A recent study by Andheri’s Kokilaben Hospital has found that an overwhelming percentage of children referred to the hospital for tuberculosis had contracted its dreaded strain–multidrug resistant TB (MDRTB)–directly from the community and not from their immediate families. What makes the situation more alarming is the fact that there are negligible treatment options available for the paediatric population, say experts.
Kokilaben Hospital, which works as a referral centre for paediatric tuberculosis cases, has found a staggering 72% of the 21 referred children with the drug resistant form of the disease. A teenaged boy also tested positive for the extensively drug–resistant tuberculosis (XDRTB), which is a rarity among kids and has only few documented cases in India.
Shockingly, during the process of contact tracing, the study found that none of the kids had an adult relative suffering from TB, leave alone its resistant form, suggesting they got the infection from outsiders. No clear treatment for kids with drug–resistant TB, say doctors
Mumbai: An alarming trend of city children contracting the dreaded multidrug resistant TB (MDRTB) from outsiders has recently come to light. Most of the children covered under a study by Kokilaben Hospital had contracted MDRTB as the primary infection. In other words, they had no previous history of TB whatsoever.
Six of the patients had contracted TB in the lungs, five in the lungs as well nodes (glands), two in lymph nodes, and one in the central nervous system.
Commonly, in adults, non–adherence to TB drugs is what pushes them to its drug–resistant form but this was not found to be the case among these young patients.
The majority of these MDRTB patients–12 out of 15–were girls aged between three and 18. Almost all the patients had wasted an average of one year before being correctly diagnosed with TB and then its resistant form. The challenge for children, though, does not end at getting diagnosed.
Dr Tanu Singhal, a paediatric infectious diseases expert from Kokilaben Hospital and the main investigator in the study, said, "The situation is scarier for children as there are no drug formulations available just for them and the few effective ones are drying up too. Drug sensitivity tests carried out during the study showed that 75% of these children were resistant to the drug regime recommended by the Revised National Tuberculosis Control Programme (RNTCP)."
Chest physician Dr Zarir Udwadia who consults at Mahim’s P D Hinduja Hospital said, "The findings are in conformity with global findings that MDRTB in children is a fast emerging threat. Since there is no clear treatment regimen or dosages, doctors are mostly halving or quartering the medicines meant for adults."
In the city, 4% of the 3,829 MDRTB patients undergoing treatment under the RNTCP are children.
Mumbai’s TB control officer Dr Minni Khetarpal said while children from any strata could get the infection from the community, those living in overcrowded slums are the most vulnerable. In three years, close to 50 children from Mumbai have been put on medication for drug–resistant TB.
On the positive side, Singhal said children also have a low bacterial count and rarely massive cavities (holes) in the lungs are noticed. "But it is tough for them to take injections for eight–nine months and the medication for up to two years. The solution clearly lies in better nutrition and hygiene and bringing down resistant TB among adults."
Times of India
24 Sep 2013