Totally drug resistant Tuberculosis hits India

Reports reveal that nearly a dozen people in India are infected with a type of tuberculosis that is resistant to all antibiotics used to treat the disease and is thus named “totally drug resistant” or TDR tuberculosis.

The World Health Organization hasn't accepted the term and still considers the cases to be what's now called extensively drug-resistant TB, or XDR. However, Dr. Paul Nunn, a coordinator at the WHO's Stop TB Department in Geneva, said there is ample proof that these virtually untreatable cases do exist.

In December, the journal Clinical Infectious Diseases published an online report that documented four of the cases. This weekend, news outlets in India reported that there were actually at least 12 people with the drug-resistant lung disease. Officials fear that what they've seen so far is just the beginning, and that many more cases are around undetected.

“It's estimated that on average, a tuberculosis patient infects 10 to 20 contacts in a year, and there's no reason to suspect that this strain is any less transmissible,” study co-author Zarir Udwadia of the Hinduja National Hospital and Medical Research Centre in Mumbai told New Scientist. “Short of quarantining them in hospitals with isolation facilities till they become non-infectious – which is not practical or possible – there is nothing else one can do to prevent transmission.” “It is concerning,” said Dr. Kenneth Castro, director of the CDC's Division of Tuberculosis Elimination. “Anytime we see something like this, we better get on top of it before it becomes a more widespread problem.”

Patients with TB must take antibiotics for a long time to cure the disease.  Many don't get the right medications, or don't take their medications properly, which allows the evolution of drug-resistant strains say researchers. This and other factors is responsible for the fact that over time TB-causing bacteria have become resistant to more and more types of antibiotics and now all.

Dr. Nata Menabde, WHO's representative in India, said a team of national experts started investigating the cases Monday. She said the government is also working to improve laboratory diagnostics to help find more drug-resistant cases, and discussions are ongoing to identify ways to regulate TB treatment in the private sector. “Now there is a high urgency attached to these findings even though the knowledge about the existence of such cases is not new,” she said. “The political momentum is right because it has attracted the top level of attention, given the seriousness of the matter.”

This is not the first outbreak of totally drug resistant TB. According to the New Scientist report, in 2007, two patients were identified with the disease in Italy; in 2009, 15 patients were identified with the disease in Iran.

Booster Shots' Jeannine Stein reported last year that worldwide, tuberculosis rates are falling.  About 8.8 million people contracted the disease in 2010, and 1.4 million people died from it.  An estimated 20 percent of the world's multi-drug-resistant cases are found in India, which is home to a quarter of all types of tuberculosis cases worldwide.

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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