A few months ago, Mumbai was in the eye of the storm after a research paper published by three doctors of Hinduja Hospital revealed 12 cases of Totally Drug Resistant Tuberculosis that were completely resistant to the known first-line and second-line drugs prescribed for treatment. This made India only the second country after Iran to have declared the existence of the deadly strain.
The government denied the finding and refused to call it TDR-TB. It even raised a question on the accreditation of the laboratory that gave the results. A Central government team flew in and reviewed the situation.
A few months later, it quietly accepted the research findings. The debate over the terminology continues. After the findings were announced, the strain was detected in three more patients.
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Today, six of the 15 are dead. “Four are responding well and have their culture converted,” Zarir Udwadia, consultant chest physician at Hinduja Hospital, said. He co-authored the paper, published in the U.S.-based Clinical Infectious Disease. “I remain alarmed by the sheer numbers of new patients with MDR that all physicians are increasingly encountering. Mumbai is the epicentre of India’s MDR epidemic,” Dr. Udwadia said.
Poverty and overcrowding are two of the causes for the spread of TB. “In the lower income groups, people are not very particular about hygiene. They do not take care of infection on time. To add to it, people live in slums and chawls, passing infection very quickly,” Jayesh Desai, physician and nephrologist, said.
“TB is found in upper economic groups too. At places like discos or where smoking goes on continuously, infection is passed quickly, ” Dr. Desai said.
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He added that, though the number of patients have stabilised over the years, there is an alarming rise in the incidence of MDR-TB. “In my practice, I see that there are at least 40 per cent MDR-TB patients… There is poor compliance of medication. Some people cannot afford some drugs, but they fail to approach the civic body or charitable trusts to get aid...”
Private practitioners
In Pune, the challenge is to involve private doctors. Recognising the lack of consistent treatment as the cause for the resistance developing, health authorities there put the onus for identifying MDR-TB cases on private practitioners.
“Since patients are encountered in private hospitals in large numbers, we need to sensitise private practitioners and involve them in a public-private partnership to control TB. We have seen that there is a lack of response,” TB officer C. Thakur said. “The Intermediate Reference Laboratory set up in Pune in January 2012 detects cases through a culture sensitivity test.”
According to official data, 5,507 cases were detected in Pune and Pimpri Cinchwad between January 2011 and January 2012. At least 25 persons were tested positive with MDR-TB during this period. Since February this year, more than 100 patients are already on Category IV treatment for MDR-TB, according to Dr. Thakur.
He added that MDR-TB prevalence is estimated to be 2.3 per cent among new cases and 12-17 per cent among cases that involve re-treatment.