India 2012: Totally Drug Resistant Tuberculosis

[Ronan Kelly]

:tiphat: Healthmap

Incurable TB strain detected at Hinduja
HT Correspondent, Hindustan Times
Mumbai, January 07, 2012

First Published: 00:58 IST(7/1/2012)
Last Updated: 01:00 IST(7/1/2012)

For the first time in India, 12 people have been detected with totally drug resistant lung tuberculosis (TDR-TB), a condition in which patients do not respond to any TB medication, at PD Hinduja Hospital in Mahim. The mortality rate for this strain of the infectious disease is 100%.

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?A TB patient comes in contact with at least 10 to 15 people on average, thus the strain is likely to spread,? said Dr Zarir F Udwadia, consultant physician at PD Hinduja Hospital, who coauthored a paper on TDR-TB that was published in the scientific journal Clinical Infectious Diseases Advance Access on December 21. The patients, including a 13-year-old girl, were diagnosed in October. Since then, a 31-year-old woman from Dharavi died in November.

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http://www.hindustantimes.com/India...rain-detected-at-Hinduja/Article1-792564.aspx

 

[Ronan Kelly]

Re: Mumbai: Drug resistant TB strain detected at Hinduja hospital

Re: Mumbai: Drug resistant TB strain detected at Hinduja hospital

Totally Drug-Resistant Tuberculosis in India
Zarir F. Udwadia, Rohit A. Amale, Kanchan K. Ajbani, and Camilla Rodrigues
+ Author Affiliations

P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
Correspondence: Zarir F. Udwadia, MD, FRCP, P. D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai 400 016, India (zarirfudwadia@gmail.com).
TO THE EDITOR?Three years after extensively drug-resistant (XDR) tuberculosis was first described in 2006, Velayati et al [1] drew attention to the emergence of totally drug-resistant (TDR) tuberculosis in a cohort of 15 patients from Iran, resistant to all first- and second-line drugs. Since the first cases of XDR tuberculosis in India were reported from the P. D. Hinduja National Hospital and Medical Research Centre [2], physicians here have grappled with increasingly resistant strains of tuberculosis. We describe the first patients from India with TDR tuberculosis. Drug susceptibility testing (DST) was ?
http://cid.oxfordjournals.org/content/early/2011/11/24/cid.cir889.extract

 

[Gert van der Hoek]

Re: Mumbai: Drug resistant TB strain detected at Hinduja hospital

Re: Mumbai: Drug resistant TB strain detected at Hinduja hospital

TDR-TB: no choice left

As if Multi-drug resistant (MDR-TB), extensively-drug resistant (XDR-TB) were not scary enough, now TB has a deadlier edge known as Totally Drug-Resistant TB (TDR-TB). As the name says it all, the physicians are literally left with no choice to treat, as all known TB combination drugs do not work on the patient, owing to the TB bacilli’s ability to mutate and get resistant to the drugs. The clinicians have little to offer these patients with TDR-TB except for drastic surgeries and some relief medications.

TDR-TB cases were first reported in Iran in 2009 and India stands as the second country to report this scary form of TB and 12 TDR-TB cases have been reported in the last 3 months at Hinduja Hospitals in Mumbai.

Of the 12 cases reported in Mumbai 83.3% of them were from the Mumbai city. Moreover, it is worrisome to note that the average age of the 12 patients is just about 32 years.

The TDR-TB strains from the reported 12 patients were found to be resistant to all the first line drugs namely, streptomycin, isoniazid, rifampicin, ethambutol and pyrazinamide and second line drugs namely, ofloxacin, moxifloxacin, kanamycin, amikacin, capreomycin, para-aminosalicylic acid and ethionamide.

In the report published in the December 2011 issue of Clinical Infectious Diseases journal, the authors declare that the emergence of TDR-TB is the failure of overall health system.

Only 1% of patients with drug resistant TB have access to second-line drugs provided by the government sector and the private sector has clinicians who do not follow appropriate guidelines for management of TB patients.

According to an earlier study on the prescription pattern of clinicians in a particular area, less than 5% of clinicians prescribed the right drugs for drug-resistant patients.

MicroBiologyBlog

Thanks to Crof

 

[Gert van der Hoek]

Re: Mumbai: Totally Drug resistant TB strain detected at Hinduja hospital

Re: Mumbai: Totally Drug resistant TB strain detected at Hinduja hospital

Maryn McKenna has some more details in her blog :

India Reports Completely Drug-Resistant TB

By Maryn McKenna January 9, 2012

- snip -

The first cases, as it turns out, were not these Indian ones, but an equally under-reported cluster of 15 patients in Iran in 2009. They were embedded in a larger outbreak of 146 cases of MDR-TB, and what most worried the physicians who saw them was that the drug resistance was occurring in immigrants and cross-border migrants as well as Iranians: Half of the patients were Iranian, and the rest Afghan, Azerbaijani and Iraqi. The Iranian team raised the possibility at the time that rates of TDR were higher than they knew, especially in border areas where there would be little diagnostic capacity or even basic medical care.

The Indian cases disclosed before Christmas demonstrate what happens when TB patients don?t get good medical care. The letter to CID describes the course of four of the 12 patients; all four saw two to four doctors during their illness, and at least three got multiple, partial courses of the wrong antibiotics. The authors say this is not unusual:

The vast majority of these unfortunate patients seek care from private physicians in a desperate attempt to find a cure for their tuberculosis. This sector of private-sector physicians in India is among the largest in the world and these physicians are unregulated both in terms of prescribing practice and qualifications. A study that we conducted in Mumbai showed that only 5 of 106 private practitioners practicing in a crowded area called Dharavi could prescribe a correct prescription for a hypothetical patient with MDR tuberculosis. The majority of prescriptions were inappropriate and would only have served to further amplify resistance, converting MDR tuberculosis to XDR tuberculosis and TDR tuberculosis.

As their comment suggests, the other TB challenge is diagnosis, especially of resistant strains, and here again the news is not good. The WHO said last spring that only two-thirds of countries with resistant TB epidemics have the lab capacity to detect the resistant strains. As a result, only one MDR patient out of every 10 even gets into treatment, and when they do, cure rates range from 82 percent down to 25 percent. That?s for MDR. None of the TDR patients have been recorded cured, and at least one of the known Indian patients has died.

Meanwhile, health authorities estimate that one patient with active TB can infect up to 15 others. And thus resistant TB spreads: XDR-TB was first identified just in 2006, and it has since been found in 69 countries around the world.

read more

 

[Ronan Kelly]

Re: Mumbai: Totally Drug resistant TB strain detected at Hinduja hospital

Re: Mumbai: Totally Drug resistant TB strain detected at Hinduja hospital

Thiruvananthapuram | Updated Jan 12, 2012 at 11:57am IST
Bangalore: 2 TDR TB cases detected at RGICD
The New Indian Express


BANGALORE: City-based Rajiv Gandhi Institute of Chest Diseases (RGICD) has diagnosed two patients with TDR TB (Totally Drug Resistant TB) cases. During the surprise visit of Medical Education Minister S A Ramdas to RGCID on Wednesday, it was revealed that, in the absence of coordination between the Health department and the institute, he was not updated about these two cases.
RGICD Director Dr Shashidhar Buggi, who had submitted the detailed report of the TDR cases in Karnatata to the Medical Education Department on Tuesday, said one of the patients was a 56-year-old man from the city and the other is a 31-year-old woman from Dakshina Kannada, who is still undergoing treatment.

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http://ibnlive.in.com/news/two-tdr-tb-cases-detected-at-rgicd/220033-62-123.html

TDR-TB threat: Ramdas says RGICD is ‘guessing’
Published: Thursday, Jan 12, 2012, 9:28 IST
By Deepthi MR | Place: Bangalore | Agency: DNA


The revelation of two confirmed Total Drug Resistant-Tuberculosis (TDR-TB) at Rajiv Gandhi Institute of Chest Diseases (RGICD) has shaken the health ministry and officials who had instantly gone into a denial mode, even as they blame the RGICD for not bringing the cases to their notice.

However, minister for medical education, health and family welfare, SA Ramdas, following a DNA report on Wednesday, has decided to constitute a three-man committee to submit a detailed report on the status of tuberculosis in the state to the government.
He also conducted a ‘surprise visit’ to RGICD and declared that he is not convinced that the two were TDR-TB cases because “the two cases were only confirmed by clinical tests,and biological tests have not been done while confirming them.”

He alleged that RGICD has only conducted a clinical analysis of the two patients wherein sputum (phlegm) culturing was not conducted. He blamed RGICD for ‘guessing’ that since the patients have not responded to the medication since two years, it must be TDR.

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http://www.dnaindia.com/bangalore/report_tdr-tb-threat-ramdas-says-rgicd-is-guessing_1636519

No city lab can certify TDR-TB


Malathy Iyer & Pratibha Masand, TNN | Jan 13, 2012, 02.26AM IST
MUMBAI: There could be more than 12 cases of the new and deadlier form of tuberculosis, Totally Drug-Resistant Tuberculosis or TDR-TB, in the city. JJ Hospital officials and a private doctor said they are treating patients suffering from TDR-TB.

JJ Hospital dean Dr T P Lahane confirmed that they have identified two patients suffering from the new strain of TB and who have been under treatment since 2003.
"We have two cases of TDR-TB. They had stopped taking the primary course after a few months of being detected. They then developed resistant strain. This happened twice to each of these patients,'' JJ Hospital dean Dr T P Lahane said.

Meanwhile, Dr Yatin Dholakia of the Maharashtra State Anti-Tuberculosis Association said that he had found TDR-TB in a patient two years ago. "The girl improved for a few months but left the city when her aunt could no longer afford the treatment,"' he said.

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http://timesofindia.indiatimes.com/...b-can-certify-TDR-TB/articleshow/11468400.cms

 

[Ronan Kelly]

Re: India 2012: Totally Drug Resistant Tuberculosis

WHO meets in Geneva; Central TB Unit sending team

Panic and chill in the air as TDR-TB claims 3 of 12 lives

? India only the third country where the deadliest form of tuberculosis has struck ? People the 12 patients came in contact with to be identified and tested for TB

Lata Mishra and Jyoti Shelar

Posted On Saturday, January 14, 2012 at 02:10:46 AM

Less than a week after top chest physician Dr Zarir F Udwadia broke the news of presence of totally drug resistant tuberculosis (TDR-TB) cases in the city, it was revealed on Friday that three of the 12 patients he studied have died in the past two weeks.

Nobody would have known of these deaths if the Directorate of Health Services and BMC's health officers, completely taken aback by Dr Udwadia's research, had not launched a drive to visit the 12 patients to collect sputum samples of their family members.

While the identities and addresses of the 12 patients are not available, Mumbai Mirror traced one of the dead patient's family to its Patilwadi, Ranade Road, Dadar (west) home.

Supriya Daware, 20, died on January 5 after three years of being treated for TB across four hospitals. She was first diagnosed with TB when she was in class 12.

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http://www.mumbaimirror.com/index.a...15&contentid=201201142012011402105193f200e756

 

[Ronan Kelly]

Re: India 2012: Totally Drug Resistant Tuberculosis

Not TDR-TB cases in Mumbai: health ministry team
PTI | 09:01 PM,Jan 20,2012
New Delhi, Jan 20 (PTI) A Central team today said there were no cases of total drug-resistant tuberculosis reported in the country and the cases made out by a Mumbai hospital fall in the category of extensively drug-resistant TB. The central team comprising senior Chief Medical Officer, Central TB Division, Consultant (Drug Resistant TB), and National Programme Pfficer (laboratory) was sent to Mumbai on Tuesday following reports of P D Hinduja hospital detecting first cases of total drug resistant TB in India. The team submitted its report to the health ministry today. "The reported cases by Hinduja hospital fall only within the category of Extensively Drug Resistant TB (XDR-TB) based on standard WHO definitions and not at all as 'Totally Drug Resistant' TB (TDR-TB)," a health ministry statement said.

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http://ibnlive.in.com/generalnewsfe...es-in-mumbai-health-ministry-team/953489.html

 

[Shiloh]

Re: India 2012: Totally Drug Resistant Tuberculosis

Source: http://www.upiasia.com/Health/2012/05/04/1336106900544/

Confirmed cases of TB resistant to drugs
Published By United Press International

MUMBAI, India, May 3 (UPI Asia) ?Tests on eight patients of tuberculosis in India have confirmed that the virus is resistant to all known drugs, a leading newspaper reported Thursday.

The confirmation has come from the National Tuberculosis Institute at Bangalore, 840km south of Mumbai, the Hindustan Times said.

The institute tested the patients after the Hinduja Hospital here claimed in January that 12 of its patients had totally drug-resistant tuberculosis, or TDR. These eight patients were among the 12 reported with TDR.

The state government forwarded the samples to the New Delhi-based Central TB Division on April 19, which monitors the outbreak of the disease across the country. The division in turn sent the samples to the Bangalore institute this week.

The World Health Organization rejects that there is such a thing as totally drug-resistant TB...