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The World Health Organization is worried about a new outbreak of tuberculosis in South Africa. This strain is known as extremely drug-resistant tuberculosis, or XDRTB. About 100 cases have been diagnosed so far. Scientists believe many cases are going undetected and fear the outbreak could spread.
Suzanne Marmion reports from Johannesburg.
SUZANNE MARMION: So-called XDRTB is a strain of tuberculosis that's resistant to treatment with most existing drugs. Studies have found cases of the disease worldwide. The first cases in South Africa cropped up recently in the poor township in the KwaZulu-Natal Province.
SOUNDBITE OF TRAFFIC
Nearly all of the dozens of people initially infected with XDRTB in South Africa quickly died. Now the disease has moved northwest to a major urban center, Johannesburg. Currently, a handful of people still alive with XDRTB in Johannesburg are being held in quarantine in a special hospital.
The Sizwe Tropical Disease Hospital is located on so much land in the middle of the city that monkeys and wild guinea fowl wander the rolling grounds. There are bars on the hospital windows and no patients could be interviewed for fear of spreading the airborne infection.
Dr. Patrick Madoona(ph) has been overseeing the patients' care. He says he's worried there may be many people outside the hospital infected with XDRTB but they don't know it yet.
Dr. PATRICK MADOONA (Physician, Sizwe Tropical Disease Hospital): The biggest problem that we're having is the testing. Currently, we have to wait for a long time before we get the results back.
MARMION: A long time means at least a month. Dr. Madoona says patients are routinely sent home to wait for TB results. TB is the main direct cause of death of people infected with HIV. As a result, the emergence of XDRTB poses a grave public health risk, especially in places like South Africa, where 5.5 million people are infected with HIV.
Dr. MADOONA: So while the patient is at home or interacting with others, there might be a problem of this resistant bacteria being transferred to other people.
MARMION: Dr. Madoona says one XDRTB patient left Sizwe Hospital in the midst of testing. She was returned to treatment within days, but not before she'd spent some time at home in the nearby township of Alexandra.
SOUNDBITE OF STREET NOISE
MARMION: Corrugated iron shacks leaning against one another line the crowded streets of Alexandra Township. As many as eight people will live and sleep in a single room here. It's easy to share illnesses in such close quarters. Alexandra's local clinics are packed.
About 60 patients sit in plastic chairs at this clinic waiting for treatments. Wakiboi Ugandwane(ph) is HIV positive and caught TB while he was volunteering at a clinic like this one. Ordinary TB like his case can be cured, but Ugandwane says it took 10 months.
Mr. WAKIBOI UGANDWANE: It is very difficult to be on TB (unintelligible) because you have to take your pills every single day and the side effects are really intolerable. You get nausea. Sometimes you vomit. You might get the swelling of the feet. So it's very difficult to stay on the treatment, which is why I believe sometimes people default.
MARMION: When people default, or miss some of their doses, they may unwittingly create drug-resistant TB. Health officials have tried to battle this with something called Directly Observed Treatment Strategy, or DOTS. Authorized observers watch as people take their medicine every day. Ugandwane says poverty can make the strategy impossible for many people in South Africa.
Mr. UGANDWANE: The fact that you have to go to the clinic every single day for treatment - sometimes you have to take a taxi because the clinic is very far from you - it becomes very difficult in that way.
MARMION: The World Health Organization convened an urgent meeting in South Africa last month. Mario Raviglione heads the WHO's Stop TB program.
Dr. MARIO RAVIGLIONE (Director, Stop TB Partnership, World Health Organization): With the flow of individuals these days with migration, with movements, you know, we live in a global (unintelligible), so what happens in one part of the world can influence later on what happens in other parts of the world.
MARMION: Raviglione says the tragedy is that ordinary tuberculosis could be dealt with before it gets out of control. But it's a disease that governments have marginalized and often ignored.
For NPR News, I'm Suzanne Marmion in Johannesburg. Transcript provided by NPR, Copyright NPR.
