This mother blamed the menopause for her symptoms – until her doctor unveiled the truth’
My whole body ached as I woke stiff, unrested and shiny from night sweats. The bruises on my shins throbbed. I forced myself into action, organising breakfast while snapping at my children.
It was clearly going to be another non-functioning day.’
Shyama Perera was 46 when she started to feel ill. From there her decline was gradual but soon became debilitating. Climbing the stairs was exhausting; she would drive to her local shop instead of walking; her productivity at work plummeted.
At first, Shyama blamed the menopause. But her condition continued to worsen until it began having an impact on her whole family.
A journalist and broadcaster (frequently seen as a newspaper reviewer on BBC news), Shyama’s inability to work forced her to re-mortgage her family home.
After her 50th birthday, she visited her GP seeking hormone-replacement therapy to ease the impact of the menopause. Shyama told the Daily Mail that while listing her symptoms, she was interrupted by her doctor:
‘Bruises on your shins? That’s not bruising – It’s erythema nodosum. I think your immune system is under attack.’
After a few tests, the underlying cause of Shyama’s illness had been uncovered: tuberculosis.
Tuberculosis – or TB – is an infectious disease spread by bacteria which primarily affects the lungs. Left untreated, it kills around 50% of those infected.
At the end of the 20th century, experts thought TB had been successfully defeated in most Western countries thanks to antibiotics as well as improved healthcare and living conditions..
But today, cities like London are seeing so many cases that they have rolled out a mobile ‘TB van’ to offer free chest x-rays – an established TB screening method.
The number of people with TB in Europe is up but that’s not the worst of it. The real story is that many of these cases are resistant to the best treatments we’ve got.
Patients often take a cocktail of medications for months – or even years – in order to beat the bug. However, even if they stick with the lengthy drug regimen, the disease can persist.
So-called multi-drug resistant tuberculosis (MDR-TB) is extremely serious. Valuable time can be lost giving patients the wrong medicines to treat the particular type of TB that is making them sick.
In some cases, by the time doctors find the right drug, the patient’s lungs are so badly damaged that they will never make a full recovery.
The World Health Organisation estimates that 5% of the world’s 11 million TB cases have multi drug-resistance disease (MDR-TB), with approximately 480,000 new MDR-TB cases and 210,000 deaths in 2013.
Europe needs some high-tech help.
And, thanks to researchers at the London School of Hygiene and Tropical Medicine (LSHTM), a solution may be at hand.
Scientists have pulled together a number of cutting edge technologies – gene sequencing, bioinformatics and microbiology – to come up with a prototype that will help doctors chose the right drug first time, every time.
It works like this: when a TB patient turns up at a hospital, their doctor takes a sputum sample (mucus coughed up from the lower airway). This is then taken to the lab where scientists use gene sequencing techniques to map the DNA of the bacteria that’s causing the TB infection.
From there, this information can be uploaded to a free online tool which instantly checks which of 11 treatment options would work best. If the bug is resistant to several of these treatments, the system tells doctors to avoid these drugs and pick the next best option.
Speaking to ThisIsMedTech¸ Dr Taane Clark, the lead researcher behind the project said this approach could be a big improvement on the current practice.
“One of the roadblocks to treating TB is the need to culture the bacteria [grow it in the lab] and challenge it with drugs to see if it’s resistant. Waiting for it to grow can take weeks or months,” he says.
Taane’s system offers a much quicker solution, offering real-time results that guide doctors’ decision-making. This ensures earlier and more effective treatment, saving time, money and offering patients the best chance of recovery.
“When the raw sequence data is uploaded, the system searches for more than 1,000 point mutations – or changes – in the DNA code to check for those associated with drug resistance,” he says.
Gene sequencing is still a relatively new technique but is becoming more common, according to Taane. “Sequencing costs are coming down and this will become routine quite shortly,” he says.
Drug-resistant TB is part of a much wider problem facing Europe – antimicrobial resistance (AMR).
At the end of May, the WHO set out a five-point plan for tackling AMR and the European Parliament has recently lent its weight to a series of proposals designed to tackle the problem.
Magdalena Kalata, Chair of the Access to Therapeutic Innovation Sub-Committee of the European Health Parliament – a platform for young professionals brainstorming the future of Europe’s healthcare systems – says that while MDR-TB is often seen as an issue for poorer countries but can spread with ease.
“The incidence has been higher in Eastern European countries, notably in rural communities, where the access to timely diagnosis and the right medication is an issue,” she told ThisIsMedTech.
“But infectious illnesses are not confined to national borders – people move around and it is quite easily spread.”
Commenting on the new online screening tool developed by the LSHTM, Magdalena said this approach had “big potential to streamline treatments.”
“With multi-drug resistant TB in particular, early diagnosis is essential so that the damage to patients is minimised.”
It seems Europe has a serious problem with MDR-TB and once the disease is present in the EU it enjoys visa-free travel throughout the EU. New high-tech solutions could help to spare thousands of Europeans the trauma that Shyama – and many more like her – have had to endure.