Children with drug-resistant TB get it from adult patients at home: Doctors
Doctors say the recorded rise in paediatric XDR cases is the tip of an iceberg. Chest physician Dr Vikas Oswal said getting samples to test for both pulmonary and extra TB in children is a challenge. Almost 50% of the new paediatric cases he sees are pre-XDR or XDR.Updated: Mar 24, 2019 16:58 IST
Five out of a 10-member family from Kurla slum were diagnosed with extensively drug resistant tuberculosis (XDR TB), a highly drug-resistant form of the disease. Among them are eight-year old Ghanshyam and his teenage sister Anjali who are being treated at a facility in Govandi run by an international aid group. Doctors said the siblings are a part of the paediatric age group that is seeing an increase in severe drug resistant cases.
“Out of 10 new paediatric TB cases I see, at least four have XDR TB. The numbers were much lesser earlier,” said Dr Ira Shah, a paediatric infectious disease specialist at Bai Jerbai Wadia Hospital for Children. According a study published in The Pediatric Infectious Disease Journal, led by Dr Shah, since 2013, 9.6% of the TB in paediatric cases were drug-resistant as compared to 5.6% such cases in 2010.
Dr Daksha Shah, the city’s municipal TB officer, said they were in the process of collecting data on the number of paediatric multi-drug resistant TB (MDR TB)and XDR TB cases. She said previous estimates showed nearly 150 out the total 5,000 MDR TB cases were among children. “In one out of two XDR cases in children, there is at least one adult TB patient in their household. What is worrying however is that children are getting infected with strains that are already drug resistant to multiple drugs,” Dr Shah said.
Doctors treating the Kurla siblings – who live with eight other family members in a small shanty – said the children may have acquired the infection at home, where their grandfather and aunt were on treatment for XDR. “The family suspected the infection only when the children started showing symptoms such as weight loss, recurrent fever and cough,” said the Govandi-based doctor who is treating them.
Neelam Sharma, the children’s mother who is a former TB patient, said that in their cramped conditions, it was impossible to keep the children away from their ailing grandfather. “He would stop taking medications as soon as he felt some relief. Soon, the symptoms would start showing up again,” Sharma said.
Doctors say the recorded rise in paediatric XDR cases is the tip of an iceberg. Chest physician Dr Vikas Oswal said getting samples to test for both pulmonary and extra TB in children is a challenge. Almost 50% of the new paediatric cases he sees are pre-XDR or XDR. “For these cases there we need to look at newer drugs such as Delamanid,” he said.
One of the challenges is getting these newer drugs. Stobdan Kalon, of the non-profit organisation Médecins Sans Frontières, said their centre in Mumbai is treating children with Bedaquiline and Delamanid.
“We have seen good outcomes with these drugs. Keeping in view the high unmet need of paediatric age group, the access to Bedaquiline and Delamanid needs to be improved for children with severe resistance,” said Kalon.