Experts stuck on TB terminology

The Central team of experts on tuberculosis on Wednesday admitted that the nine surviving patients detected with totally drug-resistant tuberculosis (TDR-TB) by Hinduja Hospital are resistant to more drugs compared to patients suffering from extensively drug-resistant TB (XDR-TB).

The Central team of experts on tuberculosis on Wednesday admitted that the nine surviving patients detected with totally drug-resistant tuberculosis (TDR-TB) by Hinduja Hospital are resistant to more drugs compared to patients suffering from extensively drug-resistant TB (XDR-TB).

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However, it objected to the use of the term TDR-TB stating that it gave a message that the situation was hopeless. The term, which should be used, according to the team, is XXDR-TB — extremely drug-resistant tuberculosis. “There is no situation as TDR-TB in the city. The World Health Organisation (WHO) does not recognise it. There is always hope with new drugs,” said Dr Ashok Kumar, deputy director-general, Central TB division.

Dr Kumar said the Hinduja announcement of TDR-TB was “premature”. He, however, added, “We are not suspecting their credibility though.” Earlier this month, Hinduja hospital had announced that it had detected the first ‘TDR-TB’ cases in the country. Three of the 12 patients died in the past two months.

“We are confident about our study. We used the term in the scientific paper because the two previous studies, from Italy and Iran, termed the disease as TDR-TB,” said Dr Camilla Rodrigues, head of microbiology and infection control committee at the hospital. She is the co-author of the study published in Clinical Infectious Diseases Advance Access on December 21.

“The terminology is not an issue. The issue is that we have patients who have more resistance and we should be finding ways of tackling it,” said Dr Ira Shah, in-charge of paediatric HIV and TB clinic, BJ Wadia Hospital for Children at Parel.

The Centre has approved a ‘fifth line’ of treatment for TB. “This is a salvage regimen. We will dispense the drugs that are normally not used for TB. There are some antibiotics, including leprosy drugs, that are reserved and will be used for treatment in these cases,” said Dr PY Gaikwad, joint director, state health department.

“This is not total drug resistance, but very high resistance. The resistance in these patients is higher than XDR patients,” said Dr SK Jindal, chairman of the Directly Observed Treatment Short (DOTS) plus programme. “But the bacteria are not new. The chances of transmission are much less compared to other infectious diseases.”

“The treatment for XXDR is salvage treatment with drugs that are normally not used for TB. It is true that these patients are resistant to all the known forms of TB medication,” he said.