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Times Of India
14 June 2012

Pune: As many as 105 multi-drug resistant tuberculosis (MDR-TB) cases have been reported in the district over the last three and half months, with the highest number of cases being found in Pune city (45), followed by Pimpri-Chinchwad (34). The interiors of the district have reported 26 MDR-TB cases. This has been revealed by the referral laboratory at the Aundh Chest Hospital which started functioning on February 10.

" This means we have diagnosed 105 patients with MDR-TB in 111 days. We detected these cases in Pune district between February 10 and May 31," said Kanchan Jagtap, chief medical officer in charge of the State TB Training and Demonstration Centre (STDC) at the Aundh Chest Hospital.

Since the lab became operational, experts have begun demarcating the MDR cases from the regular TB cases. Tuberculosis can become resistant if a patient is not treated long enough, doesn’t take the prescribed medication properly or is not prescribed the right drugs.

"All the 105 patients of MDRTB are cases of pulmonary (lung) tuberculosis," said Jagtap. But if not detected and put on treatment, a patient of MDR-TB can spread the infection through droplets.

"An MDR-TB patient becomes non-infectious after three months of intensive treatment – meaning, he does not spread the infection after three months of treatment as the sputum is devoid of the disease-causing bacteria. The patient is also taught cough-hygiene and cough-etiquettes to ward off the spread of infection. After 24 months of treatment, an MDR-TB patient can be completely cured," Jagtap said.

Jagtap said, the health department has initiated multi-pronged approach to tackle the menace TB and its resistant form. We are creating awareness, detecting patients, counseling them to adhere to treatment and offering them free treatment. The recent Union government notification has made TB a notifiable disease – meaning even private medical practitioners will also have to report a TB case to the government. The move will bring every TB case on government radar and this will automatically preclude irrational treatment," said Jagtap.

Of the 1.2 million "new" TB cases notified in 2009 in India, as many as 14,991 (1.8%) were reported to have failed the first line anti-TB treatment drug regimen. Similarly, of the 2,89,756 re-treatment TB cases, 11,265 (4%) failed the first-line re-treatment regimen.

MDR-TB (resistance to two of the potent first-line anti-TB drugs, isoniazid and rifampicin) is one of the important causes for the failure of TB treatment.

As per the guidelines of the Revised National Tuberculosis Control Programme (RNTCP), patients with drug susceptibility test (DST) results showing resistance to rifampicin are considered eligible for MDRTB treatment, irrespective of resistance to isoniazid, streptomycin or ethambutol.)

Between February 10 and May 31, the referral laboratory received samples of 250 patients suspected to have MDR-TB from the city limits. Of them, 45 samples tested positive for MDR-TB. The Pimpri Chinchwad Municipal Corporation had sent 133 samples and 34 patients tested positive. A total of 60 samples were sent from the rural parts of the district. Of them, 26 tested positive, Jagtap said.

"MDR patients constitute two to three per cent of the newly-diagnosed TB cases. Earlier, there were only suspected cases of MDR-TB. Now, now we have been able to ascertain the exact number of MDR-TB cases in the city," said S T Pardeshi, health chief, PMC.

While Pune city reported 1,412 TB cases in 2010, the number rose to 3,650 in 2011. Pimpri-Chinchwad reported 1,445 TB cases last year. The rural areas reported 4,202 cases in 2010 while the number came down to 3,892 in 2011.

Around 85% TB cases are curable. Of the remaining, deaths constitute less than 5%, defaulters (those who discontinue treatment) less than 4%, relapses more than 3% and failures up to 3%.

The state started detecting MDR-TB cases from September 2007. "Since then, we have reported over 1,100 MDR-TB cases in the state so far," Pradip Gaikwad, joint director (TB), state health services had said in an earlier interview.

Mumbai accounted for the highest number of cases, followed by Nagpur. Since the culture lab has just started functioning in Pune, more cases will be detected. MDR constitutes 2-3% of the newly-diagnosed cases.

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