Tuberculosis, Lung cancer & other lung ailments

[waltky]

People can catch TB from animals...

Animal TB threatens human health say vets and doctors
Fri, 30 Sep 2016 - Animal tuberculosis, which is spread through contaminated food, is a greater threat to human health than previously realised, leading doctors and vets warn.

The disease can be more serious and harder to treat than conventional, human tuberculosis. The world has committed to being free of tuberculosis by 2035. But bodies including the World Health Organization (WHO) say animal TB has been neglected for decades. Raw or unpasteurised milk is one of the most common sources of the infection. But animal tuberculosis - officially known as zoonotic tuberculosis - also affects those in close contact with infected animals including vets, farmers and butchers.

Dr Francisco Olea-Popelka, from the Union Against Tuberculosis and Lung Disease, said zoonotic tuberculosis was "far more common than previously recognised". The best estimates suggest there are around 121,000 new cases of animal TB each year. The figure is tiny compared to human TB, which is the biggest lethal infection in the world. But Dr Olea-Popelka told the BBC News website: "I think we should care." "This is a well-known problem and has been neglected for decades, it is a disease that is preventable, treatable and curable and yet still today we have hundreds of thousands of people suffering from it. "Ten thousand die every year from this disease, that's a lot of cases compared to many other diseases, why not care?" he added.

He is part of a group - including the WHO, the UN Food and Agriculture Organization and the Stop TB Partnership - that has published a call to action in the Lancet Infectious Diseases medical journal. One of the biggest issues the report raises is the unknown scale of the problem. Studies in Mexico suggest 28% of all tuberculosis cases are down to zoonotic TB but a study in India put the figure at 9% and one in children in California suggested a figure of 45%. Dr Paula Fujiwara, from the International Union Against Tuberculosis and Lung Disease, added: "With approximately nine million individuals contracting TB globally each year, even relatively low percentages of zoonotic TB lead to large numbers of people suffering from this form of the disease." "People living with zoonotic TB require specialized care, but in the vast majority of cases, they are not even adequately diagnosed," she added.

Animal TB is caused by Mycobacterium bovis, which is a different infection to human TB caused by Mycobacterium tuberculosis. M. bovis is inherently resistant to one of the key drugs used to treat human TB - pyrazinamide. And Dr Olea-Popelka added: "Once you get zoonotic TB it is often extrapulmonary TB, meaning it is not only in the lungs, but in other organs; that complicates the diagnosis and makes it more difficult to treat." How to tackle animal tuberculosis will be one of the themes of the Union World Conference on Lung Health taking place later this month.

Dr Olea-Popelka said the key strategies for preventing zoonotic were:

* milk pasteurisation
* farmers, butchers, vets and zookeepers protecting themselves from inhaling bacteria
* and preventing the infection in animals in the first place

Each is easier said than done.

http://www.bbc.co.uk/news/health-37498266

[waltky]

Keytruda immunotherapy works either on its own or with chemotherapy....

'New day' in lung cancer as Merck drug shines, works with chemo
October 9, 2016 - Merck & Co scored a double hit on Sunday with new clinical data showing its Keytruda immunotherapy offered big benefits in previously untreated lung cancer patients, either when given on its own or with chemotherapy.

As a monotherapy, Keytruda halved the risk of disease progression and cut overall deaths by 40 percent compared to chemotherapy alone in pre-selected patients whose tumors had been tested using a biomarker. And when given with two older chemotherapy drugs in non-selected patients, it was almost twice as likely to shrink tumors as chemotherapy alone.

Another similar drug from Roche also demonstrated broad efficacy as a so-called second-line option in patients who had received prior treatment. "Remember this day. It's a new day for lung cancer treatment," Stefan Zimmermann of Lausanne's University Hospital told reporters at the European Society for Medical Oncology (ESMO) congress as the results were presented. An editorial in the New England Journal of Medicine, where the Merck monotherapy results were published, said Keytruda could become "a new standard of care".

The various findings suggest that treating lung cancer - the biggest cancer killer globally - with powerful new immune system-boosting medicines is going to involve more permutations than some experts originally expected. Rival drugmaker Bristol-Myers Squibb had tried a catch-all approach with its Opdivo drug but it failed to help previously untreated patients when given on its own in a trial that included people with low levels of a protein called PD-L1.

Keytruda, as a sole agent, was targeted only at patients with high PD-L1, making them more receptive to immunotherapy. Lead researcher Martin Reck of Germany's Lung Clinic Grosshansdorf predicted that testing for the PD-L1 biomarker would now become standard "from today". U.S. regulators are expected to decide whether to approve Keytruda for first-line non-small cell lung cancer, the most common type, by Dec. 24. Merck had already said in June that Keytruda worked in the trial but the scale of the benefit was only disclosed at ESMO.

COMBINATION THERAPY

[waltky]

Complacency Has Allowed TB to Explode...

Global Efforts to Control TB Are Falling Short
October 22, 2016 - This year's U.N. report on tuberculosis was a shocker. The World Health Organization's Global TB Report 2016 said the spread of the disease is larger than previously estimated, and that global efforts to beat it are falling far short of what is needed.

Although the overall number of TB deaths continues to fall across the globe, new data showed 50 percent more cases exist in India than previously thought, so the total number of cases worldwide has increased from 9.6 million to 10.4 million. Six countries - India, Indonesia, China, Nigeria, Pakistan and South Africa - account for 60 percent of the total number of people with TB. Dr. Eric Goosby, the United Nations Special Envoy on Tuberculosis, told VOA in a Skype interview that because of better surveillance, the numbers are more accurate. But on the other hand, he said, not all cases of TB are being counted, because many countries have outdated surveillance systems.

Scientific modeling shows that more than four million people with TB are not being treated, but no one knows where they are. This means the disease is spreading undetected. That, Goosby said, is what worries him. "TB is the threat that can be spread by an aerosolized spread: not by behavior that increases your risk, but by standing behind somebody in line who coughs and infects you with a micro-bacterium. No high-risk behavior associated with it other than [being in the] wrong place at the wrong time." Within weeks after exposure to tuberculosis, a person develops a cough, fever, night sweats, then starts to lose weight. TB usually attacks the lungs, but it can attack any organ. It kills 5,000 people a day, more than the number of people who die of malaria and HIV. "And we cannot find it in our country budgets to prioritize TB as a health threat," Goosby said. Like Ebola, tuberculosis thrives in poor communities, where people live in crowded conditions with poor sanitation and poor nutrition.

As the world learned with Ebola, diseases don't stay put. Modern travel took the Ebola virus around the world, and it can do the same with TB. Yet, Goosby said, people have become complacent about this killer disease. "Our political will has waned, and it has been de-prioritized in ministries of health as the urgent, emergent disease to respond to. As a result, we see TB beginning to increase in the number of deaths it’s causing," the U.N. official told VOA. "We are now at a death rate of 1.8 million a year, which puts TB as the number-one infectious disease killer on the planet." "We can diagnose it, we can treat it with effective anti-microbacterial drugs, and cure it in about 90 percent of cases with the current drugs that are available." The need to find and treat people with TB is urgent because the disease is developing a resistance to the the two most potent TB drugs. The WHO views drug-resistant tuberculosis as a public health crisis that needs to be stopped.

Based on WHO estimates, some 480,000 people contracted multi-drug resistant TB in 2015 - more than half of them in India, China and Russia. And most people who have multi-drug resistant TB are not getting proper treatment. As for the millions of cases that are undocumented, Goosby said, "Every country should know what their portion of that 4.3 million is, and on a geo-mapping level, map out where those new infections are, go find them, identify them and retain them in care. It’s got to be that pro-active." As the United Nations' special envoy on TB, Goosby's challenge is to get presidents and their ministers of health and finance to see how perilous the TB epidemic is. If all countries cooperate, TB can be stopped, Goosby says. The goal is to end the disease by 2030. It's a tall order, but Goosby was a player in the global effort to bring HIV under control. He says it can be done.

http://www.voanews.com/a/global-effo...t/3561916.html

[waltky]

Cuban 'vaccine' for lung cancer gets FDA trial go-ahead...

Cuban lung cancer 'vaccine' gets FDA trial go-ahead
Oct 27, 2016 - Cancer institute in Buffalo, N.Y., to conduct clinical trial of CIMAvax on lung cancer patients

The U.S. Food and Drug administration has authorized the clinical trial of the lung cancer drug CIMAvax, according to New York Gov. Andrew Cuomo. He made the announcement at a news conference in the state capital Albany on Wednesday. The trial will be conducted by Roswell Park Cancer Institute in Buffalo in partnership with Cuba's Centro de Inmunologia Molecular (CIM), CIMAvax's namesake.

CIMAvax is part of the next generation of cancer treatment called immunotherapy, which is a way of triggering the body's natural defences to attack cancer cells. CIMAvax is already used on patients in Cuba with non-small cell lung cancer — reportedly costing as little as $1 to manufacture by one of Cuba's state biotech firms. FDA approval could clear the way for use in the U.S. and other markets.

Cuomo led a trade mission to Cuba in 2015 — a year before U.S. President Barack Obama's historic visit — after learning of the drug's potential by Roswell Park. News of the collaboration comes just as the Obama administration eliminates obstacles to medical research from Cuba. The embargo exemption announced earlier this month by the U.S. Treasury Department's Office of Foreign Assets Control (OFAC) also allows pharmaceuticals from Cuba to apply for FDA clinical trial permission.

http://www.cbc.ca/news/health/lung-c...rial-1.3824223

See also:

Cuban researchers battle lung cancer with a vaccine
Tue August 2, 2016 - A biotech center in Cuba are developing a vaccine to treat lung cancer; Small trials have shown promising results with surviving 11 more months on average

On what appears to be a residential street on the outskirts of Havana, the tan building with a guard gate seems out of place. The building is the Centro de Immunologia Molecular, the Center for Molecular Immunology (CIM), known locally as a thriving hub of biotechnology.

Sliding glass doors lead to a modern-looking lobby with a single receptionist desk, some furniture, and a timeline boasting the center's achievements. A quote from Fidel Castro is emblazoned on the wall. This facility was his idea, after all -- and Cuba would need it.

With much of the medical and pharmaceutical technology and treatments coming from the United States, Castro's country wouldn't have access to it due to an American embargo in place since the early 1960s. Cuba would have to make its own technologies and much of this has happened here, at the CIM.

In the building next to the lobby, researcher Camilo Rodriguez opens the door to a laboratory. Men and women are busy working inside, pipetting liquids into trays and putting tubes in whirling centrifuge machines. Since this place began operating in 1980, it has delivered some serious science. Rodriguez says Cuba has produced more than 70% of the medication needed in the country and produced their own vaccines for 21 different diseases.

MORE

[waltky]

DR-TB Higher than Thought in West Africa...

Drug-Resistant TB Higher than Thought in West Africa
November 03, 2016 - Researchers have found the number of multidrug-resistant tuberculosis cases in West Africa is greater than thought.

Officially, the World Health Organization estimates the incidence of new cases of so-called MDR-TB in the African region is 2 percent, and 17 percent among people who were treated for TB more than once. But investigators on the ground in eight West African countries came up with higher numbers. They report that 6 percent of new cases and 35 percent of retreatment cases are drug-resistant to more than one medication. An analysis of almost 974 sputum samples from TB patients carried out by the West-African Network of Excellence for TB, AIDS and Malaria (WANETAM), found that 39 percent were resistant to at least one first-line antibiotic used to treat tuberculosis. Additionally, bacterial isolates in 22 percent of the samples did not respond to two or more anti-TB drugs.

A doctor examines chest X-rays at a tuberculosis clinic in Gugulethu, Cape Town, South Africa.

The findings are published in the online journal BMC Medicine. WANETAM'S Martin Antonio, with the medical research council unit in Gambia, said the statistics are particularly worrying for the region's 245 million inhabitants who live in one of the poorest corners in the world. "The higher the rates in the community," he explained, "the more likely it is to be spread. And we really need to catch that." Researchers also detected the presence of what is called pre-extensively drug-resistant TB in sputum samples at all study sites in Burkina Faso, Gambia, Ghana, Guinea-Bissau, Mali, Nigeria, Senegal and Togo. These are on the verge of developing into extensively drug-resistant bacteria, which respond to neither first- or second-line drugs.

A doctor examines a child with tuberculosis as her mother holds her at the hospital of Doctors Without Borders (MSF)

The highest proportion of pre-extensive drug resistance was seen in Ghana, in 35 percent of MDR samples. Multidrug-resistant bacteria were most prevalent among patients who'd been treated for TB before in Bamako, Mali, and Lagos, Nigeria. They were four times more likely to be resistant compared to new cases. If the spread of MDR-TB continues at its current pace, according to Antonio, "it means the treatment options for those patients is highly limited. It means more patients may actually die from TB because they may be untreatable." He is calling for West African governments to put aggressive, community-wide TB containment efforts in place as soon as possible to prevent a worsening of the tuberculosis epidemic. That includes beefing up laboratories to conduct rapid testing and treatment of TB, more personnel to make sure patients take their drugs properly, and actively following those who are treated more than once for TB.

http://www.voanews.com/a/drug-resist...a/3579654.html

[waltky]

Artemisinin can be used to treat both malaria and TB...

Study: Ancient Chinese Herb Aids Fight Against TB
December 21, 2016 - Scientists have found that a drug used to treat malaria may also aid in the treatment of tuberculosis. The ancient Chinese herb, artemisinin, has the potential to shorten how long it takes to treat TB, something that could also fight drug resistance to antibiotics.

Scientists say they don't know yet by how much time artemisinin might shorten a course of standard anti-TB drugs, but experiments in the test tube suggest that it could have a significant impact. The bacterium that causes tuberculosis can lie dormant for years before taking advantage of a weakened immune system to 'wake up' and spread. It's believed a significant portion of the world’s population has latent TB. According to the U.S. Centers for Disease Control and Prevention, one-third of the world's population is infected with TB, which killed 1.8 million people in 2015. Experts say those with the active form of the disease also harbor dormant bacteria, a state in which they are largely resistant to antibiotics. That’s why it takes six months or longer to treat TB with antibiotics.

Now, researchers at Michigan State University have discovered that artemisinin, a mainstay of malaria treatment, prevents the pathogen that causes TB from going into a dormant state, exposing more of the bacteria to the drugs. Microbiologist Robert Abramovitch is a TB expert. He notes that many people who start taking antibiotics begin to feel better in a few days, as the active bacteria are killed. So they stop taking their pills, potentially causing a resistant strain of tuberculosis to develop. “It’s the dormant bacteria that take a long time to kill," he stresses. "So if we can kill the dormant bacteria with, let’s say, artemisinin or some of the other compounds we discovered, we can maybe shorten the course of therapy, and by doing that, we can reduce the sorts of clinical behaviors that are driving the evolution of drug resistant strains.” The finding was published in the journal Nature Chemical Biology.

Liquid drops into a laboratory apparatus after the conversion of dihydroartemisinic acid to artemisinin at a laboratory at Berlin's Free University, in Berlin, Germany, Feb. 1, 2012. Artemisinin has been found to have the potential to shorten how long it takes to treat TB.

Abramovitch says TB bacteria need oxygen to thrive. To fight the infection, the body’s immune system lowers oxygen levels. To protect themselves, the bacteria goes dormant. By disrupting the microbe’s oxygen sensor with artemisinin and five other compounds the team discovered, it doesn’t sense the change, remains active and can be killed by the antibiotics.

Until now, scientists couldn’t distinguish the silent bacteria from the active ones to know whether dormant mycobacterium were being killed by different compounds. Abramovitch and colleagues developed a strain of the pathogen that glows bright green. They found it stopped glowing after artemisinin came into contact with the mycobacteria's oxygen biosensor, presumably dying. “So we would all see this as an add-on to current therapies as a way to kill another sub-population of the bacteria during the infection,” Abramovitch said, adding that artemisinin could potentially be used with the drug isoniazid, the first line antibiotic used for the treatment of tuberculosis.

http://www.voanews.com/a/tb-tubercul...n/3645555.html

[Common]

My cousin was a Deputy Warden of a max security prison now retired.
He said for the first 15 yrs of his career they had a TB ward that was constantly full of inmates with TB.
By the end of his career the tb ward was dismantled and they had gone 6 yrs without a single inmate having tb.
TB was licked in the USA, immigrants made it have a comeback

[waltky]

So. Africa sees rise in XDR-TB cases...

Extensively Drug-Resistant TB on the Rise in South Africa
January 18, 2017 | Extensively drug-resistant tuberculosis, the most dangerous form of TB, is on the rise in South Africa, according to a new study. So-called XDR-TB does not respond to four or more drugs typically used to treat tuberculosis, making the condition potentially lethal.

Researchers at the U.S. Centers for Disease Control and Prevention in Atlanta, Georgia, say extensively drug-resistant tuberculosis has spread from person-to-person in South Africa's KwaZulu-Natal province, contributing to a tenfold increase in the number of cases in the country since 2002. The finding explains why it has been difficult to contain the epidemic, despite improvements in diagnosis and implementation of a system to ensure tuberculosis patients take all their prescribed medications. XDR-TB does not respond to two first-line drugs commonly used to treat TB, and it is resistant to at least two second-line drugs. Without treatment, the condition is fatal. Researchers studied 404 patients with XDR-TB to determine whether their TB had become resistant due inadequate treatment, or whether the disease was contracted through contact with another person.

A doctor examines chest X-rays at a tuberculosis clinic in Gugulethu, Cape Town, South Africa

Reporting in the New England Journal of Medicine, co-author Sarita Shah said 69 percent of the cases were transmitted person-to-person. "What this really means is that we have got to focus our attention on breaking the cycle of transmission by evaluating people who are in close contact in households, in health centers, in people who are in the community where we have been able to show in this study that the disease is being transmitted," said Shah, associate chief for science in the Division of Global HIV and TB at the CDC. Tuberculosis is a common infection in people living with AIDS. In recent years, drug resistance has begun to emerge, particularly among those who do not take their medications as prescribed. Usually, however, drugs can be found to fight the illness.

A patient who tested positive for extensively drug-resistant tuberculosis (XDR-TB) awaits treatment at a rural hospital in South Africa's impoverished KwaZulu-Natal province.

With XDR-TB, the choices become much narrower and the drugs that can be used are less effective. That makes the condition expensive and very hard to treat. By entering the community unchecked, drug-resistant TB becomes very difficult to contain, according to Shah, which puts the lives of tens of millions of people at risk. Public health officials must try to identify who is infected to keep the disease from spreading further, Shah says. "In about 30 percent of our [research] participants, we were able to identify specific links between people showing transmission occurs from person-to-person,” she said. “Half of these were occurring in hospital settings and the other half were in households ... among family members or close members in the community."

Investigators used social network analysis and genetic fingerprinting to trace cases of the disease to their source. But the work was time consuming, adding to the already difficult task of disease containment and treatment. It is not just South Africa that is experiencing a rising problem with multi-drug resistant strains of tuberculosis. Shah says more than 100 countries are now battling the disease.

http://www.voanews.com/a/extensively...a/3682432.html

[Peter1469]

It is here in the US as well. It is coming with the migrant flow from the south.

[waltky]

New Blood Test For Detecting TB Risk in Children...

Blood Test Called Highly Effective in Detecting TB Risk in Children
February 21, 2017 - A simple blood test is highly effective at identifying children infected with tuberculosis so they can be treated before it progresses to a life-threatening disease, according to research by scientists who say it is often difficult to diagnose TB in children.

One of the biggest challenges in the global war on TB is identifying people early so they can be treated before the disease becomes full-blown and potentially fatal. Finding TB in young children, in particular, poses a hurdle because youngsters often can’t produce a sputum sample necessary to diagnose the disease. The other problem, according to infectious disease specialist Jason Andrews of Stanford University, is children’s infections often settle in their kidney, spine or brain. Unlike TB infections in the lungs, a sputum test cannot diagnose infection in other organs.

'Vast majority can be cured'

“If you find them early and treat them, the vast majority — close to 100 percent — can be cured,” Andrews said. “For the preventive therapy [in children with latent infection], a single antibiotic can be given that has very good ability to prevent against going on to develop active disease." Andrews and his colleagues conducted a study on the use of a blood test to diagnose children at risk of developing TB and found it highly effective. While the test, called QuantiFERON, is sometimes used in adults, the World Health Organization (WHO) does not recommend it for children. The researchers analyzed the data from a clinical trial of an experimental TB vaccine trial in South Africa, just outside Cape Town. The vaccine turned out to be a flop, but investigators were curious about how well the blood test performed in diagnosing latent TB in young children — those at highest risk of developing an active infection.

2,500 children tested

The study involved approximately 2,500 healthy, HIV-negative babies and children. At the start, none was infected with the TB bacterium. The test was repeated one year later, to check for the development of an infection. At that point, 172 of the children tested positive for TB, and 30 were already being treated. Researchers then looked at data on the other 142 kids who had not yet developed active disease.

Testing them at the two-year mark, they found that those children with the highest levels of a blood biomarker called interferon gamma had a 40-fold increase in the risk of developing active tuberculosis. “When we saw the data in children, we were just astounded by the exceptional predictive value that it had,” Andrews said. The study was published in the journal The Lancet Respiratory Medicine. Based on the findings, Andrews would like to see the WHO change its recommendation to include the use of the blood test in children.

Powerful killer

See also:

Lab on a Paper Card Can Test Drugs for Purity
February 22, 2017 — Whether it’s brake fluid in Nigerian teething syrup, melamine in Chinese baby formula, or talcum powder in Kenyan antibiotics, contaminated food and medicine is a deadly problem. But a group of scientists, led by Notre Dame chemistry professor Marya Lieberman, hopes to eliminate the problem for millions of people in developing nations by offering a simple solution.=

A ‘lab on paper’

The PAD - or Paper Analytical Device - project began six years ago as a collaboration between Notre Dame and St. Mary's College. The simple invention replaces expensive machinery that might not be available in developing countries. Each of the 12 lines on the paper card is laced with a different chemical. When medicine is smeared across the lines and the card is soaked in water, a color change indicates whether the drug is safe. Drugs can be tested at any stage of the distribution process.

While not all alterations are deadly in and of themselves, not getting the right medicine or the correct dosage can still have fatal consequences for severely ill patients. “One in ten children who go to the hospital with pneumonia in Kenya don’t make it out,” Lieberman notes. “That’s because there is kind of a golden hour for patients to recover. If they don’t get the needed medicine in the correct dose, bacteria take over and they won’t make it.” During a trip to Kenya last year, her team discovered amoxicillin caplets cut by half with talcum powder. In that case, they devised a simple water test to check for purity. But most contamination cases need a more comprehensive test to discover errors.

A world of contaminants

In addition to testing pharmaceuticals, Lieberman’s team is developing cards to test lead, iodine, and even urine. Notre Dame graduate student Jamie Luther is working on a card to identify contaminants in milk. "There are tests that are published for people at home to mix chemicals to test their own milk,” she says. “I thought to myself, that’s so cumbersome. People shouldn’t be handling acids in their home. They shouldn’t mix dangerous chemicals with their hands." In order to discover the most common contaminants, Lieberman’s team works with 18 universities throughout the U.S. The labs use High Performance Liquid Chromatography (HPLC) machines to test drugs gathered from pharmacies throughout the developing world.

Notre Dame graduate student Nicholas Myers never considered what a big problem altered pharmaceuticals were before he started working on the project. "I just took it for granted that chemical analysis could happen anywhere,” Myers admitted. “I didn’t know the extent to which low and middle income countries did not have the capacity to do chemical testing." Veripad, a New York startup company is developing a complimentary smartphone app to help read and evaluate the cards. Because less experienced testers may not fully understand color results, and some may be color blind, the app takes away the guesswork. Testers can take a photo with their phones and get almost instantaneous results.

Lieberman says if there’s one thing this project has taught her, it’s that it’s sometimes necessary to look at a problem from a new angle to find the best answer. "If we can’t increase the capacity of analytical labs in the developing world,” she observes, “maybe we can come up with a way to bring that technology in a portable form that will be usable in the field." The World Health Organization says a functioning health care system should have 343 pharmaceuticals on hand. So far, Lieberman’s team has developed PADs to identify 60 different drugs and eventually hopes to have tests for them all.

http://www.voanews.com/a/lab-on-a-pa...y/3734740.html