China’s Ningxia Hospital sees more TB cases a year than the whole of Australia. 
A new project at the hospital, in collaboration with researchers from the Centenary Institute in Sydney, aims to identify a new way of diagnosing TB and monitoring response to treatment. The research is funded in part by the Australian Respiratory Council.
The Ningxia Infectious Diseases Hospital sees as many as 1,300 new cases of TB each year. ‘Treating that many cases is difficult with limited resources.
Tuberculosis grows slowly and can take weeks to culture, which delays diagnosis,” says one of the project’s chief investigators Dr Simone Barry of the Centenary Institute.
“Many people also put off seeing their doctor due to stigma and also fear, and this again delays diagnosis. It is during this time, before a person starts on treatment that they can pass on the bacteria to other people. Each undiagnosed case of TB will infect on average another 10-14 people each year. Drug resistance is also a big problem. Often, due to financial reasons or a lack of understanding, patients stop taking their drugs too early and it is at this time that resistant strains develop. The patient may then infect family and friends with resistant strains that are much harder to treat.”
Most patients in Ningxai Hui Automous Region (NHAR) are rural and access to specialised treatment facilities can be difficult. Standard TB treatment is six months of continuous multiple antibiotic therapy. The difficulties in diagnosis and treatment, particularly if people don’t take their medication constantly are a major health burden for the region. New ways to diagnosis and monitor patients would help case management.
Traditionally a sample of the patient’s spit is cultured in a laboratory, a process that usually takes several weeks. It requires highly trained staff working in a specialised containment laboratory.
“This hospital on its own will diagnose about 1,300 cases a year which is 30 per cent more than all of Australia combined,” says the Centenary Institute’s Magda Ellis who also conducts TB research in the region.
“Clearly when you’ve got that number of TB patients there’s no way you could treat them in the same way you would treat a patient here in Australia,” she says.
In order for doctors to detect cases early and provide rapid responses to developments in the disease they need better diagnostic tools.
The trial is aimed at discovering new methods for faster confirmation of TB infection and monitoring treatment progress. The team from Sydney believe that analysing the patient’s blood for specific disease markers holds the best hope.
“We hope that with this biomarker approach we can develop a test that is rapid, easy to use and accessible,” says Dr Barry.
These biomarkers in the patient’s blood indicate whether the disease is present and how well the body is fighting it. This approach focuses on short segments of genetic material that regulate the body’s cellular functions and is a method that has recently led to new tools for detecting cancer and neurological disorders.
The prevalence of the disease in NHAR is estimated to be more than 100 times higher than in Australia, with over 600 cases of TB per 100,000 people. Researchers suspect that even these numbers may underestimate the size of the problem.
“You’re looking at a significant proportion of patients that are undiagnosed in the province. It’s these undiagnosed cases that are the sources of ongoing transmission,” says Dr Ellis.
That’s the focus of another project in Vietnam where Centenary Institute researchers are contributing to a project to screen community members and detect TB cases earlier.
For more information: www.centenarynews.org.au
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