In January, doctors at Hinduja Hospital announced that they had detected 12 patients with extensively drug resistant tuberculosis (XXDR TB) in the state. The hospital’s findings led to a major revamp in the civic body’s approach towards tackling TB in the city.
Camilla Rodrigues, consultant microbiologist and chairperson Infection Control Committee at Hinduja Hospital, spoke to HT about the changes that have taken place.
How do you perceive the changes that have occurred after your study was published?
We never expected the kind of response the media reports generated. We had only written to a scientific journal about our findings. But after the initial few days, the response has been very positive. The Central TB Division as well as the Municipal Corporation and the State have undertaken many proactive measures. Mumbai has a population of 20 million. This is possibly as much as some entire nations in Africa.
What is the meaning of XXDR TB and how hard is it to treat such cases?
XXDR TB is essentially a lab-based definition. In our lab, we tested TB drug resistance to 12 conventional anti TB drugs. That does not mean that a patient cannot be treated at all, as some drugs that are found to be resistant in the lab may be effective. Also there are some drugs that were not tested (as they are not traditional anti TB drugs) that may still work. Of course, such a patient is at more of a disadvantage than an XDR patient, who may be resistant to up to seven drugs.
What is the need of the hour and what recommendations do you have for preventing TB?
From a laboratory perspective, accurate and timely diagnosis is vital in the control of TB. We need to expand laboratory capacity to eventually provide universal diagnostic access to all our TB patients in the city. Rapid culture and molecular methods are also important. Labs must have well-trained and committed technologists with really good quality control and assurance in place. A separate TB officer has now been appointed for each ward in Mumbai, who will be responsible for monitoring the disease. Most importantly, notification to the government has become compulsory, so that now the extent of drug resistant tuberculosis can be known and quickly acted upon. Also, DOTS-plus under the national program is now being offered to patients from the private sector.