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Times Of India.
05 July 2012

Patients of two drug–resistant strains of TB get a new lease of life as doctors at Hinduja and Sewri hospitals perform rare surgeries

Six months after Mumbai shocked the world by reporting 12 cases of Totally Drug Resistant TB (TDR–TB), the city’s feisty doctors have launched a spirited counter–attack on the nasty, mutating bacteria. And initial results say the good doctors are winning.

While Dr Zarir Udwadia of Hinduja Hospital, who reported the 12 TDR–TB cases in January this year, surgically removed a large part of one of the patient’s infected lung a month ago, giving him a fresh lease of life, Dr Harikant Bhanushali of Sewri TB Hospital performed the same procedure on two Extensively Drug Resistant (XDR) cases in the past two weeks. All three patients’ sputum cultures have since tested negative and they have all reported improved breathing.

While Dr Udwadia’s revelation of TDR–TB cases had received much flak from health authorities who labelled the discovery ‘sensationalist’, the doctor himself kept a low profile, preferring to get down to work again to beat the bacteria.

The health authorities had objected to Dr Udwadia for upping the stakes with his use of the term ‘TDR–TB’ to describe the cases, when the world over the deadliest strain is XXDR TB – Extremely Drug Resistant TB.

The term XDR–TB is used to refer to strains of TB that are resistant not only to two of the main first line TB drugs, but also to at least one of the secondline injectable TB drugs. XXDR–TB or TDR–TB refers to strains that are resistant to both first line and second line drugs.

The procedures conducted this past month by Dr Udwadia and Dr Bhanushali were video–assisted thoracic surgeries (VATS) and involved removing the infected parts of patients’ lungs. VATS has a two–prong effect – one, it eliminates a good 90 per cent of the bacteria in one go; two, it removes the infected tissue on which the bacteria feed.

Also, since a large number of bacteria get eliminated in one big sweep, something drugs would take months or years to achieve, the possibility of mutation also reduces drastically.

While use of thoracic surgeries in XDR cases is rare because the bacteria occupy a very large part of the lung, such operations have been unheard of in XXDR or TDR cases. These minimal invasive surgeries require only three small incisions to the chest to give access to the affected area. The incisions allow insertion of a fibre optic camera and surgical instruments into the chest cavity.

Surgery was the last hope for 35–yearold XXDR patient (identity withheld), who was operated upon by Dr Udwadia and Dr Gustad Davar (thoracic surgeon) early last month. The bacteria had infected one of his lungs almost entirely. However, even with one of his lungs being almost entirely lopped off in the surgery, the patient has reported improved breathing. His sputum culture too has tested negative. "The results have been excellent. However, the patient requires good post–operative care as there is risk of bleeding and infection," Dr Udwadia said.

Sadanand Jadhav, 32, who was detected with XDR–TB two years ago, was operated upon by Dr Bhanushali two weeks ago. His sputum culture has since tested negative and he is likely to be discharged soon. He has told doctors what he is going to do first when he reaches home – "I haven’t hugged my two–year–old daughter even once since her birth. She is going to get a big, tight hug from me."

Jadhav, a resident of Jogeshwari, was first diagnosed with TB in May 2010. "I was first told a six to nine months’ course of medication will do the trick. But my condition worsened. In 2011, tests done at Hinduja Hospital revealed that it was strain of Multi–drug Resistant TB. I was put on new drugs. But there was no improvement in my condition for six months. Then more tests were conducted and I tested positive for Extensively Drug Resistant TB or XDR–TB," Jadhav said.

Lata Sabale, the other XDR–TB patient operated upon by Dr Bhanushali, has since been discharged and is recuperating at home.

"Earlier I used to feel so breathless. But now, after the surgery, I am feeling much better," Sabale, who was being treated for TB for four years, told Mumbai Mirror.

In both Sabale and Jadhav’s cases, the surgeries lasted over several hours. "These two cases were challenging cases for me. It took me almost seven hours to remove the pus cells in their lungs," said Dr Bhanushali.

He said both patients are now 90 per cent tuberculosis–free, but will remain on antibiotics for a few months to deal with any remaining bacteria.

Sadanand Jadhav, 32, who has XDR–TB has watched his two–year–old daughter grow from a distance. After being discharged, he will finally be able to give her a hug

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