Wednesday, May 23, 2007

2 letters can kill you

Higher number of deadlier TB cases worry city docs

Mumbai: Not just multidrugresistant tuberculosis, its deadlier version- extremely drug-resistant TB could be emerging as one of the most serious health hazards in India, says the first-ever study of its kind conducted by a Mumbai hospital to assess its prevalance.

The Hinduja Hospital’s study found that XDR-TB, which is considered a doctor’s nightmare as far as its treatment is concerned, accounts for almost 8 % of the total MDR-TB cases. The finding appears shocking when considered against the US prevalence of 4%. Worse, in India, it seems to be affecting the normal population as against the HIV-positive patients in the West.

Extremely Drug-Resistant TB (XDR-TB) is defined as TB that is resistant to more than three or six second-line drugs. The study was presented at the ongoing conference of the American Thoraric Society’s conference in San Francisco. “We are indeed seeing more and more of this deadly form of TB,’’ said Dr Zarir Udwadia, senior chest physician at Hinduja Hospital whose resident doctor S Jain presented the paper at the American conference on Monday. “It is, in many cases, a death sentence.’’

Hinduja Hospital’s microbiology laboratory, which is a reference lab for many hospitals and smaller diagnostic laboratories in the city, studied 3,904 samples of TB culture throughout 2005. “Of these, 1264 were culture positive for mycobacterium tuberculosis. 409 samples (32.35% of positive cultures) were found to be MDR-TB, out of which 33% (8%) were XDRTB,’’ said the study, which is the first time the deadly disease’s prevalence was tracked in India. TB has emerged as a public health challenge ever since the emergence of HIV two decades ago. HIV-positive persons with their compromised immune system are highly susceptible to TB. Moreover, with the poor drug-adherence ways of Indian patients, there has been a surge in the multi-drug resistant TB in recent years.

The Indian health ministry had in its recent records stated that 3% of the fresh cases suffer from XDR-TB, while over 12% of the old cases undergoing treatment have developed this strain. The Indian Journal of Tuberculosis in its January 2007 edition noted that “this new strain is not only resistant to the two firstline therapies-antibiotic Isoniazid and Rifampincin, but also to the other six classes of drugs used in the second-line therapy.’’ What is even more worrying in the Indian context is the difference in the patient profile vis-a-vis the American context. “While most patients with XDR-TB in the US and South Africa also suffer from HIV\AIDS, most Indian patients are normal without other ailments and younger with the average age being 30 years,’’ points Dr Udwadia. Secondly, the treatment for the condition is difficult, longdrawnout and expensive.Foreign agency reports, quoting Dr Jain’s speech at the San Francisco conference, said that the death rate among XDR-TB patients was a whopping 42%. “Patients with XDR-TB need to be treated for about 30 months and take between 5 and 12 pills a day. Not only does the treatment demand physical tenacity, it is also extremely expensive,’’ says the doctor. As a result, the death rate is high. “We could lose half the patients.’’

The shockingly high prevalance of XDR-TB not only underlines the devastating levels of resistance to drugs among Indians, but also highlights the deadly potential of the TB bacterium. “Even 125 years after Robert Koch isolated the tuberculosis bacteria, we are unable to find an effective way to cure it,’’ says Dr.Udwadia.

courtesy : The Times of India, 23rd May 2007

TB anywhere is TB everywhere.

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