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CDC HIV/AIDS/Viral Hepatitis/STD/TB Prevention News Update
INDIA: India Reports New TB Strain Resistant to All Drugs
Margie Mason
January 18, 2012
Associated Press (01.16.12) - Wednesday, January 18, 2012

Doctors in Mumbai recently reported 12 cases of what they are calling "totally drug-resistant tuberculosis." Most of these infections were not transmitted from person-to-person but rather were mutations that occurred in poorly treated patients. The hospital that saw the initial cases tested a dozen medicines and none of them worked. Three patients have died, and no patients have been successfully treated.

"It is concerning," said Dr. Kenneth Castro, director of CDC's Division of Tuberculosis Elimination. "Anytime we see something like this, we better get on top of it before it becomes a more widespread problem." Mumbai doctors blamed private physicians for prescribing inappropriate drug regimens, sparking worse resistance in three of the first four cases. "These three patients had received erratic, unsupervised second-line drugs, added individually and often in incorrect doses, from multiple private practitioners," according to a letter written by Dr. Zarir Udwadia and colleagues from the P.D. Hinduja National Hospital and Medical Research Center.

All the cases were poor slum dwellers, Udwadia said. One mother passed the strain on to her daughter living in close quarters, he said. One patient was HIV-positive, and co- infection typically results in faster death.

Udwadia criticized the testing and treatment methods of India's TB program, which he said forces patients to turn to private doctors. Many of these alternative doctors do not understand proper TB treatment or drug resistance.

"[The patients] have had no help from the Indian TB system," Udwadia said. "They are the untouchables, so no one is making a fuss. They don't have the power to vocalize. There's going to be more family contacts. It's going to spread for sure." Dr. Nata Menabde, the World Health Organization's representative in India, said a team of national experts started investigating the cases Monday. The government also is beginning to improve diagnostics to find resistant cases and identifying ways to improve the regulation of TB treatment in the private sector, she said.

The letter, "Totally Drug-Resistant Tuberculosis in India," was published in Clinical Infectious Diseases (2011;doi:10.1093/cid/cir889).

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