Post by navanavonmilitaIndia is SHIT-Scared About New Delhi Metallo-1: Sid Harth
Fear And Loathing In India Over 'Superbug' Study
Categories: Health, Foreign News
12:22 pm
August 13, 2010
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by Scott Neuman
Indian officials are trotting out conspiracy theories to explain away
a report in the respected British medical journal, The Lancet, that a
drug-resistant "superbug" (an enzyme that infects bacteria, actually)
had been picked up by medical tourists to the South Asian country.
The enzyme has been, at least from the Indian perspective, unhelpfully
named after the country's capital: it's called New Delhi-Metallo-1, or
NDM-1.
Indian Health Minister Ghulam Nabi Azad has asked publicly whether
'ulterior motives' were at work with the Lancet paper, noting that
foreign pharmaceutical companies that produce antibiotics had provided
some of the funding.
It (superbug) is universal and is found in the intestine of humans and
animals. It is wrong to say that it is found only in India and
Pakistan. They say it was found in patients who visit India and
Pakistan. The study nowhere mentions if the bacteria were found even
before those persons visited India.
A prominent member of the main opposition Hindu-nationalist party, the
BJP, echoed the implication that foreign pharmaceutical companies
might be pulling the strings and expressed concern that it could hurt
India's burgeoning medical tourism industry. The Hindustan Times
It may be a sinister design of multinational companies around the
world," he said, adding that with globalisation, it was not just
populations that were migrating, but also virus [sic] and bacteria.
A bit more perspective in The Times of India story had the CEO of
India's chain of Apollo Hospitals calling for "an approach that is
more corrective than alarmist."
India, like Thailand, has become a medical tourism mecca, as
foreigners flock there to get cheaper - and frequently better -
medical care than in their home countries.
Comments
I second what (Aboo) said, a school dropout can become a doctor while
hospitals like Apollo is not employing them, they are called RMP(rural
medical practitioners) my problem with these people is they prescribe
all the antibiotics possible in Pharmacopoeia even for simple viral
infection they prescribe ceftrioxone, azithromycin etc wile it works
for the patient who would then take it for two or three days this what
makes a superbug resistant to all known antibiotics.
when I did my MBBS(MD) in nepal there was a epidemic of Typhiod fever,
6 nurses dies within few days, our microbiology lab showed that the
bug is resistent to all the antibiotics then we have to device a
dosage higer than normal at the same time maintain it below toxic
levels hen after few doctors themselves becoming sick we could control
the infection.
Instead of blaming lancet Gov of India should take stringent measures
to curb this practice of dispensing medicine by non-medicos.
this genarates what is called superbug
Friday, August 13, 2010 1:47:53 PM
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Having grown up in that part of the world I am inclined to believe
that the report in the Lancet is correct.
In India and Pakistan dispensing of medicine is totally unregulated
and uncontrolled. As a matter of fact NOTHING is regulated or
controlled. Corruption is so rampant that if you have the money you
can get anything, or get anything done.
Accordingly, pharmacies, or 'medical stores' as they are known there,
are everywhere. You need no licence to open one and once you open one
you'll be known as a 'doctor' after a few months. Even if you haven't
seen the inside of an elementary school. Then you can dispense
whatever you want to the illiterates and ignorants and even the
educated, who come to you. For just the price of cheap, and often
fake, medicine they need no prescription.
This free-for-all medical practice over decades has resulted in
absolute gross misuse of antibiotics. And resistance to antibiotics
has been a known phenomenon, and talked about in real medical circles,
for decades. Now it is just that these countries have begun exporting
their ignorance and arrogance-created problem to the rest of the
world..
Friday, August 13, 2010 1:14:56 PM
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...and I am Sid Harth
New Delhi metallo-beta-lactamase
From Wikipedia, the free encyclopedia
ND Metallo-beta-lactamase (NDM-1)[1] is a gene that makes bacteria
resistant to antibiotics of the carbapenem family. The gene is one
member of a large gene family that encode beta-lactamase enzymes
called a carbapenemase. The NDM-1 enzyme inactivates a broad range of
beta-lactam antibiotics. Bacteria that carry such genes are often
referred to in the news media as "superbugs."[2]
The NDM-1 gene was first identified in a patient who was hospitalised
in New Deli and the gene has since been detected in bacteria in India,
Pakistan, the United Kingdom and the United States. The most common
organisms carrying this gene are the gram-negative bacteria E.coli and
Klebsiella pneumoniae, but the gene can be transmitted from one strain
of bacteria to another through horizontal gene transfer. This is in
contrast to the more familiar antibiotic resistant bacteria such as
Methicillin-resistant Staphylococcus aureus, which are gram-positive.
Function
Carbapenems are a class of beta-lactam antibiotics were, until
recently, capable of killing most bacteria by inhibiting the synthesis
of one of their cell wall layers. The carbapenems were developed to be
less sensitive to inactivation by the beta-lactamse enzymes that had
evolved in bacteria resistant to antibiotics such as penicillin. The
NDM-1 gene produces a carbapenemase beta-lactamase, which is an enzyme
that hydrolyzes and inactivates these carbapenem antibiotics.
Carbapenemases are particularly dangerous resistance mechanisms, since
they can inactivate a wide range of different antibiotics.[3] The
NDM-1 enzyme is a class B metallo-beta-lactamase, while other types of
carbapenemase are class A or class D beta-lactamases.[4] The class A
Klebsiella pneumoniae carbapenemase is the most common type of this
enzyme and was first detected in North Carolina, USA, in 1996 and has
since spread worldwide.[5]
The following antibiotics are inactivated by the enzyme:
cephalosporins
penicillins
carbapenem
The resistance conferred by this gene therefore aids the expansion of
bacteria that carry it throughout a human host, since they will face
less opposition/competition from populations of antibiotic-sensitive
bacteria, which will be diminished by the original antibacterial
treatment.
Origin and spread
The resistance gene has been found in Pakistan, India and most other
Asian countries and has been brought to Europe by people undergoing
hospitalization in those countries. The gene was named after New
Delhi, the capital city of India, as it was first described by Yong et
al. in December 2009 in a Swedish national who fell ill with an
antibiotic-resistant bacterial infection that he acquired in India.[6]
The infection was unsuccessfully treated in a New Delhi hospital and
after the patient's repatriation to Sweden, a carbapenem-resistant
Klebsiella pneumoniae strain bearing the novel gene was identified.
The authors concluded that the new resistance mechanism "clearly arose
in India, but there are few data arising from India to suggest how
widespread it is."[6]
In May 2010 a case of infection with E. coli bearing NDM-1 was
reported in Coventry in the United Kingdom.[7] The patient was a man
of Indian origin who had visited India 18 months previously, where he
had undergone dialysis. In initial assays the bacteria was fully
resistant to all antibiotics tested, while later tests found that it
was susceptible to tigecycline and colistin.
As of June 2010, there were three reported cases of Enterobacteriaceae
isolates bearing this newly described resistance mechanism in the US,
the CDC stated that "All three U.S. isolates were from patients who
received recent medical care in India."[8] However, US experts have
stated that it is unclear if this strain is any more dangerous than
existing antibiotic-resistant bacteria such as methicillin-resistant
Staphylococcus aureus, which are already common in the USA.[9]
In July 2010 a team in New Deli reported a cluster of three cases of
Acinetobacter baumannii bearing NDM-1 that were found in the intensive
care unit of a hospital in Chennai, India in April 2010. As
previously, the bacteria were fully resistant to all the
aminoglycoside β-lactam and quinolone antibiotics, but were
susceptible to tigecycline and colistin. The broad spectrum of
antibiotic resistance was due to the strain bearing several different
resistance genes in addition to NDM-1.[10]
A study by a multi-national team was published in the August 2010
issue of the journal The Lancet Infectious Diseases. This examined the
emergence and spread of bacteria carrying the NDM-1 gene. This
reported on 37 cases in the United Kingdom, 44 isolates with NDM-1 in
Chennai, 26 in Haryana and 73 in various other sites in Pakistan and
India.[1] The authors' analysis of the strains showed that many
carried NDM-1 on plasmids, which will allow the gene to be readily
transferred between different strains of bacteria by horizontal gene
transfer. All the isolates were resistant to multiple different
classes of antibiotics, including beta-lactam antibiotics,
fluoroquinolones, and aminoglycosides, but most were still susceptible
to the polymyxin antibiotic colistin.
In early August a chemical compound, GSK-299423, was found to
significantly fight against antibiotic-resistant bacteria by making
such bacteria unable to reproduce, citing a likely treatment to the
NDM-1 strain.[11][12]
Indian response
The Indian health ministry has disputed the conclusion that the gene
originated in India or Pakistan, describing this conclusion as
"unfair" and stating that Indian hospitals are perfectly safe for
treatment.[13] Indian politicians have described linking this new drug
resistance gene to India as “malicious propaganda” and blamed
multinational corporations for what they describe as selective
malignancy.[13][14] A Bharatiya Janata Party politician has instead
argued that the journal article is bogus and represented an attempt to
scare medical tourists away from India.[15] The Indian Ministry of
Health released a statement "strongly refut[ing]" naming the enzyme
"New Delhi".[16]
In contrast, an editorial in the March 2010 issue of the Journal of
Association of Physicians of India blamed the emergence of this gene
on the widespread misuse of antibiotics in the Indian healthcare
system, stating that Indian doctors have "not yet taken the issue of
antibiotic resistance seriously" and noting little control over the
prescription of antibiotics by doctors and even pharmacists.[17] The
Times of India states that there is general agreement among experts
that India needs both an improved policy to control the use of
antibiotics and a central registry of antibiotic-resistant infections.
[18]
The primary author of the 2010 Lancet study, who is based in the
University of Madras, has stated that he does not agree with the part
of the article that advises people to avoid elective surgeries in
India.[18]
References
^ a b Kumarasamy et. al. (2010). "Emergence of a new antibiotic
resistance mechanism in India, Pakistan, and the UK: a molecular,
biological, and epidemiological study". The Lancet Infectious
Diseases. doi:10.1016/S1473-3099(10)70143-2.
^ Jordan, Carol (11 August 2010). "World update: More aid planned for
Pakistan". CNN. http://news.blogs.cnn.com/2010/08/11/world-update-more-aid-planned-for-pakistan/.
Retrieved 13 August 2010.
^ Queenan AM, Bush K (July 2007). "Carbapenemases: the versatile beta-
lactamases". Clin. Microbiol. Rev. 20 (3): 440–58, table of contents.
doi:10.1128/CMR.00001-07. PMID 17630334.
^ Miriagou V, Cornaglia G, Edelstein M, et al. (February 2010).
"Acquired carbapenemases in Gram-negative bacterial pathogens:
detection and surveillance issues". Clin. Microbiol. Infect. 16 (2):
112–22. doi:10.1111/j.1469-0691.2009.03116.x. PMID 20085605.
^ Nordmann P, Cuzon G, Naas T (April 2009). "The real threat of
Klebsiella pneumoniae carbapenemase-producing bacteria". Lancet Infect
Dis 9 (4): 228–36. doi:10.1016/S1473-3099(09)70054-4. PMID 19324295.
^ a b Yong D, Toleman MA, Giske CG, Cho HS, Sundman K, Lee K, Walsh
TR. (December 2009). "Characterization of a new metallo-beta-lactamase
gene, bla(NDM-1), and a novel erythromycin esterase gene carried on a
unique genetic structure in Klebsiella pneumoniae sequence type 14
from India". Antimicrob Agents Chemother. 53 (12): 5046-54. doi:
10.1128/AAC.00774-09. PMID 19770275. PMC 2786356.
http://aac.asm.org/cgi/content/full/53/12/5046?view=long&pmid=19770275.
^ Muir A, Weinbren MJ (July 2010). "New Delhi metallo-beta-lactamase:
a cautionary tale". J. Hosp. Infect. 75 (3): 239–40. doi:10.1016/
j.jhin.2010.02.005. PMID 20435372.
^ Detection of Enterobacteriaceae Isolates Carrying Metallo-Beta-
Lactamase --- United States, 2010
^ McNeil Jr., Donald G. (11 August 2010). "Antibiotic-Resistant
Bacteria Moving From South Asia to U.S.". The New York Times.
http://www.nytimes.com/2010/08/12/world/asia/12bug.html?_r=1&hpw.
Retrieved 13 August 2010.
^ Karthikeyan K, Thirunarayan MA, Krishnan P (July 2010). "Coexistence
of blaOXA-23 with blaNDM-1 and armA in clinical isolates of
Acinetobacter baumannii from India". J Antimicrob Chemother. doi:
10.1093/jac/dkq273. PMID 20650909.
^ Alazraki, Melly (6 August 2010). "GlaxoSmithKline Finds Compound
That Could Help Fight 'Superbugs'". dailyfinance.com.
http://www.dailyfinance.com/story/glaxosmithkline-finds-compound-fight-superbugs/19582888/.
Retrieved 13 August 2010.
^ http://www.indiastudychannel.com/resources/124111-NDM-Origin-Symtoms-Cure-for-NDM.aspx
^ a b Pandey, Geeta (12 August 2010). "India rejects UK scientists'
'superbug' claim". BBC News. http://www.bbc.co.uk/news/world-south-asia-10954890.
Retrieved 13 August 2010.
^ "Linking India to superbug unfair and wrong, says India". Hindustan
Times. 12 August 2010.
http://www.hindustantimes.com/Linking-India-to-superbug-unfair-and-wrong-says-India/Article1-585840.aspx.
Retrieved 13 August 2010.
^ http://expressbuzz.com/nation/superbug-an-mnc-conspiracy-bjp-leader/197607.html
^ Sharma, Sanchita (13 August 2010). "‘Don’t blame superbug on India,
it’s everywhere’". Hindustan Times.
http://www.hindustantimes.com/Don-t-blame-superbug-on-India-it-s-everywhere/Article1-585926.aspx.
Retrieved 13 August 2010.
^ Abdul Ghafur K (March 2010). "An obituary- On the Death of
antibiotics!". Journal of Association of Physicians of India 58.
http://www.japi.org/march_2010/article_01.html.
^ a b Narayan, Pushpa (13 August 2010). "Indian author says superbug
report is fudged". The Times of India.
http://timesofindia.indiatimes.com/city/chennai/Indian-author-says-superbug-report-is-fudged/articleshow/6302479.cms.
Retrieved 13 August 2010.
External links
BBC News Health - Questions&Answers about NDM-1 superbugs
National Resistance Alert 3 addendum in UK (PDF)
[show]v • d • eProkaryotes: Bacteria classification
Domain: Archaea – Bacteria – Eukaryota
G-/
OM Terra-/Glidobacteria Eobacteria (Chloroflexi, Deinococcus-Thermus)
· Cyanobacteria
Gracilicutes Proteobacteria Alpha · Beta · Gamma/Enterobacteriaceae
(Salmonella, Vibrio, Shigella) · Delta · Epsilon (Campylobacter) /
Aquificae (Aquifex)
Planctobacteria Chlamydiae/Verrucomicrobia · Planctomycetes
Sphingobacteria Bacteroidetes/Chlorobi · Fibrobacteres
Other Spirochaetes
Eurybacteria Fusobacteria · Thermotogae
Other/ungrouped Acidobacteria · Chrysiogenetes · Deferribacteres ·
Gemmatimonadetes · Nitrospirae · Synergistetes · Thermodesulfobacteria
· Dictyoglomi
G+/
no OM Actinobacteria Actinobacteridae Actinomycetales Actinomycineae:
Actinomycetaceae (Actinomyces, Mobiluncus)
Corynebacterineae: Mycobacteriaceae · Nocardiaceae ·
Corynebacteriaceae
Frankineae: Frankiaceae
Micrococcineae: Brevibacteriaceae
Bifidobacteriales Bifidobacteriaceae (Bifidobacterium, Falcivibrio,
Gardnerella)
Other subclasses Acidimicrobidae · Coriobacteridae · Rubrobacteridae ·
Sphaerobacteridae
Firmicutes Bacilli Bacillales: Bacillaceae (Bacillus) · Listeriaceae
(Listeria) · Staphylococcaceae (Staphylococcus, Gemella,
Jeotgalicoccus)
Lactobacillales: Enterococcaceae (Enterococcus) · Lactobacillaceae
(Lactobacillus, Pediococcus) · Leuconostocaceae (Leuconostoc) ·
Streptococcaceae (Lactococcus, Streptococcus)
Clostridia Clostridiales (Clostridium, Peptostreptococcus,
Selenomonas) · Halanaerobiales · Thermoanaerobacterales
Tenericutes/
Mollicutes Mycoplasmatales (Mycoplasma, Ureaplasma) ·
Entomoplasmatales (Spiroplasma) · Anaeroplasmatales (Erysipelothrix) ·
Acholeplasmatales (Acholeplasma) · Haloplasmatales (Haloplasma)
note: not all classifications are universally accepted
M: BAC
bact (clas)
gr+f/gr+a(t)/gr-p(c)/gr-o
drug(J1p, w, n, m, vacc)
[show]v • d • eMicrobiology: Bacteria
Pathogenic bacteria Bacterial disease · Coley's Toxins · Exotoxin ·
Lysogenic cycle
Human flora Gut flora · Skin flora · Vaginal flora
Substrate preference Lipophilic · Saccharophilic
Oxygen preference Aerobic (Obligate) · Anaerobic (Facultative,
Obligate) · Microaerophile · Nanaerobe · Aerotolerant
Structures Cell envelope Cell membrane
Cell wall: Peptidoglycan (NAM, NAG, DAP)
Gram-positive bacteria only: Teichoic acid · Lipoteichoic acid ·
Endospore
Gram-negative bacteria only: Bacterial outer membrane (Porin,
Lipopolysaccharide) · Periplasmic space
Mycobacteria only: Arabinogalactan · Mycolic acid
Outside envelope Bacterial capsule · Slime layer · S-layer ·
Glycocalyx
Pilus · Fimbria
Composite Biofilm
Shapes Bacterial cellular morphologies · L-form bacteria · Coccus
(Diplococcus) · Bacillus · Coccobacillus
M: BAC
bact (clas)
gr+f/gr+a(t)/gr-p(c)/gr-o
drug(J1p, w, n, m, vacc)
Retrieved from "http://en.wikipedia.org/wiki/New_Delhi_metallo-beta-
lactamase"
Categories: Bacteriology | Microbiology | Beta-lactam antibiotics | EC
3.5.2
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...and I am Sid harth