Drug resistant Tuberculosis, drug resistant flu and drug resistant meningitis!

Drug resistant tuberculosis:

LONDON - Drug-resistant tuberculosis is spreading even faster than medical experts had feared, the World Health Organization warned in a report issued Tuesday.

The rate of TB patients infected with the drug-resistant strain topped 20 percent in some countries, the highest ever recorded, the U.N. agency said.

"Ten years ago, it would have been unthinkable to see rates like this," said Dr. Mario Raviglione, director of WHO's "Stop TB" department.

"This demonstrates what happens when you keep making mistakes in TB treatment."

Though the report is the largest survey of drug-resistant TB, based on information collected between 2002 and 2006, there are still major gaps: Data were only available from about half of the world's countries.

In Africa, where experts are particularly worried about a lethal collision between TB and AIDS, only six countries provided information.

"We really don't know what the situation is in Africa," Raviglione said. "If multi-drug resistant TB has penetrated Africa and coincides with AIDS, there's bound to be a disaster."

Raviglione said it was likely that patients — and even entire outbreaks of drug-resistant TB — were being missed.

Drug-resistant strain now in 45 countries:

Experts also worry about the spread of XDR-TB, or extensively drug-resistant TB, a strain virtually untreatable in poor countries. When an XDR-TB outbreak was identified in AIDS patients in South Africa in 2006, it killed nearly every patient within weeks. WHO's report said XDR-TB has now been found in 45 countries.

Globally, there are about 500,000 new cases of drug-resistant TB every year, about 5 percent of the 9 million new TB cases. In the United States, 1.2 percent of TB cases were multi-drug resistant. Of those, 1.9 percent were extensively drug-resistant.

The highest rates of drug-resistant TB were in eastern Europe. Nearly a quarter of all TB cases in Baku, Azerbaijan, were drug-resistant, followed by about 20 percent in Moldova and 16 percent in Donetsk, Ukraine, WHO said.

High rates of drug-resistant TB were also found in China and India, the world's two most populous nations that together are home to half the world's cases.

Drug-resistant TB arises when primary TB treatment is poor. Countries with strong treatment programs, like the U.S. and other Western nations, should theoretically have very little drug-resistant TB.

That is not the case in China, however, where the government says 94 percent of TB patients complete their first TB treatment.

"There's a huge, gross discrepancy there if they are then reporting 25 percent of the world's multi-drug resistant TB cases," said Mark Harrington, executive director of Treatment Action Group, a public health think tank. "They are clearly nurturing a multi-drug resistant TB epidemic and failing to report XDR-TB at all."

With growing numbers of drug-resistant TB patients, there is concern some national health systems will soon be overwhelmed.

New drugs needed:

"We are totally off track right now," said Dr. Tido von Schoen-Angerer, executive director of Medecins Sans Frontiere's Campaign for Access to Essential Medicines. He said only 30,000 multi-drug TB resistant patients were treated last year.

Experts said new drugs are needed if the outbreak is to be curbed, along with new diagnostic tests to identify drug-resistant TB strains faster — current tests take about a month for results.

Drug resistant flu:

LONDON - A small number of flu viruses resistant to Tamiflu, a top antiviral drug, have been detected in Europe, health authorities said this week.

Data from more than a dozen European countries show that Tamiflu doesn't work in about 14 percent of H1N1 viruses, the main flu strain causing illness this year. Normally, resistance levels are well below 1 percent.

"It's an unexpected finding and a signal worth watching," said Fred Hayden, a flu expert at the World Health Organization. The resistant strains most likely emerged elsewhere, but were first identified in Europe.

The strain is resistant because of a single mutation. It doesn't cause more serious disease than regular strains, and can be treated with other antivirals. But experts are worried that if the resistance becomes widespread, Tamiflu, one of the best tools for fighting flu, might become useless.

"If I had only a single drug to choose for influenza, oseltamivir (Tamiflu) is the one I would go for," said Dr. Angus Nicoll, influenza coordinator for the European Centre for Disease Prevention and Control. Tamiflu, made by Roche Holding AG, has been stockpiled by WHO and by countries around the world for possible use in a flu pandemic.

But the resistant H1N1 strains do not mean that H5N1, the bird flu many experts fear could spark a flu pandemic, will develop similar resistance.

"The chance of this happening in an H5N1 virus is not zero, but probably very rare," said Dr. Joseph Bresee, chief of epidemiology and prevention at the United States' Centers for Disease Control and Prevention. At least two Tamiflu-resistant H5N1 strains have been found in Asia in the last few years.

Experts said that relying exclusively on Tamiflu is unwise. "This is a very good reminder that we don't know what the next pandemic strain will be sensitive to," Nicoll said. "Perhaps we should have more mixed antiviral stockpiles."

At the moment, health authorities are scrambling to find out how prevalent the resistant strain is worldwide. The highest levels have been found in Norway, where nearly 70 percent of tested strains have been resistant.

Resistance varies across Europe, with several countries including Austria and Italy reporting no resistant strains. In France, 17 percent of H1N1 strains are resistant. In Britain, Germany, the Netherlands and Sweden, less than 10 percent of their strains were resistant.

In the United States, nearly 7 percent of H1N1 flu samples have tested as resistant. "We don't know right now if this is a trend on the upswing or just a small blip," Bresee said.

Laboratories worldwide are also sequencing the mutated virus to try to determine where it came from and how it developed. Usually, resistant strains arise in people who have been treated with the drug. But that's not the case here.

In Norway, none of the viruses were from people who had been treated with Tamiflu. And in Japan, where Tamiflu use is the highest in the world, no resistant viruses have been reported this year. Investigations are ongoing in other countries.

Until now, experts had also believed that if viruses developed resistance, they would be less transmissible. "That assumption appears to have been incorrect," Hayden said.

Drug resistant meningitis:

Three cases of a drug-resistant strain of meningitis have surfaced in Minnesota and North Dakota, prompting an alert to physicians from the Minnesota Department of Health.

Three people in the Fargo-Moorhead area -- two adults last month and a child last year --developed a form of meningitis resistant to the usual types of antibiotics, known as quinolines, the Health Department said Friday.

Those antibiotics are not used to treat the sick, but to prevent people who come in close contact with meningitis patients from getting the disease, said Richard Danila, Minnesota's deputy state epidemiologist.

He said other antibiotics are available for prevention and that doctors opt for them instead.

Of the three patients, one, a 53-year-old woman in Minnesota, died of meningitis, Danila said. The other two -- a 22-year-old college student and a young child -- recovered after being hospitalized.

Danila said that meningitis is fatal about 15 percent of the time and that this strain did not appear more dangerous than usual.

Dr. Ruth Lynfield, Minnesota epidemiologist, said the discovery was important because these are the first-known cases of quinoline-resistant meningitis in the United States.

"Even though there are other drugs that can be used to prevent meningococcal disease, having one less weapon in our arsenal reminds us of the importance of appropriate antibiotic use," said Lynfield.

She said misuse of antibiotics -- such as giving them for colds -- is the main reason they lose their effectiveness. "We must use antibiotics carefully," she said.

Lynfield also said the vaccine used to prevent meningitis does not cover the strain found in the three drug-resistant cases.

The infection can be spread by sharing drinks, kissing and other close contact.

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