On the eve of World Day, WHO wants to mobilize countries to fight against the worldwide spread of forms of tuberculosis resistant to antibiotics.
Tuberculosis is now considered a “disease of the past”, which has almost disappeared in France. But if the number of cases is down in our country (around 5,000 per year, with a decrease each year), it is the disease in its most resistant forms that worries.
Multi-resistant tuberculosis (MDR) burst into French news at the end of 2012, with the discovery in several migrants from Eastern Europe of a form particularly resistant to antibiotics. Referred to the infectious disease treatment department at the Pitié Salpètrière hospital (Paris), these patients were found to be carriers of a bacillus resistant to the usual anti-tuberculosis drugs, and therefore particularly difficult to treat. “Tuberculosis is quite emblematic of a bacterium which, when confronted with antibiotics, tries to defend itself and becomes more resistant”, explains Professor Jean-Paul Stahl, head of the infectious diseases department at Grenoble University Hospital. If patients are poorly monitored, they therefore have a high risk of developing a resistant form of the disease.
Listen to Prof. Jean-Paul Stahl, Head of the infectious diseases department at Grenoble University Hospital : “ It is not surprising that we find the less wealthy countries as suppliers of resistant tuberculosis … ”
Poor patient follow-up
Following the discovery of these extraordinary patients, the General Directorate of Health (DGS) announced at the end of January 2013 that the increase in forms of multi-drug resistant tuberculosis (MDR) was considered to be ” worrying in terms of public health ”in France.
According to figures from the DGS, 92 cases were detected in France in 2012, against 64 cases in 2011 and 40 in 2010. The majority of cases concerning “people from countries of the former USSR and a few cases from” Asia (China and India) “, specifies the report, which indicates that the French population is for the moment very little exposed: only five French patients having been registered in 2012.
The discovery of these patients has above all highlighted the risks of the spread of resistant strains across the planet, due to the intensification of exchanges and movements. On March 4, 2013, Time asked the question, on the front page: “Why does treatment-resistant tuberculosis threaten us all?” In an article titled “Drugs Don’t Work”, the American magazine took a particular interest in the most resistant forms of tuberculosis found in India.
A phenomenon which is explained again by poor monitoring of patients. In fact, from the end of the 1990s, cases of tuberculosis resistant to antibiotics were identified in India, without any long and truly appropriate treatment being put in place. Twenty years later, in 2007, 30% of tuberculosis in the country were considered resistant (MDR) and 1.6% as ultra-resistant (XDR).
“We can also see the perverse effect of the West, which brings drugs to poor countries, without monitoring the prescription. “, notes Jean-Paul Stahl. “Helping countries that have infections of this kind means providing medication but also building a monitoring system, otherwise we are exposed to this kind of thing. “, he develops.
An exceptional phenomenon in France
According to Time, 84 countries are affected by this advanced form of tuberculosis: East and Southeast Asia, Eastern Europe, South Africa, Russia and India have particularly alarming rates of resistance.
In France, Prof. François Bricaire, head of the infectious diseases department at Pitié-Salpètrière, notes an increase in MDR cases, even if the phenomenon remains very limited. “There are enough people who are carriers of multi-resistant bacteria that we need to worry and take care of them. “, he emphasizes. “We are trying to identify them, and isolate them so that they do not transmit tuberculosis bacilli around them, by making sure to find the treatments that can still be effective, in particular by associating a lot of anti-tuberculosis drugs.” Sometimes, surgery is even necessary to overcome the disease.
Listen to Prof. François Bricaire, head of the infectious diseases department at Pitié-Salpètrière: ” If sick people can circulate, they can transmit, and infect people who will develop tuberculosis later “.
For his part, Jean-Paul Stahl is especially worried about the generalization of certain “rescue” antibiotics in countries with high tuberculosis endemia, at the risk of increasing the resistance of the disease even more.
WHO warns of lack of resources
On the eve of World Tuberculosis Day, March 24, the WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria stepped up to demand new funding. The two organizations particularly warned against multidrug-resistant tuberculosis, which “constitutes a major threat “for the poorest populations: it is estimated today that 630,000 people are affected throughout the world. WHO and the Global Fund have warned that resistant strains of tuberculosis could spread widely, and have said at least $ 1.6 billion is needed to ensure treatment and prevention. “If we don’t intervene today, the costs could explode. It’s about investing now, or paying forever “, even said the Executive Director of the Global Fund.
New anti-tuberculosis drugs are being tested to deal with these new forms of the disease. 1er January, a treatment capable of overcoming the most resistant forms of tuberculosis was authorized in the United States: Sirturo, produced by the American laboratory Johnson and Johnson (J&J), shows that therapeutic hope exists behind this development of disease.
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