In Mumbai, Hinduja Hospital recently announced that it had detected 12 patients to be suffering from totally drug resistant TB (TDR-TB). The government has said that the patients are not suffering from TDR-TB but extensively drug resistant TB (XDR-TB). In your opinion, is there a possibility that drug resistant TB can become incurable?
There is no definition for TDR so far. Whereas there is a clear cut definition of resistance for anti-TB drugs such as streptomycin, isonoazid, rifampicin, ethambutol, pyrazinamide, kanamycin and fluroquinolones, there is no clear cut definition for resistance for second line drugs such as cycloserine, ethionamide, PAS, thioacetazone. Though it is possible for emergence of resistance to these drugs, there is no quality assured laboratory method in the country to evaluate them. Patients having resistance to major drugs such as rifampicin, isoniazid, kanamycin, and flouroquinolones respond poorly to treatment.
Of the 12 patients, three died in the last two months. How should health officials handle the nine surviving patients? Is there a need for isolating the patients?
The surviving patients should be treated with the regimen for XDRTB designed by the WHO. There is no need to isolate them, but proper infection control strategies should be in place.
While TB is contagious, will a person contracting TB from a TB patient suffering from drug resistant (MDR/XDR/TDR) TB, contract primary TB or one that is drug resistant?
Contact with a patient suffering from drug resistant TB, should be evaluated. Not all contacts will be have resistant TB, since the infection could be from the community also.
In your years of experience in dealing with TB, do you think the incidence of drug resistant TB is rising?
In a community where repeated epidemiologic surveys including drug susceptibility test has been undertaken, there is no evidence of an increase in drug resistance for a 10-year period. There is no national drug resistance survey data available hence it is difficult to comment.
Mortality figures from the Sewree TB Hospital show that on an average more than 150 TB patients die there every month. We are aware that the worse cases land up at the Sewree hospital as a last recourse. But is the figure of 150 deaths every month alarming for the city?
This should be taken with a concern and health authorities need to look into the reasons for the same. The mortality surveys conducted in a few states had shown a mortality of around 27-60/100,000 in the community.