India Faces New Front of drug resistance in Super Bug Tuberculosis Battle
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-Pastor-Dale-Morgan-
Jan 18, 2012, 6:00:42 PM1/18/12
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Plagues,
Pestilences and Diseases
India Faces New Front of drug resistance in Super Bug Tuberculosis Battle
By GEETA ANAND
MUMBAI—A top Mumbai pulmonologist has told the Indian government he has seen 12 cases of tuberculosis in this city that are totally resistant to all of the current treatments, forcing India to confront weaknesses in its programs to combat this contagious, potentially fatal lung disease.
Zarir Udwadia, one of Mumbai's leading private pulmonologists, reported the first four cases in a letter in December to the Clinical Infectious Diseases magazine, a publication of the Infectious Diseases Society of America. He said in an interview that he has now seen and tested a total of 12 patients at Mumbai's Hinduja National Hospital and Medical Research Center since late last year who are resistant to all forms of treatment. Three of the patients have died, he said.
"While this handful of cases is worrying, it's just the tip of the iceberg," said Soumya Swaminathan, senior deputy director of the National Institute for Research in Tuberculosis, part of the Indian Council of Medical Research, the government's network of biomedical research institutions. "The bottom line is we need to take TB much more seriously."
Indian health officials met in Mumbai Wednesday with Dr. Udwadia and other pulmonologists to develop a plan of action. The municipal official who convened the meeting to develop the plan, Manisha Maiskar, couldn't be reached for comment.
India has made huge strides in fighting tuberculosis, reducing the number of deaths from the disease to 280,000 in 2010 from 500,000 in 1997, when the country began its current program to offer free testing and treatment to all, according to the government's 2011 annual report of the Revised National TB Control Program. About 1.5 million of the 2 million tuberculosis patients in India are currently being treated under this program, according to the report.
Patients following the prescribed tuberculosis treatment regimen take a combination of strong medicines three times a week over a six-month period. To try to ensure compliance, the program requires that patients take their medication in the presence of the village nurse or an agreed-upon community supervisor.
The problem is that patients' symptoms subside after one month on treatment, and it is often accompanied by side effects, such as nausea, which discourage continuation of the medicines, doctors and researchers say.
Compounding the problem is the fact that a large number of patients, particularly in cities, use private doctors, and many routinely prescribe the wrong medicines, Dr. Udwadia says.
Dr. Udwadia says a survey he conducted last year of doctors treating tuberculosis in Dharavi, the Mumbai slum made famous by the movie "Slumdog Millionaire," showed that the vast majority—103 of the 106 surveyed—prescribed the wrong medicines for the disease. "Two or three treatment errors is all it takes to create multidrug resistance," in which many of the treatments for tuberculosis don't work, he said.
The recent findings signal an even more serious scenario where no treatments work. India isn't the first country to report cases of total drug resistance. Researchers in 2009 described 15 cases of patients in Iran with total drug resistance in 2009.
Dr. Swaminathan, of the National Institute for Research in Tuberculosis, said it isn't possible to know for sure that the patients Dr. Udwadia described really are total-drug resistant because some of the laboratory tests haven't been validated. Dr. Udwadia said he is confident of his findings.
Regardless, Dr. Swaminathan said, "the "bottom line is that once a patient becomes resistant to the main TB drugs, it becomes practically untreatable." India needs to rapidly raise its tuberculosis-prevention program to a new level with increased funding, more accountability at the local level and more laboratories nationwide to test for drug resistance, she said.
India Faces New Front of drug resistance in Super Bug Tuberculosis Battle
By GEETA ANAND
MUMBAI—A top Mumbai pulmonologist has told the Indian government he has seen 12 cases of tuberculosis in this city that are totally resistant to all of the current treatments, forcing India to confront weaknesses in its programs to combat this contagious, potentially fatal lung disease.
Zarir Udwadia, one of Mumbai's leading private pulmonologists, reported the first four cases in a letter in December to the Clinical Infectious Diseases magazine, a publication of the Infectious Diseases Society of America. He said in an interview that he has now seen and tested a total of 12 patients at Mumbai's Hinduja National Hospital and Medical Research Center since late last year who are resistant to all forms of treatment. Three of the patients have died, he said.
"While this handful of cases is worrying, it's just the tip of the iceberg," said Soumya Swaminathan, senior deputy director of the National Institute for Research in Tuberculosis, part of the Indian Council of Medical Research, the government's network of biomedical research institutions. "The bottom line is we need to take TB much more seriously."
Indian health officials met in Mumbai Wednesday with Dr. Udwadia and other pulmonologists to develop a plan of action. The municipal official who convened the meeting to develop the plan, Manisha Maiskar, couldn't be reached for comment.
India has made huge strides in fighting tuberculosis, reducing the number of deaths from the disease to 280,000 in 2010 from 500,000 in 1997, when the country began its current program to offer free testing and treatment to all, according to the government's 2011 annual report of the Revised National TB Control Program. About 1.5 million of the 2 million tuberculosis patients in India are currently being treated under this program, according to the report.
Patients following the prescribed tuberculosis treatment regimen take a combination of strong medicines three times a week over a six-month period. To try to ensure compliance, the program requires that patients take their medication in the presence of the village nurse or an agreed-upon community supervisor.
The problem is that patients' symptoms subside after one month on treatment, and it is often accompanied by side effects, such as nausea, which discourage continuation of the medicines, doctors and researchers say.
Compounding the problem is the fact that a large number of patients, particularly in cities, use private doctors, and many routinely prescribe the wrong medicines, Dr. Udwadia says.
Dr. Udwadia says a survey he conducted last year of doctors treating tuberculosis in Dharavi, the Mumbai slum made famous by the movie "Slumdog Millionaire," showed that the vast majority—103 of the 106 surveyed—prescribed the wrong medicines for the disease. "Two or three treatment errors is all it takes to create multidrug resistance," in which many of the treatments for tuberculosis don't work, he said.
The recent findings signal an even more serious scenario where no treatments work. India isn't the first country to report cases of total drug resistance. Researchers in 2009 described 15 cases of patients in Iran with total drug resistance in 2009.
Dr. Swaminathan, of the National Institute for Research in Tuberculosis, said it isn't possible to know for sure that the patients Dr. Udwadia described really are total-drug resistant because some of the laboratory tests haven't been validated. Dr. Udwadia said he is confident of his findings.
Regardless, Dr. Swaminathan said, "the "bottom line is that once a patient becomes resistant to the main TB drugs, it becomes practically untreatable." India needs to rapidly raise its tuberculosis-prevention program to a new level with increased funding, more accountability at the local level and more laboratories nationwide to test for drug resistance, she said.
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