News broke a few days ago that there are several reported cases of totally drug-resistant tuberculosis in India. According to Indian news outlets, there are 12 confirmed cases. None of this is good news, but let’s put this in some context.
Tuberculosis is a big killer and has been for quite some time. With the emergence of antibiotic treatments, doctors were able to help improve the outcomes for patients and reduce the threat of the disease; however, super resistant strains have emerged, strains that have no cure.
How can this happen? Well, antibiotics help the body fight a disease by killing the microbes that are causing the disease. However, some strains of microbes develop that are resistant to the antibiotics. It is evolution in action: the antibiotics work as the selective force on the microbes, killing off all but the most resistant forms. Tuberculosis has been treated with the same basic drugs for around half of a century, setting up a consistent type of selection on the strains. The problem is further exacerbated by using antibiotics incorrectly, like not finishing a full round of treatment.
The problem of drug-resistant strains is not new: extensively drug-resistant tuberculosis, a type of tuberculosis that is resistant to most treatments but not all, has been documented in 58 countries. The cases in India are not even the first time that we have seen the totally drug-resistant tuberculosis: the first case appeared in Italy in 2007, and another group of cases popped up in Iran in 2009. Tuberculosis is not getting the headlines.
One reason tuberculosis is not splashed all over the front pages is that is it not highly contagious. It takes multiple exposures to the disease to catch it – it is definitely not as easy as getting sneezed on in the subway. Another reason may be that tuberculosis is viewed as a “disease of poverty” and is mostly prevalent in countries categorized as developing economies. However, with the increasing globalization of the world and the increased movement of people between many different nations, diseases must be viewed within a global context.
But good news may be around the corner – research is ongoing to develop new treatments for tuberculosis, including the current totally and extremely drug-resistant strains.