Maryn McKenna

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CDC: Superbug NDM-1 Spreads Within a US Hospital

June 21, 2012 By Maryn Leave a Comment

Last night, prompted by Michael Coston’s excellent primer on NDM-1 (one of a set of short courses he publishes periodically), I scrolled through the literature to see what had happened recently with the spread of the “Indian superbug” — actually a gene and enzyme that were first spotted in 2008 and create resistance to almost all antibiotics. (My past posts on NDM-1, going back several years, are here.)

There was a lot to see: Cases in countries as varied as Belgium, Japan, Oman, Singapore and China. Indications that transmission of NDM-1, which at first indicated some travel or family connection to South Asia, has become a pan-European problem with clusters in several countries. Concern that international travelers are transporting bacteria containing the gene without realizing it. And, disappointingly, reassurances from within India, in a new study, that it can “easily combat” NDM-1 — though the fact that a study was conducted, as opposed to the problem just being denied out of existence, must be an encouraging sign.

That tour through the literature made me curious what has been happening in the United States since NDM-1 was first identified in patients here two years ago this week, and I made a note to check when I got back to work today. And then the Centers for Disease Control and Prevention forestalled me, by announcing this morning that there have been 13 cases in the United States so far — including two in which the infection apparently spread within the same hospital.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: CDC, CRKP, india, KPC, NDM-1, Science Blogs

Highest Rates Ever Recorded of Multi-Drug-Resistant TB

February 16, 2012 By Maryn Leave a Comment

On the heels of the news of totally drug-resistant (TDR) TB being identified in India — and disavowed, unfortunately, by the Indian government — the World Health Organization has released an update on the background situation of drug-resistant TB around the world.

The news is not good. Drug-resistant TB is at the highest rates ever recorded.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: Africa, Europe, india, Russian, Science Blogs, TB, TDR, Who

TDR-TB: The Indian Government Denies It

January 29, 2012 By Maryn Leave a Comment

An update to the news two weeks ago of totally drug-resistant tuberculosis, TDR-TB, being identified in India (and earlier in Italy and Iran): The Indian government has announced that it doesn’t exist, and is putting pressure on the physicians who identified it to say they made a mistake.

Because, of course, that’s going to keep a disease from spreading.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, india, NDM-1, Resistance, Science Blogs, TB, TDR

Totally Drug-Resistant TB: A Patient Is Missing

January 14, 2012 By Maryn Leave a Comment

There was a lot of interest in  in TDR-TB Friday; both The Leonard Lopate Show on WNYC and Science Friday kindly asked me to be on to talk about it. While I was waiting for the phone link to Science Friday to become live, an alarming bulletin arrived in my e-mail. The early-warning list ProMED reported that the existence of two additional cases of TDR-TB have been disclosed, in Bangalore, 600 miles from Mumbai where the first known Indian cases were identified. The patients, a 56-year-old man and a 29-year-old woman, had been coming to a hospital for directly observed administration of their TB for more than two years; they were initially recognized as MDR-TB patients, with disease that was highly resistant but not untreatable, but were not getting better. For the past two weeks, though, the man has not shown up, and no one appears to know where he is.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: animals, antibiotics, india, Iran, Italy, Resistance, Science Blogs, TB, TDR

Totally Resistant TB: Earliest Cases in Italy

January 12, 2012 By Maryn Leave a Comment

A follow-up to Monday’s post on the recognition in India of totally drug-resistant tuberculosis, TDR-TB: The fantastic early-warning list ProMED points out that the earliest recorded cases of TDR were not the current 12 known cases in Mumbai or the 15 cases in Iran in 2009, but rather two women from Italy who died in 2003 after  being sick for several years.

It’s a sad story that was briefly recounted in 2007 in the journal EuroSurveillance, published by the European Centre for Disease Prevention and Control (ECDC).

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, india, Iran, Italy, Resistance, Science Blogs, TB, TDR

India Reports Completely Drug-Resistant TB

January 9, 2012 By Maryn Leave a Comment

Well, this is a bad way to start the year.

Over the past 48 hours, news has broken in India of the existence of at least 12 patients infected with tuberculosis that has become resistant to all the drugs used against the disease. Physicians in Mumbai are calling the strain TDR, for Totally Drug-Resistant. In other words, it is untreatable as far as they know.

News of some of the cases was published Dec. 21 in an ahead-of-print letter to the journal Clinical Infectious Diseases, which just about everyone missed, including me. (But not, thankfully, the hyper-alert global-health blogger Crawford Kilian, to whom I hat-tip.) That letter describes the discovery and treatment of four cases of TDR-TB since last October. On Saturday, the Times of India disclosed that there are actually 12 known cases just in one hospital, the P. D. Hinduja National Hospital and Medical Research Centre; in the article, Hinduja’s Dr. Amita Athawale admits, “The cases we clinically isolate are just the tip of the iceberg.” And as a followup, the Hindustan Times reported yesterday that most hospitals in the city — by extension, most Indian cities — don’t have the facilities to identify the TDR strain, making it more likely that unrecognized cases can go on to infect others.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, india, Resistance, Science Blogs, TB, TDR

NDM-1 in India: Drug Resistance, Political Resistance

October 16, 2011 By Maryn Leave a Comment

It’s been more than a year since the “Indian superbug” NDM-1 — not actually a bacterium, but a gene that directs production of an enzyme — hit the news. The enzyme, whose acronym is short for New Delhi metallo-beta-lactamase-1, disables almost all antibiotics directed against it, leaving the bacteria in which the gene appears vulnerable to only two imperfect and sometimes toxic drugs.

The enzyme and its gene, blaNDM-1, were first identified in 2008 in people who had traveled in India or sought medical care in South Asia. Hence its name: Many beta-lactamases, enzymes that denature the very large class of everyday antibiotics known as beta-lactams, are named for countries and cities where they were first identified. Since its identification, NDM-1 has been discovered in patients in more than a dozen countries and has also been found to be widely harboured outside hospitals in India, and in surface waters and sewage there.

The unveiling of NDM-1 clearly caused embarrassment for India, and media and lawmakers there struck back, throwing around intemperate language and claiming the naming of the enzyme was a plot to derail the subcontinent’s medical-tourism industry — even though the Indian doctors had attempted to raise the alarm earlier and had been ignored.

So it seemed like a promising signal of openness when an international conference on antibiotic resistance opened in New Delhi a week ago. But in its wake, just what is going on in India — and whether its government is willing to face up to what might be an international crisis — is less clear than ever.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, E. coli, india, Klebsiella, NDM-1, Resistance, Science Blogs, Who

File Under WTF: Did the CIA Fake a Vaccination Campaign?

July 13, 2011 By Maryn Leave a Comment

A number of years ago, I was in New Delhi, at the end of an exhausting 18 hours  in which I had torn around the city to watch a National Immunization Day. On those days — like a national holiday, with flags and banners and kids let out from school — tens of millions of children line up to stick out their tongues and receive the sugary drops that contain the vaccine that should protect them against polio.

The Indian government, along with the Centers for Disease Control, the World Health Organization and the volunteer ground troops of Rotary International, has been organizing these days now for most of two decades, always coming closer to the goal of eradicating polio, never quite getting there. On this day, which occurred close to the end of weeks I had spent embedded with a WHO “STOP Polio” team, 135 million children were expected to queue in cities and suburbs and rich neighborhoods and slums. I spent the day with the team I had been observing, racing in a battered turquoise Tata from neighborhood to neighborhood, trying to understand where the campaign’s message was working and where its earnest persuasions had failed. (You can read my account of the day here.)

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: CDC, CIA, india, polio, Science Blogs, vaccination, Who

WCSJ: Plant Diseases, Farmer Suicides And The Peril of A Hungry Future

July 3, 2011 By Maryn Leave a Comment

Here’s my second report from the World Conference of Science Journalists — and if you thought the first one on diabetes in China was depressing, just wait for this one.

Since I wrote SUPERBUG the book and started this blog, I’ve been fascinated by stresses and problems in food production. (For evidence, see any of this long archive.) This conference in Qatar, which drew 726 journalists, most from the global south, was a chance to hear from people  immersed in food issues in places we in the north don’t know enough about. So for my panel on agriculture and food security, I invited people whom I wanted to learn from.

And wow, did I.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: Africa, agriculture, drought, food, food policy, india, Science Blogs

Superbugs Found in New Delhi's Water and Sewage

April 7, 2011 By Maryn Leave a Comment

Last fall, not long after the bloom of news about the “Indian superbug” NDM-1 — a newly identified enzyme that renders common gut bacteria indifferent to almost all antibiotics — I spoke to one of its lead researchers, Timothy Walsh of the University of Cardiff, about next steps in their research.

His work and his collaborators’ had demonstrated that many of the people infected with or carrying bacteria that incorporated the gene had undergone medical treatment in India and Pakistan, sometimes for elective surgery such as medical tourism, sometimes because they had been injured or ill while traveling. But not all, he said — and that was making them wonder whether the spread of NDM-1 had an environmental component. It was a plausible hypothesis given the apparent concentration of NDM-1 in India, a country whose sanitation systems have not kept up with its booming population. A recent UN report estimated that almost half of India’s residents — that would be up to 650 million people — lack treated drinking water and modern toilets. If you sat down to design a system to facilitate the spread of an enzyme carried by bacteria in the gut — that is, in feces — you couldn’t do better than what India already has.

“There has been very little work done or analysis done on the effect that (poor sanitation) would have on the spread of resistance and on carriage of NDM-1 within a normal population,” Walsh told me at the time. “There’s no water sampling for fecal flora or antibiotic-resistant flora.”

Well, now there is: Walsh and his collaborators have done it. And the news, as they suspected, is bad. [Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, india, NDM-1, Resistance, Science Blogs

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