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Two patients in the last one year have been diagnosed with a new borderline strain of Tuberculosis (TB) in Kenya, The Standard on Saturday has exclusively learnt.
Known as pre-XDR TB, this strain is resistant to one form of the drugs used to treat Multi-Drug Resistant TB and could graduate to the more infectious form known as XDR-TB if left untreated.
Head of the National Tuberculosis, Leprosy and Lung Disease programme (NTLD) Enos Masini told the Standard on Saturday that the first case of a patient with unique strain of the respiratory disease was diagnosed last year and investigations done revealed that they were resistant to one form of TB medicines.
“This particular strain of TB is a stage between MDR-TB and XDR-TB (extensively drug-resistant TB) where the patient is resistant to either an injectable drug or a type of antibiotic called fluoroquinolone- the two key drugs used for MDR-TB treatment ,” said Dr Masini noting that treatment for both MDR and XDR requires treatment with other drugs that are less potent, more toxic and much more expensive..
“One of them began treatment for pre-XDR TB in May this year whereas the other is waiting for an additional new drug called bedaquiline to bolster his treatment,” said Dr Masini adding that due to the specificity of the type of drug required to treat Pre-XDR TB of the respiratory disease, the drug takes longer to be available.
These two cases come at a time when Kenya is carrying out a national TB survey with the pilot ending tomorrow (Sunday) before the campaign kicks off nationally on 26th September beginning in Machakos and Kiambu Counties for ten days.
The national survey that seeks to identify challenges in testing and treating TB is the first since Independence to ascertain Kenya’s actual TB burden and is expected to inform on more effective ways to prevent infections and recurrence.
“The field team targets persons above 15 years and we are testing for TB by asking for sputum and x-rays and any cases of TB will be referred to treatment,” said Dr Masini adding that 120 field workers are collecting the data in two counties simultaneously and expected to complete the exercise in eight to ten months.
The target is 72,000 respondents from 47 counties in a campaign themed, ‘Assessing Kenya’s TB burden,’ South Africa currently accounts for the highest XDR-TB in Sub-Saharan Africa with outbreaks being reported in various provinces since 2006.
Closer home, Kenya has had 5 cases of XDR TB; one was cured, two are on treatment and two died from the complications of this extreme form of TB that costs Sh2 million to treat per patient for a period of two years.
For MDR TB, Kenya has successfully treated 1,500 patients who were on treatment for at least 20 months for a treatment regime that included eight months of injections alongside oral medications at a cost of Sh1.5 million each.
XDR treatment for TB takes two years at a cost of two million shillings to treat each patient. Globally, TB is a major public health problem with drug resistant strains of the disease threatening to destabilise its control and eventual elimination.
In Kenya, two out of every 100 adults and adolescents have ever been diagnosed with TB and this burden is aggravated by HIV with the likelihood of having been diagnosed with TB nearly eight times higher among the HIV-infected than uninfected adults and adolescents.
What is tuberculosis?
Tuberculosis is an airborne infectious disease caused by a germ called mycobacteriumtuberculosis and mainly affects the lungs and is spread from person to person through the air. When an infected person coughs, sneezes or spits, they propel the TB germs into the air.
The symptoms of active TB of the lung are coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats. Tuberculosis is treatable with a six-month course of antibiotics.
Dr Masini points out that the fight against TB has been complicated by resistance to drugs thus patients are placed on more expensive drugs requiring strict adherence.
Dr Masini says TB treatment is initially made using the ‘first line’ and if the disease becomes resistant to these, the disease is referred to as ‘multidrug-resistant tuberculosis’ (MDR-TB), and requires stronger medicines known as ‘Second line. If resistance develops further, it usually means that the other drugs in that class will also become ineffective leading to the development of ‘extensively drug-resistant TB shortened as XDR-TB.
The main causes of TB resistance to drugs include poor choices of drugs, failure to complete prescribed treatment and use of sub-standard drugs.
On the cure-rate compared to ordinary TB, The World Health Organisation notes that with the current drugs available, the likelihood of success is much smaller than in patients with ordinary TB or even MDR-TB.
In Kenya, there have been four XDR patients, three of whom died.
The diagnosis for this type of TB also takes longer, estimated at around six to 16 weeks.
Currently research is ongoing to come up with simpler, shorter-course TB drug schedules from the current six-month treatment course.
The current BCG vaccine provides limited protection for newborns and children yet none against pulmonary TB in adults, which accounts for most of the TB cases worldwide.
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