17 January 2012
By Umesh Isalkar
Plans are afoot to set up a sophisticated tuberculosis laboratory in the state on the lines of national reference labs. The new lab will facilitate early diagnosis and help treatment of the deadly totally drug resistant TB (TDR–TB).
Currently, the state does not have a facility even to detect TDR TB. The state’s existing facilities in Mumbai, Pune and Nagpur can only detect resistance of TB causing bacteria to Rifampiocin and Isoniazid, two of the most effective anti–tuberculosis drugs. First there was multi–drug resistant tuberculosis (MDR TB), followed by an extensively drug resistant strain (XDR TB), and now a totally drug resistant form (TDR TB) has emerged. At least 12 patients in one hospital in Mumbai, India (at the P.D. Hinduja National Hospital and Medical Research Centre) have been confirmed to have the new totally drug resistant type of tuberculosis (TB).
“This means their infections are resistant to all drugs known to treat the bacterial infectious disease (to include the three first–tier drugs and the nine second–line drugs). Currently, we do not have a facility which will detect TDR TB. The existing facilities in Mumbai, Pune and Nagpur can detect resistance to only two tuberculosis drugs. While there are 12 anti–tuberculosis drugs used in treatment of TB,” said Pradip Gaikwad, joint director (TB) of state health services, who heads the state’s TB control programme.
“We are thinking of either upgrading one of the exisiting facilities or set up an altogether new sophisticated laboratory on the lines of three national tuberculosis reference laboratores based in Chennai, Bangalore and New Delhi,” Gaikwad said.
The country has three national tuberculosis reference laboratories – the Tuberculosis Research Centre, Chennai, National Tuberculosis Institute, Bangalore, Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases (LRS), New Delhi. The Agrabased National Jalma Institute of Leprosy and Other Mycobacterial Diseases also has BSL 3 laboratory which facilitates work in leprosy and TB.
A three–member team that includes a chest specialist, a World Health Organisation official and a scientist from the central TB division has come down Mumbai to gauge the menace of TDR TB. “We will discuss the possibility of setting up such a futuristic lab with them and assess its viability,” Gaikwad said.
The country's central TB division has asked the Maharashtra government to collect data for the last six months from all other labs in the state dealing with TB.
At present, less than 3% of all new cases of TB are MDR while nearly 17% of re–treatment cases are drug resistant. Around 3%–5% of MDR TB cases are XDR TB.
Resistant strains of tuberculosis bacteria (Mycobacterium tuberculosis) are manmade; they develop when the medications used to treat the disease are not used or managed correctly. Most areas of India do not have the capability to detect TDR TB. If the infection is undetected, people can continue to spread all forms of tuberculosis – resistant or not.Factsheet
- TB kills about 1,000 people a day in India
- While Iran first reported TDR TB cases three years ago, India seems to be the second country to report this deadly form of the disease. As the full form of TDR–TB suggests, none of the known TB combination drugs work on the patient
- MDR TB is a serious menace in India. The nation has plans to put in place 43 labs to diagnose MDR TB. So far, 31 labs have been accredited to conduct MDR TB detection tests. The rest are expected to be in place by end of this year
- Every year, India reports 15 lakh new cases of TB. The WHO says around 73,000 of the notified new TB cases in 2010 were already multi–drug resistant. Of this, less than 3,000 were detected
- The direct and indirect cost of TB to India amounts to an estimated $23.7 billion annually. Studies suggest that on an average three months of work time is lost as result of TB, resulting in an average lost potential earning of 30% of the annual household income
- Those with active TB when left untreated can infect on an average 15 people every year. In 2000, the prevalence rate of TB in India was 338 per 100,000 population and the mortality due to TB was 42 per 100,000 population. In comparison, in 2009, the prevalence of TB in India was 249 per 100,000 population and the mortality due to TB was 23 per 100,000 population