The Hindu     24.03.2017  

TB cases surge by 9%; BMC attributes it to better detection

Multi drug-resistant cases rose from 3,608 to 4,374 in 2016

The city recorded a 21% rise in multi drug-resistant cases (MDR) of
tuberculosis (TB) in 2016 and a nearly 9% rise in the overall TB cases
in the city.

While the statistics, released by the Brihanmumbai
Municipal Corporation (BMC) show the increasing threat of the disease,
it also highlights the improved case detection mechanism and
notification. As per the data, 38,667 TB cases were recorded in 2015,
which increased to 42,115 in 2016. The MDR cases rose from 3,608 to
4,374 in 2016, out of which 555 were extremely drug-resistant or XDR TB
patients. Of the overall TB cases recorded in 2016, 8.6% were pediatric.

Dr.
Padmaja Keskar, BMC’s executive health officer, said, “The attitude of
people is changing. Instead of hiding the disease, a large number of
people now prefer to get treated, which is a good sign.” The officer
added that at least 75% doctors from the private sector have started
notifying the disease regularly. “The better diagnostic facilities have
also improved the case detection,” she added.

Drug-resistant TB

Doctors,
however, say that increase in drug-resistant TB cases is something to
worry about. This threat has been highlighted in a paper published in
Lancet Respiratory Medicine Commission today (Friday), authored by
Hinduja Hospital’s chest physician Dr. Zarir Udwadia and consultant
microbiologist Dr. Camilla Rodrigues, among other renowned doctors from
across the world.

The paper states, “Although tuberculosis control
has been effective in some regions of the world, these gains are
threatened by the increasing burden of multidrug-resistant (MDR) and
extensively drug-resistant (XDR) tuberculosis.”

It
adds, “XDR tuberculosis has evolved in several tuberculosis-endemic
countries to drug-incurable or programmatically incurable tuberculosis
[totally drug-resistant]. This poses several challenges similar to those
encountered in the pre-chemotherapy era, including the inability to
cure tuberculosis, high mortality, and the need for alternative methods
to prevent disease transmission.” The paper says that this phenomenon
mirrors the increase in antimicrobial resistance across the world and
the emergence of other MDR pathogens, like malaria, HIV, and
Gram-negative bacteria. “MDR and XDR tuberculosis are associated with
high morbidity and substantial mortality, are a threat to health-care
workers, prohibitively expensive to treat, and are therefore a serious
public health problem.”

Primary drug-resistant

According
to pulmonologist Dr. Vikas Oswal, who practices in Govandi, an
extremely high risk area for TB in the city, the primary drug-resistant
TB infection (wherein people directly get infected with the
drug-resistant strain of the bacteria) is a bigger threat looming on us.

“In
today’s date, at least 15% drug resistant cases are primary infections.
With limited number of medicines, we need to tackle this with better
efficiency,” Dr. Oswal said, adding that the scenario in the public
health system has changed a lot, for good, over the last few years.

He
said, “There are more GeneXpert machines, better cartridges to detect
the bacteria and its resistance, and private practitioners are being
trained in better TB diagnosis as well.” GeneXpert helps in detecting
drug-resistant TB within two hours.