World Health Organization has rushed teams of doctors to Hinduja National Hospital in Mumbai, India, where 12 cases of totally drug resistant or TDR mode of tuberculosis have been reported. Three patients are now dead. India has become one of the few countries in the world where totally drug resistant tuberculosis has been detected. Iran, China, Italy and Peru have also reported cases of TDR strain of tuberculosis.
Tuberculosis is an acute or chronic bacterial infection found most commonly in the lungs though it can affect other parts of the body too. The disease is spread by infectious droplets through coughing, sneezing, or spitting. It thrives in conditions of poverty, poor ventilation and overcrowding thus making overpopulated cities and slum neighborhoods of developing countries a perfect breeding ground for this contagious and potentially fatal lung disease.
The history of tuberculosis indicates that the disease may have existed as early as 4000 BC and has been known by many names in ancient literary and religious texts. The disease has been called consumption, because it seemed to consume people from within, with a bloody cough, fever, pallor and long relentless wasting. Its other names included ''phthisis'' (Greek for consumption), the wasting disease, the white plague because its victims appeared very pale; king's evil and the Pott's disease.
Once a widespread disease, tuberculosis was curtailed with the help of antibiotics developed in the 1950s and it was hoped that the disease has been eliminated for good. This optimism was dashed in the 1980s with the rise of drug resistant strains around the globe. Today, this new and dangerous form of TB has created a public health crisis in many large cities worldwide.
So what causes the sickness to become drug resistant?
According to World Health Organization, drug-resistant TB is caused by
›Inconsistent or partial treatment, when patients do not take all their medicines regularly for the required period because they start to feel better,
›Doctors and health workers prescribe the wrong treatment regimens.
›Unreliable and interrupted drug supply.
A person with active TB can infect an average of 15 people annually. Populations at high-risk for TB include closely quartered prisoners, slum dwellers, immigrants, institutionalized patients, AIDS patients, and those living in congested urban areas where there is poor sanitation.
In India, the annual case detection rate for tuberculosis is 156 per 100,000. In Mumbai, this number is 213; in the slum area in the eastern part of the city, the rate is 394.
The government’s health ministry sent in its own experts to counter the findings of Dr. Zarir Udwadia, one of Mumbai's leading private pulmonologists who was the first to alert the nation and global health authorities to the dangers of this new medical menace in India.
The Delhi health ministry team has announced that the cases should be called Extensively Drug Resistant TB (XDR-TB) and not totally drug resistant TB. They have also accused that “Mumbai's Hinduja Hospital had been ‘premature’ in labeling 12 patients as TDR-TB patients, adding that there is “no doomsday situation in India."
Taking pains to diffuse the panic, the team issued a press release asserting that the term "totally drug resistant TB” is "non-standardized" and "misleading" because there is always a drug that works on TB patients. Steps have already been taken to isolate and treat the patients reported by the Hinduja Hospital.
The Indian media has accused the government of turning a blind eye towards the enormity of the situation. Not totally convinced by the government line, the print and electronic media is pointing out that Mumbai’s Hinduja Hospital is among the few in the country to boast of a laboratory that has been recognized by the WHO to carry out TB-related work. Nor can the credentials of medical experts like Dr. Zarir Udwadia be ignored.
Analysts assert that the government cannot live in denial any longer. It is the need of the hour that awareness is created about the contagious disease and better healthcare provided to the poor people of India. Meanwhile, health officials from India and the WHO are scheduled to meet in Mumbai soon to discuss how to manage the cases of highly drug-resistant strain in tuberculosis patients.