Tuberculosis (TB) and its more virulent strains such as multiple drug resistant (MDR) and extremely drug resistant (XDR) have become major health concerns.
In 2013, there were 145 cases of XDR TB in the state and Mumbai reported 112 cases. In 2014 the number rose to 469 in the state and to 396 in the city. However, it was just three years ago that the public health system was equipped to diagnose XDR-TB cases.
“It isn’t as if there were no XDR cases till 2012. We just did not have the means and facilities to diagnose them. In fact, many did not even know that there could be XDR cases,” said Dr Arun Bamne, public health consultant, Brihanmumbai Municipal Corporation (BMC).
In 2012, when doctors from Mumbai had identified the presence of extensively extreme drug resistant (XXDR) TB in Mumbai for the first time, it made international headlines. Since then, not only was TB made a notifiable disease, but the Revised National TB Control Programme (RNTCP) was to take charge of both diagnosis and treatment.
Though statistics show that the number of XDR cases has been on consistent rise in the past two years, experts said one of the reasons could be better diagnosis and reporting.
Mumbai presents a distinct challenge for TB control because of crowded and unhygienic spaces, making it conducive for transmission particularly in slum areas. “Other than diagnosis and better reporting, what has happened is that many of those who were taking treatment in the private sector have come under the public health umbrella [through the RNTCP]. With repeat diagnosis test they were found to have developed multiple drug resistance or even become XDR cases,” said Dr Yatin Dholakia, pulmonologist and honorary secretary at the Maharashtra state anti-TB association.
Experts said another reason for the increase is inadequate and improper treatment. “With the widespread use of group of drugs called Quinolones, which are used to cure all kinds of infections, the resistance to drug has increased,” Dr Amita Nene, chest physician at Bombay Hospital. “Some doctors are using it to treat sensitive TB cases. Extensive use of Quinolones has led to the rise in XDR TB cases as against MDR.”