Times of India
26 April 2011
By Umesh Isalkar
Pune, India

Multi–Drug Resistant Tuberculosis
The culture lab for diagnosis and treatment of multi–drug resistant (MDR) tuberculosis at Aundh civil hospital has proved to be a non–starter even after a year. The Rs 5–crore lab is lying nonoperational for want of a basic equipment – hi–fi generator – expenses on which do not exceed Rs 20 lakh.

The department had tried to procure the equipment through donations from the World Health Organisation, international NGOs and the National Rural Health Mission (NRHM), but didn’t succeed. Once started, the lab will diagnose MDR–TB patients and also offer them free treatment as the cost of treatment often runs into more than Rs 2 lakh per patient per year.

"A generator of high specification and capacity is needed to roll on the work of the culture lab which is otherwise ready for the last threefour months. We had made a request to the joint director’s office in January, but we haven’t received it so far. We cannot start the lab without a generator," said Kanchan Jagtap, chief medical officer and in charge of the lab.

When contacted the office of the joint director (tuberculosis), a medical officer, requesting anonymity, said: "There is no denying the fact that the lab is lying unused due to lack of a generator. We have been trying to procure it through donations from the WHO or the NRHM. We had even tried to seek financial help from an international NGO, but in vain. The efforts are on."

"As bacteria are grown on a particular medium, continuous electricity supply is needed round the clock for its unhampered growth. Power failure even for a minute can arrest the bacteria growth and, in such case, the entire procedure goes waste," Jagtap said.

"There are suspected MDR patients in Pune region. But they are not eligible for DOTS–Plus treatment as there is no lab in the region which can confirm their MDR status. At present, the sputum samples of suspected patients are sent to Mumbai or and Nagpur labs for confirmation," Jagtap said.

There are currently two functioning culture labs in the state – on the premises of the Government Medical College, Nagpur, and at Hinduja Hospital, Mumbai. The positive MDR patients are given DOTS–Plus treatment, which is very costly. There are four DOTS–plus sites in the state for initial indoor care of diagnosed MDR patients. They are at GMC Nagpur, Indira Gandhi Medical College, Akola, Shewri TB hospital, Mumbai, and the Government Medical College, Aurangabad.

"The MDR is an advanced stage of TB, where patients require multiple drug treatment prescribed through culture tests diagnosis. The culture lab houses requisite infrastructure to demarcate the MDR cases from normal TB patients," Jagtap said.

Tuberculosis can become resistant if a patient is not treated long enough, doesn’t take prescribed medications properly, or doesn’t receive the right drugs. "The percentage of MDR is two to three per cent of the total TB patients," Jagtap said. The culture lab at Aundh civil hospital will ascertain the diagnosis of MDR as per the guidelines of the WHO, she added.

"Around 4,000 TB patients are diagnosed every year in the city, of which more than 85 per cent are cured," said Dilip Jagtap, deputy health officer of the Pune Municipal Corporation.

Of the remaining, deaths constitute less than 5 per cent, defaulters (those who discontinue treatment) less than 4 per cent, relapses more than 3 per cent and failures up to 3 per cent. The failure category is a chunk of patients who are not responding to treatment, Dilip added.

"They are the patients who form what we call as multiple–drug resistant TB patients. Such patients are put on category II drugs for eight months and when it is found that they are still not responding, they are asked to undergo culture sensitivity test (CST)," he said.

Stressing on the benefits of the facility, Major Pradip Gaikwad, joint director (tuberculosis), said: "Initially, two samples will be taken for CST. One will be carried out at the Aundh lab and the other will be sent to the National Tuberculosis Institute in Bangalore. Results of both the reports will be matched at a stretch for six months to streamline the working of the Aundh lab. Then it will be operational."

The facility will also cater to patients from Satara and Solapur. Later, it will cater to other cities in western Maharashtra.

The microbiologists and lab technicians responsible for the functioning of the culture lab will undergo an intensive training at the National Tuberculosis Institute in Bangalore from May 16 and May 26. This will be followed by a liquid culture training, which will continue till June 4.