Bali, Tuberculosis, Diabetes and Artemisia

Our associations IFBV-BELHERB from Luxembourg and M4L from Paris are involved in clinical trials with African partners to study the in vivo effect of Artemisia annua and Artemisia afra on these diseases. Screening trials in 2015 had been promising and recent large scale, randomized, double blind have resulted in an obvious therapeutic effect of these plants against Mycobacteria, not only tuberculosis but also Buruli ulcer. After three weeks of treatment the Ziehl stain assay is negative for alcohol-resistant bacteria. These trials were run in the province of Maniema, RDC Congo, in accordance with the WHO protocol and ethical approval of the local health authorities. They will be published in the scientific literature. Most of us ignore that on Nov 3, 2015 a Convention was signed in Bali declaring the fight against the looming TB-Diabetes co-epidemic, one of the greatest global health challenges. An estimated two billion people, or one third of all people worldwide, live with a tuberculosis (TB) infection, of whom 9.6 million people develop active TB disease annually. TB is the leading cause of death worldwide due to a single infectious pathogen, responsible for 1.5 million human deaths in 2014, and 95 percent of human TB deaths occur in low- and middle-income countries. Diabetes mellitus is escalating worldwide. More than half of people with diabetes are unaware of their condition as they have never been tested, and 84% of all undiagnosed cases live in low and middle income countries, People with diabetes are two-to-three times more likely to develop TB when compared to people without diabetes. The excess vulnerability to TB disease in people with diabetes is mainly related to altered immune response to TB infection as a consequence of high blood sugar due to undiagnosed or poorly controlled diabetes. A Lancet study in 2009 had confirmed the convergence of the two epidemics (KE Dooley et al. Lancet Infect Dis. 2009. 91, 737-746). In 1934 already this link had been discovered in Boston MA (H Root, N Eng J Med 1934, 210,78). In a study in Egypt, which compared 119 patients with treatment failure to 119 controls, diabetes conferred a 3 times increased risk of treatment failure (AM Morsy et al., East Meditter Health J. 2003, 9, 689-701). Two retrospective cohort studies of patients with pulmonary tuberculosis in Maryland, USA, have shown a 6.5 times increased risk of death in diabetes patients (KK Oursler et al., Clin Infect Dis 2002, 34, 752-59). It appears also that tuberculosis may lead to diabetes in those not previously known to be diabetic (GP Nichols, Am Rev Tuberc 1957 76, 1016-30).