Delay in diagnosis leads to worsening of multi drug-resistant TB in country

April, 2016, New Delhi

The fight against tuberculosis in Mumbai, dubbed as the country's TB capital after news of totally drug-resistant TB emerged in 2012, will soon pack a stronger punch. The Centre is ready to announce universal drug susceptibility testing (DST) in Mumbai as a pilot project, said Dr Sunil Khaparde, Deputy DG of the Central Tuberculosis Division, at a meet in the city. The universal DST plan entails testing every presumptive TB patient for drug resistance as soon as he/she goes to a doctor. The fight against tuberculosis just got fiercer. The Centre is ready to announce universal drug susceptibility testing (DST) in Mumbai as a pilot project for the rest of the country , said Dr Sunil Khaparde, Deputy Director General of the Central Tuberculosis Division. .

The universal DST is a part of the World Health Organisation's strategy to 'end TB by 2035'. Currently, a patient is first tested for simple TB that needs six to nine months of treatment. If the patient doesn't respond to this treatment within, say, three months, he is tested further for drug resistance. If the patient is resistant to two of the normal drug regimens, he is said to suffer from multi drug-resistant (MDR) TB. If the patient is resistant to more than two drugs as well as an antibiotic injection given to MDR-TB patients, he has extensively drug resistant (XDR) TB. Drug-resistant TB needs over two years of treatment, with drugs costing more than Rs 2 lakh.

The magnitude of the delayed-treatment problem in Mumbai can be judged from a study done by the Foundation for Medical Research that showed that, on an average, drug resistant TB patients take 192 days to start treatment from the time symptoms appear. “We estimate that there are roughly 75,000 cases of MDR-TB cases in India. But in 2015, we had only 26,000 on treatment," said Dr Khaparde. "There is a huge gap that could be addressed by a better detection system such as universal DST."

"Of the 1,539 MDR-TB cases identified by the TB laboratory at Hinduja Hospital in Mumbai (which included samples from both public and private patients), only 30% were truly MDR-TB; the remaining cases represented preXDR, XDR, and resistance beyond XDR-TB," said an editorial in Lung India. In other words, nearly two-thirds of this sample would have received incorrect dosage of drugs and risked developing higher levels of resistance, the article explained.


Mumbai's TB officer Dr Daksha Shah said the city already offered universal DST to a few categories of patients such as children, HIV-positive people and those in close contact with MDR-TB patients. “We are waiting for the Central nod to offer the test to others as well," she said. The need for universal DST follows India's agreement to WHO's protocol that patients should be offered individualised treatment instead of the present "one-drug regimen for all drug-resistant TB cases".

Dr Udwadia, who in 2011 published a letter in the CID (Clinical Infectious Diseases) medical journal highlighting 12 patients who did not respond to any of the drugs known to treat TB, said that universal DST would be a welcome addition.

Incidentally, a research paper written by the Central TB division's Dr K S Sachdeva, said that widespread deployment of high-sensitivity diagnostic testing (like GeneXpert that give the result of drug-resistance in a sample within two hours) and universal DST could help the country avert more than 1.8 lakh cases of MDR-TB between 2015 and 2025.Times Now Health