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