Fatima is the first patient with multidrug-resistant tuberculosis (MDR-TB) to be cured of the infection in the conflict zone of north-western Syria. The 23-year-old from the Afrin district of Aleppo is one of 23 MDR-TB patients currently receiving treatment in this area of the country, and the first to fully recover.
Fatima was living a normal, healthy life at home with her parents when she contracted TB from her sister. She spent the next 8 months receiving regular TB treatment at Blue Crescent Hospital in Azaz. Yet her condition deteriorated, and she underwent surgery to remove the right side of her lung. The infection remained and she suffered a relapse in August 2020. TB mycobacteria and resistance to rifampicin were confirmed by a rapid nucleic acid amplification test, the Xpert MTB/RIF assay.
A group of clinical experts, hosted by WHO/Europe, reviewed Fatima’s case virtually and recommended a series of investigations, including blood tests, X-rays, a bacterial culture growth, and rapid drug susceptibility tests. Based on these highly accurate test results, they advised a short, patient-oriented, fully oral bedaquiline-containing treatment regimen.
Local treatment and support
Fatima wished to be assigned back home to Afrin for her treatment, which began in April 2021. Her case was managed by local TB centre clinician Dr Ayoub Ismail, and monitored by TB focal point in north-western Syria Dr Hasan Ibrahim. She saw Dr Ismail for clinical assessment and laboratory-based monitoring, as well as to monitor and reduce the risk of negative side effects from the new treatment.
Throughout the course of her treatment, Fatima was visited by a supportive care-at-home team who ensured treatment continuity and advised her family on infection control measures. The team also provided psychosocial support to allow Fatima to quickly reintegrate back into the community after becoming non-infectious. She and her family received a substantial food basket on a biweekly basis.
“Today, 20 January 2022, after a thorough medical evaluation, we found Fatima completely cured of multidrug-resistant tuberculosis,” said Dr Ismail. He added, “She is now fully recovered, all TB symptoms are gone, she has gained weight, and her energy levels and mental health are restored. We will continue to see her for monitoring purposes on a quarterly basis for another year, until she can return to life off the medical radar, as a valuable member of society.”
WHO has supported the Afrin TB centre since 2019 by providing TB drugs, laboratory equipment, consumables and other supplies, including food baskets, and by offering training and capacity-building for medical staff, in triangulation with the International Organization for Migration (IOM).