ProMED-mail |

Published Date: 2012-01-13 13:55:38
Subject: PRO/EDR> Tuberculosis, TDR - India (02): (KA) RFI
Archive Number: 20120113.1009005

TUBERCULOSIS, TDR - INDIA (02): (KARNATAKA), REQUEST FOR INFORMATION
********************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

[1]
Date: Wed 11 Jan 2012
Source: DNAIndia.com [edited]
http://www.dnaindia.com/bangalore/report_tb-in-its-new-avatar-arrives-in-bangalore_1636125

Following the discovery of 4 cases of totally drug resistant tuberculosis (TDR-TB) in a Mumbai hospital 3 days ago, 2 confirmed cases with the deadly new strain of TB have been detected at the Rajiv Gandhi Institute of Chest Diseases (RGICD) in Bangalore. But the scarier scenario is this: one among them, a 56-year-old man (the hospital has not disclosed his name), has gone absconding, raising the threat perception many levels higher, considering that he could infect others with the deadly strain.

Shockingly, the RGICD has not informed the state health department. Dr Shashidhar Buggi, director, RGICD, said: "If they ask us, we will let them know. We are a national institute; if the state government asks us for the report, we will definitely give it to them."

This spells another concern. While one of the confirmed TDR-TB patients has gone missing, state health department officials remain in the dark.

TDR-TB is a strain of tuberculosis which cannot be treated by any available drug. This means that a person afflicted by this strain faces a 100 percent mortality rate and, until death, can infect many others.

Both the TDR-TB cases in Bangalore were confirmed after the RGICD sent their sputum (phlegm) samples to Chennai's Intermediate Reference Laboratory, where the samples tested positive for the deadly TDR-TB strain. The other patient suffering from the TDR-TB is a 29-year-old woman (name undisclosed).

"These patients were being treated for over 2.5 years. After 8 months, when they were not responding to medication, we sent their sputum samples to the Intermediate Reference Laboratory in Chennai. It was then found that they had both become extremely resistant to the drug‚ a condition named extreme drug resistance (XDR). When this condition continued for more than a year, it was confirmed that they had multi drug resistance (MDR). Now, it has been 2 years since they have been getting treatment, and the tests have confirmed that they have TDR," said Dr Buggi.

Over 498 cases of MDR alone have been registered with the RGICD since 2005, of which 230 have been treated and discharged. "In 2009, we had 114 cases; in 2010, there were 74 fresh cases. The number came down to 50 MDR cases in 2011," he said. "We have sent samples of 8 suspected TDR-TB patients to Chennai and are awaiting the results. The tests identify micro-organisms causing infections in the lower respiratory tract like TB," he said.

When DNA [DNAIndia.com] tried contacting senior health officials, none of them were available.

--
Communicated by:
ProMED-mail from HealthMap alerts
<promed@promedmail.org>

******
[2]
Date: Wed 11 Jan 2012
Source: DNAIndia.com [edited]
http://www.dnaindia.com/bangalore/report_its-deadly-a-tdr-tb-patient-on-the-loose_1636131

Even as 2 cases of totally drug-resistant tuberculosis (TDR-TB) have been detected in Bangalore, one of the patients is missing. This poses a grave threat of rapidly spreading the deadliest strain of _Mycobacterium tuberculosis_, the bacterium that causes the disease.

A 56-year-old man has been missing for 2 weeks, as he has not turned up at Rajiv Gandhi Institute for Chest Diseases (RGICD) for treatment and may be a cause of concern in the city. "TB can spread fast. A person with TB, if not treated, can spread it to 10 other people around him, on average," said Shashidhar Buggi, director of SDS Tuberculosis and Chest Diseases Hospital and RGICD.

Now, this patient is like a ticking time-bomb. And nobody is coming forward to inform the authorities about his whereabouts, or whether he has died.

"We don't know why he stopped coming to the hospital. But we have not seen him in 2 weeks. We are now considering operating [on] the other patient (a 29-year-old woman) depending on her condition. But for now, we have no news of the other patient," he said.

The absconding patient is said to have been taking treatment for TB at the RGICD for 2 years. "We had 2 cases of TB for which we had been giving treatment for more than 8 months. We sent their phlegm for testing in Chennai, where it was confirmed that both have developed extreme drug resistance. After another 6-8 months of treatment, it was found that they were suffering from multi-drug resistance (MDR)," Buggi said.

It has been 2 years since the 2 patients started treatment for MDR. Buggi said the RGICD had recently sent samples of phlegm for testing at Chennai's Intermediate Reference Lab; out of the 10 samples, 2 were confirmed to have TDR.

[Byline: Deepthi MR]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

******
[3]
Date: Thu 12 Jan 2012
Source: DNAIndia.com [edited]
http://www.dnaindia.com/bangalore/report_tdr-tb-threat-ramdas-says-rgicd-is-guessing_1636519

The revelation of 2 confirmed totally drug resistant-tuberculosis (TDR-TB) cases at Rajiv Gandhi Institute of Chest Diseases (RGICD) has shaken the health ministry and officials who had instantly gone into a denial mode, even as they blame the RGICD for not bringing the cases to their notice.

However, minister for medical education, health and family welfare, SA Ramdas, following a DNA report on Wednesday [11 Jan 2012], has decided to constitute a 3-man committee to submit a detailed report on the status of tuberculosis in the state to the government. He also conducted a "surprise visit" to RGICD and declared that he is not convinced that the 2 were TDR-TB cases because "the 2 cases were only confirmed by clinical tests, and biological tests have not been done while confirming them."

He alleged that RGICD has only conducted a clinical analysis of the 2 patients wherein sputum (phlegm) culturing was not conducted. He blamed RGICD for guessing that, since the patients have not responded to the medication for 2 years, it must be TDR.

Biological tests (also called culture and sensitivity tests) include culture of the sputum being subjected to multiple tests during which the DNA strands are isolated.

The tests involve allowing the bacteria "_Mycobacterium tuberculosis_" to grow, and various drugs are used on it to indicate whether the samples are TDR-TB-positive or not. These tests are conducted only in Chennai and at New Delhi's National Institute of Tuberculosis.

Ramesh, joint director, Lady Willingdon State Tuberculosis Centre's Revised National Tuberculosis Control Programme, which is a state government-administered organisation, said: "We have not received TDR cases so far, and if Rajiv Gandhi Institute for Chest Diseases has them, then they should have informed us." Despite that, RGICD authorities stand by their version that 2 patients are indeed confirmed as TDR-TB cases, one of which‚ a 56-year-old man, is missing

Ramdas, however, does admit that there are 56 cases of major multi drug resistant tuberculosis (MDR-TB), and 6 cases of extreme drug resistant tuberculosis (XDR-TB).

"We have sent 4.8 lakh [a lakh is a unit in the South Asian numbering system equal to 100 000] sputum samples from the state to Chennai's Intermediate Reference Lab and received 68 000 TB-positive cases, of which 56 are MDR positive and 6 have extreme drug resistance [XDR]. If there are other cases, we will trace the patients and give them appropriate treatment," he said.

There is no denying that the state ministry is concerned despite its initial reaction, hence the constitution of the 3-member committee, which in all likelihood comprises Dr Suryakanth, officer in-charge at Lady Willingdon State Tuberculosis Centre's Revised National Tuberculosis Control Programme; Dr Sathya Prakash, senior scientist, National Tuberculosis Institute; and Dr Raghupathi, resident medical officer, state health department.

[Byline: Deepthi MR]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[For a discussion of MDR-, XDR-, XXDR- and TDR-TB, see the moderator's comments in the prior ProMED-mail post Tuberculosis, TDR - India: (MH, KA) 20120110.1005663.

The situation concerning the presence of so-called "totally drug resistant" tuberculosis (TDR-TB) in the Indian state of Karnataka is quite confusing. According to the news report posted one day ago by ProMED-mail (Tuberculosis, TDR - India: (MH, KA) 20120110.1005663), Rajiv Gandhi Institute of Chest Diseases (RGICD), which is a government-run institute specializing in treating tuberculosis, stated that there were no cases of TDR-TB in the state of Karnataka, of which Bangalore is the capital. However, the 1st 2 news reports above state that 2 confirmed cases with TDR-TB have been detected at the Rajiv Gandhi Institute of Chest Diseases (RGICD) in Bangalore. Nevertheless, the 3rd news report above raises questions about the validity of the TDR-TB diagnosis in these patients, stating that these diagnoses were based on lack of clinical response to drug therapy, not on drug susceptibility testing. We await further information to make sense of the situation.

A map of the states of India can be accessed at http://www.globalsecurity.org/military/world/india/images/IndiaMap_tourism.gif. The HealthMap/ProMED-mail interactive map of India can be accessed at http://healthmap.org/r/1mm2. - Mod.ML]

See Also