he’s had to remove some ribs to let his one lung – the other also removed by the doctors – breathe more easily. He has an ancient sickness, tuberculosis, but his is a wretched new mutation of the disease that now seems impervious to almost all of mankind’s very much ageing weapons against it.

The 50-year-old former oil driller from Strezhevoy, a Rosneft company town in the far northwest of the Tomsk Oblast, is nevertheless surprisingly upbeat and chatty. “I suppose I’ll never run a marathon now,” he jokes, “I just wish I could at least walk a few metres without losing my breath.”

He’s been in the Tomsk TB hospital undergoing treatment for a disease against which very few drugs work at all for four years now. He complains that four years is a long time for a hospital whose library doesn’t have much of a selection, but he’s happy his wife has not left him “as, you know, it happens a lot in Russia,” and that she and his children come to visit.

But however bad he looks – there is a reason TB was once called consumption, or the wasting disease – his doctors say that he’s actually on the mend and they are confident that in another two years he will be cured.

“He’ll survive,” says Dr Evgeny Nekrasov as he paints a picture of this very typical patient and his disease, proud of the work they are doing in Tomsk, Siberia’s university town long forgotten, if it was ever known, by the rest of the world but a model region for Europe in combatting TB.

Multi-drug resistance

Vladimir has what is called XDR-TB, they say, or ‘extensively multi-drug resistant TB’, a form of the bacteria resistant to most drugs and that emerged in 2006 from the already robust MDR-TB, or plain old ‘multi-drug resistant TB’.

TB is usually treated with a course of four standard, or first-line, anti-TB drugs over the course of six to nine months under the direct supervision of a healthcare worker. The full course can cost as little as $11. A patient is classified as MDR if he is resistant to the two most powerful of these. MDR takes longer to treat – up to 24 months – with second-line drugs that have more profound side-effects and that are much more expensive.

An XDR patient is resistant to almost all of these first-line drugs and some second-line drugs are also ineffective. XDR TB treatment can cost a thousand times what everyday TB costs. In the most extreme cases, strains are resistant to all existing TB antibiotics.

Vladimir, for his part, is resistant to eight first-line medicines and sensitive to just two of them. The doctors say that from the beginning, his TB developed in a very advanced manner. This was then compounded by the fact that he was not very compliant with his treatment, interrupting it to stay home. “There were periods of alcohol abuse,” his surgeon explains.

It is this interruption that has been the major cause of the development of MDR and subsequently even more virulent XDR, in turn a product of deteriorating diagnostic facilities and healthcare systems that do not have the manpower or time to ensure at-risk patients continue to take their medicine. “Patients believe they are better, because after a short period of treatment, many symptoms go away, but they are not cured, and then the drugs have a limited effect.”

To read the rest of the feature, visit the EUobserver website.

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