Antibiotic resistant TB strain in Colombia

miamimike says on Jul 15, 2008, 06:07:

Too many poeple self diagnosing themselves and overusing Antibiotics in Colombia, they need to stop this rampant use of Antibiotics, make them available by prescription from a Doctor only.

"Wait a minute. What did you just say? You're predicting $4-a-gallon gas? That's interesting. I hadn't heard that." -- Feb. 28, 2008 --George W. Bush, Washington, D.C.

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tomtom33 says on Jul 15, 2008, 06:18:

Not exactly, Pee. Anyone can walk into a pharmacy in Colombia and buy antibiotics.

I picked up a bug from the Cartagena water and am still fighting it 5 months, a colonoscopy, and a lot of antibiotics later. I believe that the easy access to antibiotics in Colombia contributed to making this bug very resistant.

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romy says on Jul 15, 2008, 06:23:

from reading just the posted article, I would not be so quick to blame antibiotic overuse... the common gap in people's knowledge is that if there is a certain mutation that survives antibiotics, it is going to do so regardless of proper antibiotic administration. After all antibiotic resistance is caused randomly by natural selection...
Anyways, seeing the history of the person from Buenaventura I would suggest this is the case of an imported strain.

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perezoso says on Jul 15, 2008, 06:24:

Duh, folks. The strain came from China, not Colombia. While there are places where it is more prevalent than others, you can get MDR and XDR TB almost anywhere on the planet.

Availability of OTC antibiotics in Colombia had no impact on this development.

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romy says on Jul 15, 2008, 06:29:

"Duh", how do you know it came from China?
I have no time to read the article but I found this (http://www.ncbi.nlm.nih.gov/pubmed/10827122)
clearly, this strain could have came into Colombia from different places...

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sloopskipper says on Jul 15, 2008, 06:29:

The abuse of antibiotics is not only in Colombia. I see it in Panamá, and saw it as well in Puerto Rico. I have a friend, who is a radiologist, routinely self medicates with Cipro for trivial complaints. I was prescribed Cipro, by phone, in Perú, and was able to buy it in farmacia, without a physical script.

If you must elevate to Vancomycin, due to developing a tolerance to Cipro, etc, there are few alternatives left (in 2001).

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romy says on Jul 15, 2008, 06:36:

"However, in the Beijing region of China, a particular genotype was found in >80% of the TB patients and was thus designated the Beijing genotype[2]. In other parts of China and in Asian countries such as Mongolia, Thailand, and Korea, 40% to 50% of the tested M. tuberculosis isolates represented this genotype"

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sloopskipper says on Jul 15, 2008, 06:38:

That was not true with my doctor in Pennsylvania, even 30 years ago. He never prescribed antibiotics as a first course of treatment.

They are ineffective against viruses, but only for a possible secondary infection.

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miamimike says on Jul 15, 2008, 09:47:

sloopskipper says on Jul 15 (today): flag

That was not true with my doctor in Pennsylvania, even 30 years ago. He never prescribed antibiotics as a first course of treatment.

They are ineffective against viruses, but only for a possible secondary infection.

===================================================================

Bingo! Your Doc nailed it! Send him to Colombia!

"Wait a minute. What did you just say? You're predicting $4-a-gallon gas? That's interesting. I hadn't heard that." -- Feb. 28, 2008 --George W. Bush, Washington, D.C.

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sloopskipper says on Jul 15, 2008, 10:00:

I'm afraid our Internist retired some years ago.

But trust me, I've had a lot more experiences with antibiotics (and the risks/side effects) than anyone would want, up to and including Vancomycin orally (cost more than $600 for a few ounces) and simultaneously with 7X24 infusion pump delivery directly into the heart, although I wasn’t the patient.

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miamimike says on Jul 15, 2008, 10:14:

Vancomycin--Wow, that is one Stiff Drug! Drug(ab) one of the drugs of last resort,,,

"Wait a minute. What did you just say? You're predicting $4-a-gallon gas? That's interesting. I hadn't heard that." -- Feb. 28, 2008 --George W. Bush, Washington, D.C.

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sloopskipper says on Jul 15, 2008, 10:19:

For sure, that was the end of the road in 2001, maybe still is.

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sloopskipper says on Jul 15, 2008, 10:20:

And before that, Keflex was believed to have caused spatial visual displacement.

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perezoso says on Jul 15, 2008, 10:28:

Romy: With very few exceptions, a bug strain named for a place carries the name of where it was identified first (i.e. Beijing) which, generally, corresponds with the general area where the strain originates. (Assuming there is a decent public health system that is capable of identifying new bugs.)

In this case, it is a strain that was first identified years ago in China, which is known to infect many people in China, and which heretofore was never found in Colombia.

The strain, therefore, did not originate in Colombia and practices with antibiotics in Colombia have nothing to do with the strain's appearance in Colombia or evolution (to date) or virulence. (Add to that the fact that it appeared in a port town, where the chances of it having recently arrived from abroad are much higher.)

TB is a bacteria, so it is treated with antibiotics. Where Colombian antibiotic practices might come into play is if the Beijing strain acquired new antibiotic resistance in Colombia as a result of improper use of medicine. That could make it harder to treat, if the new resistance was therapeutically relevant. Then you could make the case that Colombian antibiotic practices were creating problems with the TB strain.

But, so far, all we seem to have is a new TB strain (for Colombia), probably being imported somehow through the port in Buenaventura (for example, through an infected crew member). I'm sure the epidemiologists are going to try to figure it out.

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romy says on Jul 15, 2008, 11:00:

"The strain, therefore, did not originate in Colombia and practices with antibiotics in Colombia have nothing to do with the strain's appearance in Colombia or evolution (to date) or virulence. (Add to that the fact that it appeared in a port town, where the chances of it having recently arrived from abroad are much higher.)"
I already made this point, just the comment before your original comment.... I just had a problem with your "Duh" arrogance, considering it's not definite that the carrier of this strain came from China. Sure originally it was probably first identified in China (the true origin however, I don't believe is known), the 'cesspool of disease' (I mean it as a joke for anyone that might be offended). It's a very interesting field of study of why so many diseases originate in China, Guandong particularly.

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lpdiver says on Jul 16, 2008, 04:37:

EVERY Paisa that I know (14-15) that I have been involved in with their immigrations physicals tested positive for TB?

In my wifes case there was not further treatment required.

ts

"cook some rice!"

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romy says on Jul 16, 2008, 05:16:

I'd rather watch the movie Outbreak :)

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miamimike says on Jul 16, 2008, 05:39:

lpdiver says on Jul 16 (today): flag

EVERY Paisa that I know (14-15) that I have been involved in with their immigrations physicals tested positive for TB?

In my wifes case there was not further treatment required.

ts

"cook some rice!"
=================================================================

LP Diver--maybe your Wife received a TB Vaccine when she was a child in her area of Colombia. If so, she will probably have a + reaction the rest of her life when tested. She(her body) has developed the Antigens(antibodies to the disease) and will always react + when exposed to the TB testing liquid used in clinics. When I worked at the Clinic in the Krome Federal Detention center here in Miami, I tested(injected, tb tine test) and read the results in literally 1000s of detainees for TB as part of their Physical. In some countries like Haiti, many Detainees when young, received this TB Vaccine and they (most) had + reactions. In Followup tests(which was protocol for us, US PHS protocol) which included a Chest Xray on these detainees, only 2 out of 10 showed a reaction again and were then referred to the next series of tests, which included 3 Sputum samples. If they tested + with their Sputum samples, they were then placed on AB Therapy and placed in Reverse Air Isolation for usually 2 weeks. This was usually the period of time it took for the AB therapy to render the Disease into the non-infective stage. Amazingly, about 5 years ago, US Public Health Protocol changed and they NO longer administer TB Skin Tests(injection) at US detention Centers around the US, only chest X-Rays and our incidence of active TB has been steadily rising here in the US. What possessed our Government to institute this change boggled the minds of many,,,

"Wait a minute. What did you just say? You're predicting $4-a-gallon gas? That's interesting. I hadn't heard that." -- Feb. 28, 2008 --George W. Bush, Washington, D.C.

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gamm2 says on Jul 16, 2008, 05:46:

I tested positive for TB, after having tested negative 3 years before. This was right after returning home from a year in Mexico working with street kids. So I then had to have a chest x ray and it was found to be non infective, but then I had to take medicine for 9 months!! I have finally finished, but boy did I and my family freak out when I first tested positive. I was imagining myself quarantined and everything!

But yeah alot of older people had a TB vaccine and thats why they end up testing positive.

Is it true that its kind of dangerous for me to have the test now?

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miamimike says on Jul 16, 2008, 06:06:

Gamm2--I never heard that having this test was dangerous. We had a lot of Mexican Detainees(a well as those from other central american countries test +) tesing + when I was doing these TB Screenings so I'm not surprised at all by your + test. If you received a dose of TB testing liquid(antigen) that by accident, was inattenuated(live tb vaccine), then it would be dangerous. You would, in essence, be having the live TB bateria injected into your system and the possibility of a + conversion would be high. This happened in the late 70s to a large group of people with the Flu vaccine in Pennsylvania and several elderly people who received this live flu vaccine died. Others who received this Vaccine who had a compromised Immune system(like those on transplant anti-rejection drugs,chemo ect) also died. BTW, this Flu Vaccine had our goverment's FDA stamp of approval so just because a drug has FDA doesn't mean its 100% safe. Another example recently was Vioxx, FDA Approved, but many who took the drug had serious complications and their systems were not compromised. I had to laugh a few years ago when Bush crowed on about how Drugs from Canada may NOT be safe for import into the USA when that debate was raging here in the USA yet a few months later when we(here inthe usa) ran short of FLU Vaccine and we needed to import extra Flu vaccine from Canada(they had a surplus from the same drugmaker we got our vaccine from) all of a "Sudden" Canada's drugs became safe. A Lame arguement at best and not very scientific,,LOL

"Wait a minute. What did you just say? You're predicting $4-a-gallon gas? That's interesting. I hadn't heard that." -- Feb. 28, 2008 --George W. Bush, Washington, D.C.

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lpdiver says on Jul 16, 2008, 06:42:

None of the individuals that I was involved with had the vaccine.

ts

"cook some rice!"

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miamimike says on Jul 16, 2008, 07:09:

LPDiver-many in Mexico simply were exposed at some time in their life to the TB Antigen and while they may never have developed the active disease, they can be carriers. TB, unlike the HIV Virus, is a communicable disease spread by casual contact. HIV-spread by the exchange of intimate body fluids, is not classified by the authorities as a communicable disease. In TB, disease transmission can be something as simple as walking past a person who has the TB antibody in his/her system and who sneezes, putting droplets in the air(in an area of poor air circulation, these droplets can stay suspended for several minutes). You may be in close proximity and as you walk by and breathe in the droplets and Bingo, your system(usually but not always) develops antibodies becase your system was exposed to the TB Bug.

"Wait a minute. What did you just say? You're predicting $4-a-gallon gas? That's interesting. I hadn't heard that." -- Feb. 28, 2008 --George W. Bush, Washington, D.C.

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lpdiver says on Jul 16, 2008, 07:33:

This is what I believe to be the case. Most if not all were from very poor rural families with double digit siblings.

I had a coworker who was a heavy smoker who developed lung cancer. Well, after removing his lung it was discovered that it was an old benign case of TB. However, everyone at my facility (2,000 people) had to be tested.

In my wifes case, her doctor wanted her to take a long course of medication. After reviewing the facts, we elected not to. Fortunately, she was not force by immigrations to do so.

ts

"cook some rice!"

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gamm2 says on Jul 16, 2008, 07:40:

Ahhhh why did your wife choose not to take the medicine?? I really really hated taking the medicine. I had to take this additional medicine at the same time because it was supposed to be really bad for my liver. At first I was not going to take the medicine, but then I did because everyone wanted me to. Im so glad its over now.

To actually pass the disease on, you have to actually have a full blown infection. Like I couldn't have passed it to anyone with what I had.

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lpdiver says on Jul 16, 2008, 07:59:

We weighed the possible risk against the possible gains and along with her physician decided it was not worth it. I have been in very close proximity to her for four years and tested negative. Her chest X-ray was clear.

ts

"cook some rice!"

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miamimike says on Jul 16, 2008, 13:58:

Gamm, not necessarily true what you wrote.As far as it being bad for your liver, it may be(but not always) if your have a pre-existing liver ailment/deficiency. Here in the states and many european countries as well as advanced clinics in the Americas, they give you a Liver Function test prior to starting you on the TB Medication regimen.


"To say you cannot pass it on with what I had" If your system becomes compromised, for example by HIV(not saying you had it, only using it as an example) then the latent TB(say you were a person who didn't receive treatment) this new infection could then compromise your bodily defenses and allow the latent TB to bloom into full blown TB. Our clinic always re-tested the patients we treated for 2 weeks who were in reverse air isolation with 3 consective sputum samples to ascertain definitively that the TB Bug was at a low level that would not allow him/her to infect others he comes in contact with. In some people(approx 5%), the TB Bug can be extremely difficult to kill.

"TB control:
One arm of the dual strategy is to control tuberculosis by detecting cases and ensuring that the person gets thorough antibiotic treatment. The discovery of antibiotic drugs which kill bacteria was a turning point in TB control. In the richer countries, the disease formerly known as consump-tion used to be "treated" with a special diet and bed rest, usually in a sanatorium. In the late 1950s, it was established that neither was necessary. TB could be cured with well-supervised antibiotic treatment at home.

A proper combination of anti-tuberculosis drugs achieves both prevention and cure Effective treatment quickly makes the individual non-contagious. This prevents further spread of the TB germ. Achieving a cure takes six months of daily treatment with a combination of antibiotics. To ensure thorough treatment, it is important for the individual to take his or her pills in the presence of someone who can supervise the therapy.""""" This approach – called DOTS (directly observed treatment, short course) – cures the disease in ****95%*** of cases."""""



http://www.medguide.org.zm/aids/tubraids.htm

"Wait a minute. What did you just say? You're predicting $4-a-gallon gas? That's interesting. I hadn't heard that." -- Feb. 28, 2008 --George W. Bush, Washington, D.C.

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viajero123 says on Jul 16, 2008, 14:46:

My girlfriend also tested positive on TB (she also got it in Mexico) and the doctor gave me a skin test to see if I had it too. Fortunately, she didn't pass it to me. She had to take some stupid pills for a really long time and couldn't drink beer at the beach with me!

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sloopskipper says on Jul 17, 2008, 11:28:

docwilliam says on Jul 16, 2008, 04:48: flag

'"Vancomycin orally (cost more than $600 for a few ounces"

Damn Sloop! Was that in the States?'

Yeah Doc, Pennsylvania 2001.

It had to be compounded/mixed in a hospital pharmacy because it was not readily available for oral consumption. I'm sure the Vanco for the the infusion pump was probably even more expensive.

This article states: "The drug must be given intravenously, because it is not absorbed orally.": http://en.wikipedia.org/wiki/Vancomycin

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