“I HOPE MY CHILDREN WILL HAVE A GREAT LIFE” The Kyrgyz family of Zarina got hit hard by extensively drug-resistant tuberculosis (XDR-TB). The mother of five children first lost her husband due to XDR-TB. She herself and her two youngest sons Nursultan and Danyar also fell ill with this form of drug-resistant TB.
It all started when my husband got sick, tells Zarina (37) in the living room/bedroom of her house on the outskirts of Bishkek with the snowy mountains as a backdrop. “When he was diagnosed with TB, he initially started the treatment. At that time he was still on the old regimen. He soon gave up.” Later on Zarina’s husband was diagnosed with multidrug-resistant tuberculosis (MDR-TB) and then XDR-TB after not treating his infection with TB properly.
Also two of Zarina’s children, Nursultan (7) and Danyar (8), were diagnosed with XDR-TB. The two boys were first hospitalized for three months. Then they continued their treatment at home using Video Observed Treatment (VOT). This is a digital adherence tool which KNCV Tuberculosis Foundation (KNCV) has introduced in Kyrgyzstan. Patients show they take their daily pills by sending videos through to the health care worker with a smartphone the family got supplied with. Fortunately, the boys received the new drugs and regimens that were introduced in Kyrgyzstan some years ago as part of the USAID-funded, KNCV-led Challenge TB project. The new treatment models are not only more effective in curing the disease, but they are also easier for patients to follow. The new drugs have fewer side effects. For patients with MDR-TB, the treatment is shorter: between nine and 12 months, instead of 24.
Despite the new drugs the boys still had problems with some side effects. Zarina: “I used to mix the pills with yoghurt but it made them throw up. Danyar also got mental problems. He would throw with things. The KNCV case manager helped us a lot. We are very thankful to her.”
Zarina used to work in the nearby hospital. But she also got infected with TB, fell sick and couldn’t work during the treatment. “I received treatment for six months. With six pills a day.” She really suffered with both herself, her husband and her two children sick. Her younger brother helped her and the family received food aid from the Red Cross. At the end her husband lived at home and couldn’t work. He just drank and smoked. Zarina: “I used to tell him: “Don’t give up”. Stop drinking and smoking. He said no. He said he didn’t believe in the treatment. He died a year ago.” Due to their treatment the kids and Zarina got better. The family now has hope again. Danyar wants to become a doctor when he grows up and help children. Nursultan wants to become a police man “to catch bad guys who steal money”. Zarina is happy that she and the kids are recovered. “I just hope it won’t come back again and that my kids will have a great life.” www.kncvtbc.org
Background Information. An overview of the biggest challenges with antibiotic-medicine treatments for tuberculosis.
The biggest challenges with antibiotic medicine treatments for tuberculosis are multifaceted and include pharmacological interactions, delivery of optimum care, integration of services, treatment duration, drug resistance, and diagnosis delay.
In short; The Research of Aguado et al., 2009, highlights the challenge of pharmacological interactions between rifampin and immunosuppressive drugs in solid-organ recipients, emphasizing the need for careful management of drug combinations.
Riza et al., 2014 emphasized the challenge of delivering optimum care and integrating services for tuberculosis and diabetes, particularly from a health systems perspective
Mathad & Gupta, 2012, pointed out the complications associated with multidrug-resistant tuberculosis regimens in pregnant and postpartum women, underscoring the need for close monitoring and management
Chuang et al., 2016, discussed the primary obstacles to eradicating M. tuberculosis infection, including the need for combination antibiotic treatment and the prolonged duration of treatment due to replication-deficient, antibiotic-tolerant persistent bacteria or persisters
Stanley et al., 2022, emphasized the unrelenting global burden of tuberculosis and the reliance on antibiotics as the most effective tools to save lives and control the spread of Mtb
Furthermore, the challenges of diagnosis delay, treatment-related toxicities, and drug interactions in the management of tuberculosis in lung transplant recipients were highlighted by Cassir et al., 2017.
Additionally, the widespread development of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB) was identified as a significant challenge in treating the disease, Felnagle et al., 2007; Vicente et al., 2008.
The genetic heterogeneity of Mycobacterium tuberculosis within a patient was also noted as a concern that might complicate antibiotic treatment and cause treatment failure, Liu et al., 2015.
Moreover, the ability of M. tuberculosis to form persistent long-term infections that are difficult to treat with antibiotics was highlighted as a hallmark challenge, Hjort et al., 2020.
As conclusion, the challenges with antibiotic medicine treatments for tuberculosis encompass various aspects, including:
- pharmacological interactions,
- delivery of optimum care,
- treatment duration,
- drug resistance,
- diagnosis delay,
- and the ability of M. tuberculosis to form persistent infections.
Addressing these challenges requires a multifaceted approach that considers the complexities of tuberculosis management and the development of effective treatment strategies.
References:
1.Aguado, J., Torre‐Cisneros, J., Fortün, J., Benito, N., Meije, Y., Doblas, A., … & Muñóz, P. (2009). Tuberculosis in solid‐organ transplant recipients: consensus statement of the group for the study of infection in transplant recipients (gesitra) of the spanish society of infectious diseases and clinical microbiology. Clinical Infectious Diseases, 48(9), 1276-1284. https://doi.org/10.1086/597590
2.Cassir, N., Delacroix, R., Gomez, C., Secq, V., Reynaud-Gaubert, M., Thomas, P., … & Drancourt, M. (2017). Transplanted lungs and the “white plague”. Medicine, 96(13), e6173. https://doi.org/10.1097/md.0000000000006173
3.Chuang, Y., Dutta, N., Hung, C., Wu, T., Rubin, H., & Karakousis, P. (2016). Stringent response factors ppx1 and ppk2 play an important role in mycobacterium tuberculosis metabolism, biofilm formation, and sensitivity to isoniazid in vivo. Antimicrobial Agents and Chemotherapy, 60(11), 6460-6470. https://doi.org/10.1128/aac.01139-16
4.Felnagle, E., Rondon, M., Berti, A., Crosby, H., & Thomas, M. (2007). Identification of the biosynthetic gene cluster and an additional gene for resistance to the antituberculosis drug capreomycin. Applied and Environmental Microbiology, 73(13), 4162-4170. https://doi.org/10.1128/aem.00485-07
5.Hjort, K., Jurén, P., Toro, J., Hoffner, S., Andersson, D., & Sandegren, L. (2020). Dynamics of extensive drug resistance evolution of mycobacterium tuberculosis in a single patient during 9 years of disease and treatment. The Journal of Infectious Diseases, 225(6), 1011-1020. https://doi.org/10.1093/infdis/jiaa625
6.Liu, Q., Via, L., Luò, T., Liang, L., Liu, X., Wu, S., … & Gao, Q. (2015). Within patient microevolution of mycobacterium tuberculosis correlates with heterogeneous responses to treatment. Scientific Reports, 5(1). https://doi.org/10.1038/srep17507
7.Mathad, J. and Gupta, A. (2012). Tuberculosis in pregnant and postpartum women: epidemiology, management, and research gaps. Clinical Infectious Diseases, 55(11), 1532-1549. https://doi.org/10.1093/cid/cis732
8.Riza, A., Pearson, F., Ugarte-Gil, C., Alisjahbana, B., Vijver, S., Panduru, N., … & Crevel, R. (2014). Clinical management of concurrent diabetes and tuberculosis and the implications for patient services. The Lancet Diabetes & Endocrinology, 2(9), 740-753. https://doi.org/10.1016/s2213-8587(14)70110-x
9.Stanley, S., Liu, Q., & Fortune, S. (2022). Mycobacterium tuberculosis functional genetic diversity, altered drug sensitivity, and precision medicine. Frontiers in Cellular and Infection Microbiology, 12. https://doi.org/10.3389/fcimb.2022.1007958
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