Drug resistance tuberculosis concerns

By Dr. Ananya Mandal, MDMar 23 2011

WHO on drug resistant TB

According to a report released Wednesday, the World Health Organization revealed that drug resistant tuberculosis (TB) accounts for about 440,000 cases and 150,000 deaths worldwide each year. The WHO called for better diagnosis and more funding for treatment of the drug-resistant disease that's harder to cure.

Tuberculosis is a serious infectious lung disease that may affect other parts of the body too. TB is passed person to person via airborne germs like the common cold. The drug-resistant forms are no exception. WHO identifies 27 countries with the highest number of such cases, including Bangladesh, China, the Philippines, the Russian Federation and South Africa.

The report says, “While drug-resistant TB is generally treatable, it requires extensive chemotherapy (up to two years of treatment) with second-line anti-TB drugs which are more costly than first-line drugs, and which produce adverse drug reactions that are more severe, though manageable.” The report is entitled, “Towards universal access to diagnosis and treatment of multi-drug-resistant and extensively drug-resistant tuberculosis by 2015.”

The report adds that the biggest problem is transmission of drug-resistant TB by those who are undiagnosed and therefore spreading it. Doctors Without Borders documents its success in treating the disease in Khayelitsha, South Africa, by using new and quicker detection methods. The report reads further, “A new automated molecular test for TB has the potential to get patients on treatment sooner by reducing diagnostic time from 6-8 weeks in a specialized laboratory, to two hours at clinic level…With increased numbers of people being diagnosed and requiring treatment, new demands will require donor commitments to the purchase of TB medicines, and a competitive drug production market to reduce prices.”

Today – Thursday – 24^th of March 2011, is being observed as the World TB Day.

TB updates – India

In India TB kills two persons every three minutes in the country. Rise of drug resistant TB in India is partly due to widespread abuse of medications and congested environs say experts. Mumbai accounts for 10-17% drug resistant cases among total TB cases. A study done four years back in a city hospital put the MDR-TB incidence at 9% of all cases.

Chest specialist Dr Ashok Mahasur from Hinduja Hospital in Mumbai said, “No patient perceives an immediate threat due to TB. Hence they choose to ignore the symptoms for as long as possible. In the process, they end up spreading the disease in the community.” The city registered 29,528 cases of TB last year reveals the Municipality of Mumbai (BMC). Chest specialist Dr Alpa Dalal from BMC's TB specialty hospital in Sewri said, “I would say 8% to 12% of my new patients suffer from MDR-TB.” A sentinel survey from Nagpur said between 10% and 17% of all TB patients had MDR-TB.

According to a BMC health official, “In 2010, Mumbai registered 29,528 TB cases, only 1% less than last year. Of these 21,000 were new cases, while the rest were getting a re-treatment as the first line of treatment did not work for them.” Many of these possibly have MDR-TB but due to poor availability of testing facilities and expensive medication of over Rs 15,000 per month, exact numbers are unavailable. BMC provides testing and medicines at only three zones so far. The official added, “From the public hospitals, a total of 84 samples were sent for MDR-TB testing in Hinduja Hospital. We pay the hospital Rs 2,000 for testing each sample. Out of these, 60 people tested positive.” What is worrying doctors is the worsening of the resistant phase. “We are already getting one or two new patients every week with extreme drug resistance or XDR-TB. We have to find a mechanism to quickly diagnose and treat these patients,”' said Dr Dalal.