Drug-resistant tuberculosis strain found in India

Tuberculosis, one of the world's leading causes of death, may have just become a bigger threat, after a drug-resistant variant of the disease was reported recently in India.

 

At least 12 patients were reported infected with TB that has become resistant to all the drugs used against the disease, tech site Wired.com said.

 

Physicians in Mumbai are calling the strain TDR, for Totally Drug-Resistant, Wired.com said. "In other words, it is untreatable as far as they know," it said.

 

"TB is already one of the world’s worst killers, up there with malaria and HIV/AIDS, accounting for 9.4 million cases and 1.7 million deaths in 2009, according to the World Health Organization," it added.

 

At best, TB treatment is difficult, requiring at least six months of pill combinations with side effects and must be taken long after the patient begins to feel well.

 

The Wired.com report noted news of some of the cases was published Dec. 21 in an ahead-of-print letter to the journal Clinical Infectious Diseases.

 

At least four cases of TDR-TB had been described since last October in the letter.

 

Wired.com also noted health authorities estimate that one patient with active TB can infect up to 15 others.

 

"And thus resistant TB spreads: XDR-TB was first identified just in 2006, and it has since been found in 69 countries around the world," it said.

 

Tip of the iceberg

 

On Saturday, the Times of India said there are actually 12 known cases just in one hospital, the P.D. Hinduja National Hospital and Medical Research Centre.

 

"The cases we clinically isolate are just the tip of the iceberg," it quoted Hinduja’s Dr. Amita Athawale as saying.

 

Another report on the Hindustan Times said most hospitals in the city do not have the facilities to identify the TDR strain - making it more likely that unrecognized cases can go on to infect others.

 

Mismatched treatment, symptoms

 

The mismatch between treatment and symptoms has led some people not to take their full course of drugs.

 

From that, it said there are multi-drug resistant and extensively drug-resistant, MDR and XDR, TB.

 

Citing WHO figures, the WHO said there were about 440,000 cases of MDR-TB per year, accounting for 150,000 deaths, and 25,000 cases of XDR.

 

"At the time, the WHO predicted there would be 2 million MDR or XDR cases in the word by 2012," it said.

 

But as for TDR-TB, the first cases were not these Indian ones but an equally under-reported cluster of 15 patients in Iran in 2009.

 

"They were embedded in a larger outbreak of 146 cases of MDR-TB, and what most worried the physicians who saw them was that the drug resistance was occurring in immigrants and cross-border migrants as well as Iranians: Half of the patients were Iranian, and the rest Afghan, Azerbaijani and Iraqi," it said.

 

Wired.com said the Iranian team raised the possibility at the time that rates of TDR were higher than they knew, especially in border areas where there would be little diagnostic capacity or even basic medical care.

 

On the other hand, Wired.com said the Indian cases disclosed before Christmas demonstrate what happens when TB patients don’t get good medical care.

 

It said the letter to CID describes the course of four of the 12 patients - all four saw two to four doctors during their illness, and at least three got multiple, partial courses of the wrong antibiotics.

 

Most of these unfortunate patients sought care from private physicians in a desperate attempt to find a cure for their tuberculosis.

 

"This sector of private-sector physicians in India is among the largest in the world and these physicians are unregulated both in terms of prescribing practice and qualifications," it said.

 

It said a study that we conducted in Mumbai showed that only five of 106 private practitioners practicing in a crowded area called Dharavi could prescribe a correct prescription for a hypothetical patient with MDR tuberculosis.

 

Majority of prescriptions were inappropriate and would only have served to further amplify resistance, converting MDR tuberculosis to XDR tuberculosis and TDR tuberculosis, it said.

 

Diagnosis challenges

 

Also, the other TB challenge is diagnosis, especially of resistant strains, and here again the news is not good.

 

The WHO said last spring that only two-thirds of countries with resistant TB epidemics have the lab capacity to detect the resistant strains.

 

As a result, only one MDR patient out of every 10 even gets into treatment, and when they do, cure rates range from 82 percent down to 25 percent.

 

"That’s for MDR. None of the TDR patients have been recorded cured, and at least one of the known Indian patients has died," it said. — TJD, GMA News