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New drug-resistant TB found in India

17th January 2012

Doctors in India say they have proved that a new strain of the tuberculosis (TB) is totally drug-resistant.

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However, the World Health Organisation (WHO) has disputed the term 'totally drug-resistant', leaving public health professionals confused as to how to refer to the new strain.

According to the WHO, the strain should be classified as 'extremely drug-resistant'. The new strain apparently represents the emergence of a long-feared killer disease that does not succumb to any form of treatment.

Although some doctors do not expect the strain to spread very far, experts believe that there may be many cases of infection which the Indian study failed to notice.

And other doctors believe that the strain will definitely spread.

Kenneth Castro, director of the Division for Tuberculosis Elimination, a branch of the US Centre For Disease Control (CDC), who was not involved in the study, said that any time doctors saw something like a new, drug resistant form of tuberculosis, they felt they needed to gain control over the situation to avoid widespread problems.

This is not the first time doctors have made note of the emergence of such a highly-resistant strain.

About eight years ago, patients in Italy and Iran were recorded as having a highly resistant strain of the disease.

Impoverished rural areas seem to be key breeding grounds for the deadly bacteria. However, the disease is spread through close contact, and is less contagious than a virus.

In the case of the new strain, most cases were not actually spread from one person to another. Rather, the bacterium itself mutated, forming a totally resistant strain.

Paul Nunn, a coordinator at the WHO's Stop TB Department, said that although his organisation disputed the term 'totally drug-resistant' with regard to specific strains, that did not mean that totally drug-resistant cases of the disease did not exist in practice.

For the study, the Indian hospital simply conducted a rigorous test of current treatment regimes in patients who seemed to have a drug-resistant form of TB.

Ordinarily, TB is curable within nine months, using antibiotics.

But in the case of the Indian patients, none of the treatments had any effect whatsoever, even when the treatments were delivered over the course of two or three years.

Three of the 12 patients have also died, since the study began.

Part of that drug-resistance may be due to the improper prescription of antibiotics, in which patients are not given a full course of antibiotics.

In that case, the bacterium infecting the patient has a chance to mutate into a drug-resistant strain.

The doctors, of the PD Hinduja National Hospital and Medical Research Centre, wrote that the three patients had received erratic, unsupervised second-line drugs.

They said that the drugs were often added individually and often in incorrect doses, from multiple private practitioners.

One of the doctors, Zarir Udwadia, said he felt there was little hope for the patients, who all lived in poor slums.

He said that the situation was bound to happen, and that he felt the totally-resistant strain was definitely going to spread, since the 12 patients were all members of the 'untouchable' caste, and had received no help from the Indian TB system, but rather from incompetent private doctors.

Nunn said it was no surprise that another report was coming out from India regarding drug-resistant TB.

He said it was surprising that it had taken so long for the report to emerge.

TB lies dormant in 1 in 3 people worldwide, while about 10% of people with dormant TB eventually develop active TB.

Each TB victim typically infects another 10 to 15 other people every year, through sneezing or coughing.

 

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