Eastern Cape treatment dysfunction boosts virulent new XDR-TB strain.

At least half of all known drug-resistant tuberculosis (DR-TB) patients in the Port Elizabeth area (and possibly the entire Eastern Cape) are being treated with too few drugs, fuelling the spread of extensively drug-resistant (XDR)-TB and condemning them to death. Similar dynamics, though not quite as alarming, pertain in KwaZulu-Natal and to a lesser extent in the Western Cape. An atypi-cal (Beijing) strain of multiple-drug-resistant (MDR)-TB, first detected by researchers at Stellenbosch University 2 years ago, is being created via a 'one-size-fits-all' system of de centralised, nurse-led TB clinics with an insufficient array of drugs and wholly in adequate expertise. In the Eastern Cape, the situation is being worsened by a woeful lack of local political will and/or understanding – resul ting in a virulent, 'export-ready' budget-crippling potential domestic time bomb. Researchers spoken to by Izindaba say that patients carrying this 'aberrant' pre-XDR MDR strain and/or the ensuing full-blown XDR are being detected in significant numbers in the Western Cape metropole, the primary destination for the Eastern Cape's huge migrant worker popu lation. The Beijing strain is one mutation away from XDR and is being driven by treatment with an insufficient array of drugs. Izindaba has reliably learnt that the National Health Laboratory Service (NHLS) in Port Elizabeth conducted a Line Probe Assay (using the latest Hain LifeSciences technology) on two locally predominant MDR-TB strains, one in particular (Beijing) described as 'pre-programmed to become XDR'. The conclusion of their lab technicians? The Port Elizabeth (PE) metropole, in particular , has a 'real problem'. 'It appears to be fuelled by our patients being put onto a standard regimen of treatment in which very few drugs are effective, ' one source said. An infectious diseases doctor working in the Eastern Cape explained that nurses could wait for up to 6 weeks for culture results to confirm the DR strain. This 'archaic' confirmation followed the 2-hours-or-less GeneXpert result confirming rifampicin resistance. While the samples were at the laboratory to confirm or identify additional resistance markers by culture, nurses and doctors were 'blindly' putting patients onto standard MDR-TB treatment – inadequate to treat many of the circulating strains and thus amplifying resistance. Médecins Sans Frontières (MSF) is strengthening its MDR drug regimen in the Western Cape, leading the way in combating this new pre-XDR strain. (National policy on TB treatment is to get as many patients onto treatment as soon as possible and to …