Survival from XDR-TB is associated with modifiable clinical characteristics in rural South Africa

Background

Drug-resistant tuberculosis (TB) is a major threat to global public health. Patients with extensively drug-resistant TB (XDR-TB), particularly those with HIV-coinfection, experience high and accelerated mortality with limited available interventions. To determine modifiable factors associated with survival, we evaluated XDR-TB patients from a community-based hospital in rural South Africa where a large number of XDR-TB cases were first detected.

Methodology/Principal Findings

A retrospective case control study was conducted of XDR-TB patients diagnosed from 2005–2008. Survivors, those alive at 180 days from diagnostic sputum collection date, were compared with controls who died within 180 days. Clinical, laboratory and microbiological correlates of survival were assessed in 69 survivors (median survival 565 days [IQR 384–774] and 73 non-survivors (median survival 34 days [IQR 18–90]). Among 129 HIV+ patients, multivariate analyses of modifiable factors demonstrated that negative AFB smear (AOR 8.4, CI 1.84–38.21), a lower laboratory index of routine laboratory findings (AOR 0.48, CI 0.22–1.02), CD4>200 cells/mm³ (AOR 11.53, 1.1–119.32), and receipt of antiretroviral therapy (AOR 20.9, CI 1.16–376.83) were independently associated with survival from XDR-TB.

Conclusions/Significance

Survival from XDR-TB with HIV-coinfection is associated with less advanced stages of both diseases at time of diagnosis, absence of laboratory markers indicative of multiorgan dysfunction, and provision of antiretroviral therapy. Survival can be increased by addressing these modifiable risk factors through policy changes and improved clinical management. Health planners and clinicians should develop programmes focusing on earlier case finding and integration of HIV and drug-resistant TB diagnostic, therapeutic, and preventive activities.     

The Maloti minnow Pseudobarbus quathlambae (Barnard, 1938) is not extinct in South Africa

Despite concerted surveys, the Maloti minnow Pseudobarbus quathlambae (Barnard 1938) had not been recorded in South African waters for almost eighty years since the original collections were made at the type locality in the upper uMkhomazana River in 1938. The species was therefore declared extinct in South Africa, whereas extant populations were considered confined to various rivers in the Lesotho highlands. In April 2017, however, this species was rediscovered in the Mzimkhulu River system in KwaZulu-Natal. The rediscovery of a species that was considered locally extinct supports the need for extensive surveys to determine its distribution range, estimate population sizes, assess conservation status and implement effective strategies to ensure its continued existence in KwaZulu-Natal.     

Epidemic levels of drug resistant tuberculosis (MDR and XDR-TB) in a high HIV prevalence setting in Khayelitsha, South Africa

Background

Although multidrug-resistant tuberculosis (MDR-TB) is emerging as a significant threat to tuberculosis control in high HIV prevalence countries such as South Africa, limited data is available on the burden of drug resistant tuberculosis and any association with HIV in such settings. We conducted a community-based representative survey to assess the MDR-TB burden in Khayelitsha, an urban township in South Africa with high HIV and TB prevalence.

Methodology/Principal Findings

A cross-sectional survey was conducted among adult clinic attendees suspected for pulmonary tuberculosis in two large primary care clinics, together constituting 50% of the tuberculosis burden in Khayelitsha. Drug susceptibility testing (DST) for isoniazid and rifampicin was conducted using a line probe assay on positive sputum cultures, and with culture-based DST for first and second-line drugs. Between May and November 2008, culture positive pulmonary tuberculosis was diagnosed in 271 new and 264 previously treated tuberculosis suspects (sample enriched with previously treated cases). Among those with known HIV status, 55% and 71% were HIV infected respectively. MDR-TB was diagnosed in 3.3% and 7.7% of new and previously treated cases. These figures equate to an estimated case notification rate for MDR-TB of 51/100,000/year, with new cases constituting 55% of the estimated MDR-TB burden. HIV infection was not significantly associated with rifampicin resistance in multivariate analyses.

Conclusions/Significance

There is an extremely high burden of MDR-TB in this setting, most likely representing ongoing transmission. These data highlight the need to diagnose drug resistance among all TB cases, and for innovative models of case detection and treatment for MDR-TB, in order to interrupt transmission and control this emerging epidemic.     

Theory from the South: Or,how Euro-America is Evolving Toward Africa

‘The Global South’ has become a shorthand for the world of non-European, postcolonial peoples. Synonymous with uncertain development, unorthodox economies, failed states, and nations fraught with corruption, poverty, and strife, it is that half of the world about which the ‘Global North’ spins theories. Rarely is it seen as a source of theory and explanation for world historical events. Yet, as many nation-states of the Northern Hemisphere experience increasing fiscal meltdown, state privatization, corruption, and ethnic conflict, it seems as though they are evolving southward, so to speak, in both positive and problematic ways. Is this so? In what measure? What might this mean for the very dualism on which such global oppositions rest? Drawing on recent research, primarily in Africa, this paper touches on a range of familiar themes—law, labor, and the contours of contemporary capitalism—in order to ask how we might understand these things with theory developed from an ‘ex-centric’ vantage. This view renders some key problems of our time at once strange and familiar, giving an ironic twist to the evolutionary pathways long assumed by social scientists.     

Biotechnology in South Africa

Since adopting the National Biotechnology Strategy in 2001, the South African government has established several regional innovation centres and has put in place initiatives to encourage international partnerships that can spur internal development of life science ventures. This strategy seeks to capitalize on the high quality of research carried out in public research institutions and universities but is hampered, somewhat, by the lack of entrepreneurial culture among South African researchers due to, among other reasons, the expenses involved in registering foreign patents. Although private sector development is still relatively embryonic, start-ups are spinning out of universities and pre-existing companies. These represent a vital source of innovations for commercialization in the future, provided that the challenges facing the emerging South African biotechnology industry can be overcome.     

Biotech in South Africa

Cover illustration: Biotech in South Africa. This BTJ special issue is edited by Professor Don Cowan (Cape Town, South Africa) and highlights many aspects on South African research and industry, ecology and economy. Images © Don Cowan (grasslands at the base of the Drakensberg Mountains, KwaZulu-Natal Province, SA), USGS (coal), USFDA (sugarcane) and Corbis Digital Stock (vines).