The extent of the new outbreak is unknown because tests are expensive and specialized. Dr. Tony Moll identified the strain in tests carried out at King George V Hospital in Durban, the provincial capital about 150 miles southeast of Tugela Ferry, where Moll works at a government hospital.
"Most hospitals don't have such facilities and support," Moll said in an interview this week.
Extreme drug resistant TB has been identified among highly mobile miners and probably can be found all over the country, Moll said.
"In some of the mines, they have identified (extremely drug-resistant TB) and, because our population is so mobile, if you looked in other provinces, no doubt you will find" the new strain, he said.
The World Health Organization warned about the new strain Moll discovered at a news conference in London on Friday, and said people could be dying in places that don't have the capacity to find and diagnose patients. WHO classified the strain as extremely drug-resistant, saying drugs from two of the six medicines used as a last line of defense against TB proved ineffective against the new strain.
Drug resistance is a common problem in TB treatment, but the new strain appears particularly virulent. Worldwide, about 2 percent of drug-resistant TB cases are classified as extremely drug-resistant.
Moll found only a few cases in thousands of people tested, but said the strain was "very highly troubling and alarming because of the very high fatality rate."
TB has been on the rise because AIDS has lowered so many South Africans' ability to fight off it and other infections. All 53 patients who had extreme drug-resistant TB tested positive for HIV or were suspected positive, Moll said.
The government estimates more than 5.5 million of the 44 million South Africans are HIV-positive, second only to India. On average, more than 900 people die of the disease a day in South Africa.
A high illiteracy rate and poor adherence to the grueling six-month regimen of medication that can cure TB has in turn fueled a crisis with multidrug-resistant TB in South Africa. About 330,000 South Africans have TB at any given time and about 6,000 have the multiple drug-resistant variant.
Moll said that his Church of Scotland Hospital, founded by Scottish missionaries and now government-run, has 1,300 people on antiretrovirals but that there probably are 10,000 or 12,000 in the community going untreated for many reasons, including the stigma attached to AIDS.
He is the only doctor prescribing antiretrovirals to adults in an area covering 650 square miles.
Moll said he became suspicious when AIDS patients responded well to antiretrovirals but died rapidly. Further tests showed the TB strain was drug-resistant. Sixty percent of the patients had never had TB before, so had no history of failing to complete the medication course, which usually leads to resistance. The patients came from all over the district.
"What actually happened here at Tugela Ferry is what we call a true outbreak ... one single bug that was fingerprinted and that was transmitted," he said. "These people caught TB for the first time and were infected by a super bug that was already resistant to this whole spectrum of medication ... making them practically untreatable."
He said it appeared to attack newly compromised HIV victims. Some patients had been previously hospitalized, and could have caught the bug in the hospital, he said. At least two were hospital health workers.
Officials from the 14-country Southern African Development Community along with the World Health Organization and the U.S. Centers for Disease Control start a two-day conference in South Africa from Thursday to discuss how to confront the threat posed by drug-resistant TB.
Conference organizers said such cases were increasing in Botswana, Mozambique and South Africa. And they warned that the extreme drug-resistant strain was becoming "a major threat to successful HIV treatment and care in sub-Saharan Africa."
South Africa's Health Department said Tuesday it was monitoring "the magnitude of the problem" of extreme drug resistant TB in KwaZulu-Natal, and making plans to extend surveillance to other provinces.
"The solution to this problem is to prevent the development of such resistant strains by ensuring that people are treated properly right from the beginning and that they complete the treatment," the Health Department said.
Last week, the government banned Health Ministry officials from talking to the media about AIDS. It seemed that ban might have been expanded to include TB this week. An AP interview with doctors treating extreme drug-resistant TB at King George V Hospital in Durban was canceled at the last minute by health officials.
U.S.-based AIDS activists, including a Yale University doctor who co-authored Moll's study, said they were prevented Wednesday from making a long-planned video at the Tugela Ferry hospital, and urged South African officials to stop obstructing them.