Extremely drug resistant TB a growing problem in India

[Gert van der Hoek]

Extremely drug resistant TB a growing problem in India

ATS 2007, SAN FRANCISCO -- Extremely drug resistant TB, or XDR-TB, is a serious problem in India, according to a study presented at the American Thoracic Society 2007 International Conference, on Monday, May 21.

The study, the first in India to look at the prevalence of XDR-TB, found this type of TB accounts for 8% of multi-drug-resistant cases, compared with about 4% in the United States.

MDR-TB (multi-drug resistant TB) describes strains of tuberculosis that are resistant to at least the two first-line TB drugs, isoniazid and rifampicin. XDR-TB is MDR-TB that is also resistant to three or more of the six classes of second-line drugs. XDR-TB leaves patients (including many people living with HIV) virtually untreatable using currently available anti-TB drugs.

Recent findings from a survey conducted by the World Health Organization and the Centers for Disease Control and Prevention found that XDR-TB has been identified in all regions of the world but occurs most frequently in the countries of the former Soviet Union and in Asia.

Sushil Jain of the Hinduja National Hospital in Mumbai, India, and colleagues examined 3,904 lab samples at their hospital, and found that 1,274 were positive for Mycobacterium tuberculosis. Of these, 32% were found to be MDR-TB, out of which 8% were XDR-TB. Tuberculosis can infect many sites in the body but most commonly affects the lungs.

All XDR-TB cases were in patients with pulmonary tuberculosis, or TB found in the lungs, which can be spread by coughing, sneezing, laughing or singing. Repeated exposure to someone with TB disease is generally necessary for infection to take place.

The death rate of XDR-TB patients in the study was 42%, which Dr. Jain calls "alarmingly high."

"An important finding was that the majority of patients with XDR-TB were of younger age group (their average age was 30 years), thus posing a major threat to our economically productive population," Dr. Jain notes. "Serious efforts are needed to tackle this deadly disease which may become a global emergency."

Dr. Jain says that XDR-TB has long existed in India but has been under-recognized and under-treated. "Most labs in India are not equipped to perform drug susceptibility tests so exact prevalence is difficult to ascertain, and treatment in the absence of reliable sensitivity reports is difficult. Compounding the problem is the huge costs of treating these most difficult TB patients," he said.

http://www.eurekalert.org/pub_releases/2007-05/ats-edr051407.php

 

[Gert van der Hoek]

Re: Extremely drug resistant TB a growing problem in India

Fake drugs increase MDR TB in Kashmir

Haroon Mirani

Srinagar, June 11, 2007 (Kashmir Newz Desk) :


Trying to fight the spread of Tuberculosis in Kashmir, health officials are finding themselves pitted against another enemy, which they say is a major cause of occurrence of Multiple Drug Resistant Tuberculosis (MDR TB) -fake drugs.

Health officials in Kashmir have come across many cases of Multiple Drug Resistant Tuberculosis (MDR TB), which they attribute to usage of fake drugs.

A study carried out by the state's premier medical institute, Sher-e-Kashmir Institute of Medical Sciences (SKIMS) has shown that the free availability of fake drugs in the state has helped develop immunity among the disease causing microbes for a variety of drugs.

Among them Mycobacterium tuberculi is one of the most vulnerable.

Dr Manzoor Thakur, Infection Control Officer at the SKIMS, who undertook a three year study on the efficacy of first and second generation cephalosporins, says that the health sector in Kashmir is undergoing a drastic change. "We are fast loosing the curing power of these drugs due to many reasons," said Thakur.

The research has pointed out that Tuberculosis treatment programme in Kashmir too has been affected.

"Drugs available in the market are devoid of the original content or they have very low content in their preparations," the study reveals.

Isoniazide, Rifampcin, Streptomycin and Pearamino Salicylic Acid are some of the drugs that are used for the treatment of Tuberculosis. These drugs are readily available in Kashmir under various brand names but Dr. Thakur has reservations about the genuineness of the products. "Most of the drugs available in the market for treatment of Tuberculosis in Kashmir are from fake companies," Thakur said.

Lesser content of Isoniazide and Rifampcin in the drugs used to control Tuberculosis prove ineffective in killing the Tuberculi microbe. Experts say that the Tuberculi particular microbe gets maimed instead of dying. With the passage of time these microbes become resistant and evolve into the MDR TB.

The startling findings are becoming a concern for doctors who seem to be losing their arsenal against microbes. If the pace of losing efficacy remains the same, they fear it can lead to a 'health disaster' in the shape of outbreak of MDR TB among the patients suffering from Tuberculosis.

Statistics available with the state's largest Chest Disease hospital in Srinagar show an increase in the percentage of MDR TB patients over the years. Out of the total number of Tuberculosis patients registered with the hospital, 2.45 per cent are the cases of MDR TB.

However, lack of proper data and information regarding the total number of MDR cases in Kashmir is the major impediment in the identification and solution of the problem. There is every apprehension that the actual figure is much higher than what is being shown in the statistics.

DOTS (Directly Observed Treatment, Short Course) programme launched under RNTCP is not going smoothly in the valley. In Kashmir valley it is assumed that 2,074 patients are undergoing treatment (under DOTS Programme) for the Tuberculosis but the directorate of Health Services in Srinagar has so far not been able to compile the data regarding number of MDR TB cases.

Although the drugs administered under DOTS are of high quality but a sizeable number of TB patients prefer private practitioners, who administer them alternate drugs available in the market, whose quality is always doubtful.

Kashmir lacks a facility for quality testing of drugs. In the absence of any drug testing facility in the state the plans to have curbs on these spurious drugs is a long forgotten illusion.

"Doctors can't do anything in this regard as the government is least concerned with it," said Dr Mushtaq, a practitioner in Srinagar.

It is believed that there is a huge nexus between health authorities and the drug companies that is paving way for the drug companies to dump unchecked drugs in Kashmir. However, the doctors in Kashmir deny any knowledge in this regard. Dr Muzaffar Mirza, Head of Department in Chest Disease Hospital, Srinagar says, "We prescribe the best available drugs for the patients but we can't comment on the quality."

Bad diagnosis too contributes towards the occurrence of MDR. Doctors say that they don't have facilities to detect MDR TB in Kashmir. Dr Anjum, Head of the Department of Microbiology at Government Medical College Srinagar says, "Doctors in Kashmir detect the MDR TB after they feel that the TB patient is not responding to the usual drugs," she says.

Government hospitals send the samples outside the state for testing, where it takes more than a month for confirmation of single MDR TB case. Mismanagement in handling of samples also nullifies some tests.

Drug Controller Kashmir Dr M A Khateeb while talking to Kashmir Newz admitted that the department too has received such complaints. ?We have come across such reports and we are trying our level best in dealing with these fake and counterfeit drugs in market that are posing dangers to our population in a number of ways,? Khateeb says.

According to Khateeb, the state is just weeks away from having state-of-art drug testing facilities. He said that the work is in full swing at the drug testing centers in Srinagar and Jammu, the summer and winter capital of the state, wherein they are being updated with latest machinery. ?We take every complaint seriously and fully investigate the matter to the satisfaction of all,? he added.

http://www.kashmirnewz.net/n000173.html