HEALTH
SUPPLEMENT
THE WEEKLY OBSERVER THURSDAY, jANUARY 19, 2017
The Race Against Superbugs A new generation of drug-resistant pathogens are testing the defenses against major diseases Rishiraj Bhagawati
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astSeptember a woman died in the United States after being infected by a superbug during a trip to India. Doctors said that the infection was caused by a multidrug-resistant organism carrying an enzyme with an Indian name. The New Delhi metallo-beta-lactamase (NDM-1) has been found to make a pathogen (a microorganism known to carry a disease) resistant to around 26 different antibiotic drugs, rendering the pathogen a superbug. The Times of India reported in September 2015 that NDM-1 has now spread to over 70 countries and has covered most major regions in the world. There are four categories of antibiotics, set in ascending order of their power to act upon pathogens. If a pathogen is immune to a Type-4 antibiotic— which includes those of the Carbapenem family —the pathogen is deemed a superbug. The ability to break antibiotics down and thus remain immune to them is made possible by certain enzymes. NDM-1 is one such enzyme, and not a superbug as some have mistakenly suggested, which when carried by bacteria like E coli and Klebsiella, makes them superbugs. The organism that infected the American woman was also intermittently resistant to tigecycline, an antibiotic specifically developed to treat drug-resistant organisms. Essentially, there were no treatment alternatives left. Superbugs carrying NDM-1 were first identified in a Swedish patient returning from New Delhi in 2008. The Times report says that joint research by scientists
from Rice, Nankai and Tianjin universities had recently found superbugs carrying NDM-1 in wastewater disinfected by chlorination. What this means is that chlorination, the most common domestic method to purify water, does not kill the superbugs carrying NDM-1 and may even help it thrive. The report went on to state that tests at two wastewater treatment plants in northern China had revealed that antibiotic-resistant bacteria carrying the deadly enzyme were not only escaping purification but also breeding
and spreading their dangerous cargo. The implication of this seems to be that we have to redesign the method and equipment used for wastewater treatment. The report also said that in New Delhi, Cardiff University scientists had found that the NDM-1 gene had already spread to the bacteria that cause cholera and dysentery in
India. This means that it will now be more difficult to treat cholera and dysentery with traditional antibiotics, and by extrapolation, may result in the return of these diseases on a significant scale. Additionally, the temperature range at which the superbugs carrying NDM-1 thrive best in coincides with the usual temperature in North India. But that fact is not enough to predict that their numbers will increase significantly in the near future; superbugs need specific nutrients to survive and replicate, and there is no evidence to show that these are adequately available here. However, it is also worth noting that the NDM-1 enzyme is particularly mobile, which means that they do not remain local to the pathogen carrying it. The enzymes that create resistance to antibiotic drugs are carried on mobile pieces of DNA which are called plasmids, and can easily spread on to other types of bacteria. People have pointed to a myriad reasons as to how superbugs took birth at all, the most commonly agreed upon of which is misuse of antibiotics. When doctors prescribe more antibiotics than are required or prescribe antibiotics for non-bacterial infections, pathogens build resistance against the drugs instead of getting wiped out. Over time, they have overcome (almost) all antibiotic drugs ever administered. While it seems like we have a major public problem at hand, research is underway at top laboratories around the world to come up with a new generation of antibiotics to counter superbugs – even if they too ultimately prove as short-lived as their predecessors.
Giving the Gift of Life
Despite knowing their lives might one day depend upon the kindness of strangers, few people are willing to donate their organs after death. Mrigakshi Dixit
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second life is the ultimate gift a person can ever receive. That’s precisely what the donation of a vital organ, a scientific miracle in itself, is and one, moreover, that’s within everybody’s power to give. Sadly, although there are many in need, they find few willing to give them that precious gift. According to the Organ Procurement and Transplantation Network,last year more than 24,891 organs were transplanted around the world. However, there still aremany thousands more awaiting a lifesaving organ transplant. The Mohan Foundation, an NGO, estimates the organ-donation rate in India is just 0.26 per million while the United States and Spain boastdonation rates of 26per million and 35.3 per million respectively. In India Tamil Nadu, Maharashtra and Kerala have registered the highest number of organ donations, the numbers donated standing at 519, 216 and 222 respectively, in 2015. Organ donation can be classified into three types: brain-stem death, circulatory death and living donation. In 1994, the government of India passed the Transplantation of Human Organ Act that allowed for organs to be donated aftera person was declared brain dead. In India, around 3,500-4,000 transplants take place in a year according to World Health Organisation (WHO). “Many people in India are still unaware of the concept of brain death,”says Priyanka Shailendra, director operations at Gift Your Organ Foundation. With the increasing number of cases of kid-
ney and liver failurereported in India, there is a huge demand for both organs.Between 1971 and 2016,just 21,395 kidneys have been transplanted. “In Karnataka, just for kidney transplant there are 200 patients on the waiting list. There is a severe shortage of donorsand over 1.9lakh patients are surviving on dialysis,” says Shailendra. Almost70% of liver transplants are made possibleby live donors and 30% receive cadaver donations. Over the past few years, India has been facing a grow-
ing mismatch between demand and supply of organs. “Hospitals in Bengaluru like Fortis, Apollo and Manipal are licensed for the donation of only specific organs,” said Shailendra.’ In many parts of India there is lack of specialised doctors and infrastructure. Apart from the lack of awareness, these factors also contribute to the shortage of organs. People need to be educated about the benefits of organ donation in order to increase their awareness.Our NGO has conducted surveys that show most people are ignorant about the procedure for donation. Gift your organ foundation organises several seminars to educate people,” she adds. The shortfall in the availability of organs has given rise to a thriving black market. India is a global hub of the kidney racket and many poor people are lured to donate their kidneys for money. Several cases have been reported in Uttar Pradesh where kidneys harvested locally have been taken to the United States for transplant. Althoughthe Transplantation of Human Organs and Tissues 2011 Act provides protection against organ trafficking, many rackets thrive in the country. According to reports by WHO, 2,000 people sell their kidney every year. Many illegal organ donation cases have been reported in the last few yearslike the Indraprashtha Apollo Kidney racket in 2016 and Gurgaon Kidney scandal in 2008. With the great strides that technology is taking today, Shailendra believes that organ donation has a bright future and will be able to save more lives but provided there is greater awareness. After all, one day you may be to live longer because somebody thoughtful and compassionate decided to donate her organs.