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CDC HIV/AIDS/Viral Hepatitis/STD/TB Prevention News Update
INDIA: TB We Can't Treat Is Spreading in India
Andy Coghlan
January 31, 2012
New Scientist (01.21.12) - Tuesday, January 31, 2012

The recent report of 12 TB cases in Mumbai that researchers are calling "totally drug resistant" came as no surprise to some experts. In 2009, only an estimated 11 percent of multidrug-resistant TB (MDR TB) cases globally were being treated, the World Health Organization (WHO) reported. Just 11 of 27 countries with high burdens of resistant TB had national plans to address the problem.

"What's surprising is that we've not heard of it earlier in India, because the conditions for creating drug resistance are present there," said Paul Nunn of WHO's Stop TB Partnership. India's government has focused on conventional forms of TB that can be treated for $20 per patient, rather than on resistant forms that can cost $2,000-$12,000 to treat, he said.

Without state-sponsored MDR TB treatment, patients turn to private doctors. Zarir Udwadia and colleagues at Mumbai's Hinduja National Hospital and Medical Research Center, where the 12 cases were diagnosed, found that just five of 106 local private practitioners surveyed could prescribe the correct treatment for MDR TB.

An analysis of similarly resistant TB identified in a 2009 Iranian outbreak found the bacteria had unusually thick cell walls. The walls were 20 nanometers wide, compared with 17 nanometers for MDR TB and 15 nanometers for ordinary TB, which might form a physical barrier to drugs. "We don't know if the walls are permeable, but one problem is that not many people are going to volunteer to work with them to find out," said Ruth McNerney, of the London School of Hygiene and Tropical Medicine, a co-author of the 2009 European Respiratory Journal study.