The researchers found that vitamin C has strong bactericidal (ability to kill bacteria) against TB bacteria through a study that suggests that it might be worthwhile to explore the addition of vitamin C to standard anti-TB treatment. The results of the study were published today in the journal, Nature Communications.

‘Vitamin C has never been shown to kill TB bacilli,’ William Jacobs Jr, professor of microbiologist at the Albert Einstein College of Medicine in New York and principal investigator of the study, told The Telegraph. ‘The observation that vitamin C can sterilise (laboratory) cultures of drug-susceptible, multi-drug resistant and extreme-drug resistant strains of TB bacilli is striking and totally unexpected,’ Jacobs said in a telephone interview to the Calcutta Telegraph.

Three years ago, microbiologists at AIIMS, Delhi had observed that vitamin C can arrest the growth of TB bacilli and make them dormant.  Jaya Sivaswamy Tyagi and her colleagues at AIIMS had also speculated about the ‘protective role’ of vitamin C against TB through mechanisms that the role of vitamin C to bolster immunity.  The study also suggests that the acidity of vitamin C is dependent on iron. In the experiments, iron came from the culture medium – the nutrients in which TB bacilli is grown. Vit C reduces ferric ion into ferrous ion, which forms a reactive oxygen species that can kill bacteria.  ‘We’re hoping this study will spur interest in testing the addition of vitamin C to current TB treatment regimen,’ Jacobs said.

But medical researchers don’t know whether  this work for human patients.

‘I would call this a proof-of-concept study,’ said Madhukar Pai, an associate professor who leads a Tuberculosis Research Group at the McGill University in Canada. ‘The question is whether we’ll see this effect of oxidative burst occur exactly at the sites of infection when vitamin C is administered orally,’ Pai, who was not associated with either the US or the AIIMS study, told the same newspaper.

What is tuberculosis?

 Tuberculosis is a common infectious disease caused by bacteria called mycobacterium tuberculosis which affects the lungs. Main symptoms of TB are severe cough that lasts for three weeks or longer, bloody or discoloured sputum, night sweats, fever, fatigue and weakness, pain in the chest, loss of appetite, and pain during breathing or coughing. India had the highest total number of TB cases worldwide in 2010 partly due to poor disease management by the private healthcare sector. TB can be prevented by vaccination and maintaining high levels of hygiene. One infected, the patient should follow the medication regimen properly. By not doing so, there are chances of developing resistance to anti-TB drugs resulting in an aggressive form of TB called MDR-TB (multi-drug resistant TB). 

 India, 2 patients succumb every three minutes to TB disease. Urban metros like Mumbai with have it worse because of poor hygienic condition and widespread poverty.  Despite our best efforts to control this disease, mortality has been increasing. What makes it worse are the new drug resistant forms of TB which are leaving many doctors flummoxed. Here are some things you should know about the deadly disease:

Did you know?

Most of us have latent TB foci inside our lungs. We all are exposed to the organism early on in life and would have formed foci of infection in the lungs (primary TB). Our immune system would have contained the infection and prevented us from suffering the disease. It is when our immune system becomes weak for some reason or is overwhelmed by the infection or any other cause, that we suffer the disease (reactivation). The organisms can travel from the foci of infection in the lungs to other sites leading to secondary infection (TB of lymph nodes, spine, etc.).Click here to read more facts.

A handbook on TB in India, which provides a comprehensive overview of the challenges around TB control in India and the role of policy-makers was released. ‘The campaign should involve lakhs of school children, they would take the message to their parents and teachers. The handbook which provides information on TB should be distributed to them,’ Dikshit said. The forum will not only raise awareness on the need for improved TB control but its members will formulate key recommendations to address these challenges which will be presented to the ministry of health and family welfare (MoHFW) for further action. ‘The forum will serve as a platform to bring together various stakeholders to highlight and address the complex challenges facing TB in India, a disease that is easily preventable and treatable,’ Dalbir Singh, convener of the forum said. Tuberculosis kills one Indian every two minutes. India bears the highest burden of tuberculosis in the world, with two million suffering from this disease annually. 

What is tuberculosis?

Tuberculosis is a common infectious disease caused by bacteria called mycobacterium tuberculosis which affects the lungs. Main symptoms of TB are severe cough that lasts for three weeks or longer, bloody or discoloured sputum, night sweats, fever, fatigue and weakness, pain in the chest, loss of appetite, and pain during breathing or coughing. India had the highest total number of TB cases worldwide in 2010 partly due to poor disease management by the private healthcare sector. TB can be prevented by vaccination and maintaining high levels of hygiene. One infected, the patient should follow the medication regimen properly. By not doing so, there are chances of developing resistance to anti-TB drugs resulting in an aggressive form of TB called MDR-TB (multi-drug resistant TB).

With inputs from IANS

Source: IANS

What is tuberculosis?

Tuberculosis is a common infectious disease caused by bacteria called mycobacterium tuberculosis which affects the lungs. Main symptoms of TB are severe cough that lasts for three weeks or longer, bloody or discoloured sputum, night sweats, fever, fatigue and weakness, pain in the chest, loss of appetite, and pain during breathing or coughing. India had the highest total number of TB cases worldwide in 2010 partly due to poor disease management by the private healthcare sector. TB can be prevented by vaccination and maintaining high levels of hygiene. One infected, the patient should follow the medication regimen properly. By not doing so, there are chances of developing resistance to anti-TB drugs resulting in an aggressive form of TB called MDR-TB (multi-drug resistant TB).

What is MDR-TB?

MDR TB refers to Multi-Drug resistant Tuberculosis. It is a type of tuberculosis that is resistant to the first line anti-TB drugs. It is often caused because people stopping their medication midway instead of following the complete regimen as prescribed by the physician. It is spread in the same manner as tuberculosis. Symptoms are same as regular TB and include severe cough which lasts for three weeks or longer, producing bloody or discoloured sputum, night sweats, fever, fatigue and weakness, pain in the chest, loss of appetite, and pain in breathing or coughing. However, in these cases, the symptoms progressively get worse and may cause complications and death since the patient does not respond to most anti TB drugs.

‘Only one surgery was conducted at the start of the year, in January. Since then, the lack of an anaesthesia machine for almost a month and the refusal of doctors at  major civic hospitals like Sion, Nair and KEM, to assist in operations, has led to surgeries being put off over the past three months,’ said a senior doctor at the  hospital.

The Operation Theatres at the Sewri TB hospital had been closed for six years but reopened after the multi-drug-resistant TB scare last year. Since then, over 40 patients have been operated upon, 12 of them with drug-resistant TB and only one patient died due to the disease. Suhas Katwate, who was operated on in November, describes himself as one of the lucky ones. ‘I was diagnosed with tuberculosis in 2002 and suffered for ten years, until the specialists at the hospital gave me hope and operated on me,’ said the 30-year-old resident of Jogeshwari. A portion of his TB-infected lung was removed.

‘In a month’s time, the tests showed that I was free of tuberculosis bacteria. I was elated after the torture that I went through for ten years. It is really sad that surgeries are not taking place over the past three months. I hope that the problem is solved soon, as hundreds of lives are at stake,’ Katwate told DNA. Nearly 50 new cases are admitted at the Sewri TB hospital daily. And the mortality is appalling. ‘In a day, about 10 patients die at the hospital. At times, the number goes up to even 20. Operating on a patient can make him well. But with surgeries stalled the lives of many are in jeopardy,’ an insider said.

The surgical programme was started with a lot of enthusiasm last year but hit numerous roadblocks and impasses. They had trouble finding doctors willing to operate and also anaesthetists for the operation.  According to the civic body 3003 patients were diagnosed with MDR-TB but there is no case of XXDR-TB in the city.

No XXDR-TB in Mumbai?

In other TB-related news, civic officials in Mumbai claimed that no one in the city was suffering from the extra extensively drug resistant tuberculosis (XXDR-TB), and all six patients who had initially been categorised to have that TB strain were doing well and responding to medication.

Last year, PD Hinduja Hospital in the city had diagnosed 12 patients with a deadly TB strain that didn’t respond to any known drugs and created quite a stir all around the world. The diagnoses sparked a furious debate about the dangers of XXDR-TB, which had so far been reported in only Iran, India and Italy, and what it could mean if there was an outbreak in a crowded metropolis like Mumbai.

Since then six patients have died of the disease and the TB officer of Mumbai Dr Khetarpal claimed that the patients responded when administered a combo of the drugs.  Six surviving patients had been downgraded to extensively drug-resistant TB category. BMC executive health officer Dr Arun Bamne said the six surviving patients have now been downgraded to the extensively drug resistant (XDR) tuberculosis category. ‘There are currently 44 patients in the city suffering from XDR tuberculosis and we regularly follow up with them,’ he said. The civic body also assured people that the long-dormant lung program at Sewri hospital.

What is tuberculosis?

 Tuberculosis is a common infectious disease caused by bacteria called mycobacterium tuberculosis which affects the lungs. Main symptoms of TB are severe cough that lasts for three weeks or longer, bloody or discoloured sputum, night sweats, fever, fatigue and weakness, pain in the chest, loss of appetite, and pain during breathing or coughing. India had the highest total number of TB cases worldwide in 2010 partly due to poor disease management by the private healthcare sector. TB can be prevented by vaccination and maintaining high levels of hygiene. One infected, the patient should follow the medication regimen properly. By not doing so, there are chances of developing resistance to anti-TB drugs resulting in an aggressive form of TB called MDR-TB (multi-drug resistant TB). 

When the chest pain and racking cough of tuberculosis patient Asha (31) refused to subside even after six months of treatment, the doctor got her sputum tested again – only to find that she had developed a worrying form of the disease known as Extensively Drug Resistant TB, which is nearly impossible to treat as of now. India is already grappling with the disease burden of Multi-Drug Resistant (MDR) tuberculosis, which manifests when a patient fails to take all the TB medicines exactly as prescribed and misses out some doses. The TB bacterium, which remains in the patient, mutates and cannot be treated with the first and second line of treatment.

The bacterium has mutated even more as Extensively Drug Resistant TB (XDR-TB) that is resistant to normal drugs. Doctors are now trying combination drugs to treat it. According to the World Health Organization (WHO), India is home to 73,000 patients with MDR-TB. The figure for XDR-TB is not yet known. ‘XDR-TB is a reality,’ Vivek Nangia, director (Pulmonology and Infectious Diseases) at Fortis Hospital in Vasant Kunj, told IANS. ‘XDR-TB develops a couple of years after MDR-TB if it is not treated properly,’ he added.

According to Chand Wattal, chairman (Microbiology Department) of Sir Gangaram hospital, unless XDR-TB is realised as a danger, the situation cannot be controlled. The prevalence ratio of TB in India is about 1:32, according to the Tuberculosis Association of India. India’s Directly Observed Treatment Shortcourse (DOTS) strategy, which is implemented through the Revised National Tuberculosis Control Programme (RNTCP), is aimed at achieving an at least 85 percent cure rate amongst new patients.

 Rajiv Chawla, senior consultant (Respiratory Critical Care) at Indraprastha Apollo Hospital, said that though the threat of XDR-TB is not absolute as of now, it can very soon assume dangerous proportions if preventive measures are not taken quickly. Doctors also said that XDR-TB raises concerns of a future TB epidemic with restricted treatment options, jeopardizing the major gains made in TB control and progress on reducing TB deaths among people living with HIV/AIDS.

 It is, therefore, vital that TB control is managed properly and new tools are developed to prevent, treat and diagnose the disease, they said. The true scale of XDR-TB is not known as many countries lack the necessary equipment and capacity to accurately diagnose it. It is, however, estimated that there are around 40,000 cases per year globally. As of June 2008, 49 countries have confirmed XDR-TB cases. By 2010, that number had risen to 58.

Like other forms of TB, XDR-TB is spread through the air. When a person with infectious TB coughs, sneezes, talks or spits, TB germs, known as bacilli, are propelled into the air. Inhaling even a small number of these leads to an infection. According to Nangia, ‘The Indian TB treatment is not working as our population is larger.’

 Wattal said in India, ‘The population needs to be tracked. Family members and contacts of patients need to be tracked. In India there is no accountability, no surveillance. Patients need to be put on a data base,’ he said, adding, MDR-TB doesn’t need long to turn into the extreme form.

One in three people in the world is infected with the TB bacteria. Only when the bacteria becomes active do people contract the disease. Bacteria becomes active as a result of anything that can reduce the person’s immunity, such as HIV, advancing age or medical conditions. Significantly, fewer people are dying of tuberculosis in Southeast Asia today compared to 1990, according to the World Health Organization. The death rate due to the disease has decreased by more than 40 percent in the past 13 years. As access to TB care has expanded substantially, the number of people with TB, or the TB prevalence rate, has also declined by a fourth in the region compared with 1990. All the 11 member-countries of the WHO in South Asia have adopted the WHO Stop TB Strategy. More than 88 percent known TB patients have been successfully treated. Tired of reading? Check out our YouTube Channel 

Source: IANS

Why we need to be worried?

The problem with a disease like tuberculosis is multi-fold. For starters, when TDR-TB landed on Indian soils the government went into complete denial mode refusing to believe that such a disease exists. The current government programme wasn’t equipped to handle or even detect any form of multiple-drug resistant TB which caused delayed diagnosis allowing the disease to spread in a city like Mumbai where people live cheek-by-jowl. Rough estimates suggest that even one undetected TB patient could affect 10-15 more people in one year.

With the government unable to provide medical services, the patients turned to private practitioners who only aggravated the situation with some of them prescribing incorrect drugs in wrong doses which actually worsened the diseased and also made the strain more resistant to the drugs prescribed. Finally the government did get their act together and rolled out new tests including a machine called the GeneXpert which can detect TB in a matter of hours.

But the problem isn’t just having these facilities in place but utilising them. For starters, millions – in rural and urban India – have no access to even the basic healthcare services which coupled with lack of awareness means that we are always sitting on a powder keg of an infectious disease outbreak.

What needs to be done to contain the disease?

What the government needs to do is increase awareness about the disease, treatment methods and also awareness about how the disease spreads. There’s also the growing disconnect between the private and public sector in healthcare which needs to be bridged through public-private partnerships because even now, 70% of all TB patients are being treated by the private sector. Also any new treatment methods need to be shared with private practitioners to ensure that the same treatment is being used for all multiple drug resistant TB cases. So on World Tuberculosis Day, let’s stop living like ostriches and take a vow to end TB in our lifetime because believe us when we say this – the battle against tuberculosis needs a lot of soldiers and ammunition.

While antibiotics kill bacteria, they are not effective against viruses.  90 to 98 percent of sinus infections are caused by viruses. But ironically they are the fifth leading reason for antibiotics prescriptions! According to a WHO study, 53% people take antibiotics without a doctor’s prescription and 18% save it for later use with an intention to use it next time they have the same symptoms or for other family members. But what people like them do not understand is that they are setting themselves up for deadly antibiotic resistance, which basically means that the antibiotics which help you now may not necessarily do so during a health crisis in the future when you really need it.

What is antibiotic resistance?

Microorganisms constantly evolve to efficiently adapt to new environments and antibiotic resistance is one such adaptation. The ability of microorganisms to grow in the presence of an antibiotic that would normally kill them or limit their growth is called antimicrobial resistance. The bacteria which have become resistant cause infections which cannot be treated with the usual drugs, dosages or concentrations. Bacteria which have developed resistance to multiple antibiotics are called multidrug resistant (MDR) bacteria or more commonly, superbugs.

What causes antibiotic resistance?

Antibiotic resistance has become a common phenomenon due to their misuse. It could be in the form of indiscriminate self-medication, prescribing incorrect dosage, not following prescribed dosage, failure to complete the course and excessive use of prophylactic (preventive) antibiotics. Another major reason is prescription of antibiotics to treat viral infections such as the common cold.

Why is antibiotic resistance dangerous?

The availability of antibiotics changed the course of history. Many infections previously not treatable found cure. But with increasing menace of resistant bacteria we are now facing severe infections with little or no antibiotics to cure them.  Existing drugs have become less effective against antibiotic resistant bacteria. Diseases that were easily treatable with mild forms of antibiotics now need to be treated with stronger combination forms of antibiotics. If you are infected with antibiotic resistant bacteria you are more likely to have longer hospital stays and more complicated treatment thereby increasing your medical costs and financial burden. You may be left with potentially untreatable infections increasing the risk of death.

Since the duration of infection is longer, there is a greater risk of spread of resistant microorganisms to others. The antibiotic resistant bacteria may compromise the success of cancer chemotherapy, organ transplantation, etc.

Read: Why antibiotics need warning signs

Common Antibiotic Resistant Infections

• Tuberculosis: Every year, around 440000 new cases of multidrug-resistant tuberculosis (MDR-TB) emerge resulting in 150000 deaths. India had an estimated 63,000 cases of notified multidrug-resistant tuberculosis (MDR-TB) in 2010, the highest in the South East Asia region. Extensively drug-resistant tuberculosis (XDR-TB) has been reported in 64 countries to date. Multi-drug resistant TB (MDR-TB) does not respond to at least two of the most potent first-line anti-TB drugs. This form of the disease requires up to 2 years of multidrug treatment. XDR-TB, the less common form, is resistant to any of the three second-line drugs. It needs up to 2 years of extensive drug treatment.

• Hospital-acquired infections: Methicillin-resistant Staphylococcus aureus (MRSA), a hospital-acquired infection, has evolved into a serious public health concern during the past four decades. Hospital-acquired infections may also be caused by vancomycin-resistant enterococci.

• Infection from Gram-negative bacteria: Increased resistance to many, most, or all available antibiotic drugs has been reported in certain types of Gram-negative bacteria leaving patients with potentially untreatable infections. Most of these infections are typically treated with broad-spectrum antibiotics followed by carbapenems, often the last resorts to fight resistant bacterial infections. However, carbapenem-resistant Enterobacteriaceae (CRE), the ‘nightmare bacteria’, have surfaced killing up to half of the patients who get bloodstream infections from them. CRE normally live in the digestive system and people who need breathing machines, urinary or intravenous catheters or take certain antibiotics long-term are most at risk from CRE infection.

Read: Disarm, don’t kill bugs, to counter antibiotic resistance

Tips to prevent antibiotic resistance:

• Follow your doctor’s directions when you take antibiotics.
• Complete the complete antibiotic course even if you feel better.
• Do not save antibiotics for later use.
• Do not take antibiotics prescribed for someone else, even if you have similar symptoms.
• Adopt healthy lifestyle habits. Maintain good hygiene, wash your hands frequently, have a well-balanced diet, exercise regularly and get adequate rest. These steps can help prevent illness thereby preventing antibiotic overuse and misuse.

Ever since Alexander Fleming accidentally discovered penicillin in 1928, antibiotics have been instrumental in saving human lives and revolutionizing medicine. If we want them to continue to do so for generations to come, we need to stop popping them every time we have a cold!

Read: Drug-resistant TB – why you should be worried

Azad said no application under the drugs and cosmetic rules had been received by the the Drug Controller General of India (DGCI) for the grant of permission for any drug from the United States. A new drug can only be introduced in the Indian market after due approval from DCGI.  The minister said at present, the replacement of drugs used under the Revised National Tuberculosis Control Programme was not required. Those patients who suffer from drug-resistant TB are treated with a regime containing drugs to which the TB bacillus was not resistant, he said.

Read: Ten facts you didn’t know about TB

For more health related information checkout our YouTube Channel.  

1. Most of us have latent TB foci inside our lungs. We all are exposed to the organism early on in life and would have formed foci of infection in the lungs (primary TB). Our immune system would have contained the infection and prevented us from suffering the disease. It is when our immune system becomes weak for some reason or is overwhelmed by the infection or any other cause, that we suffer the disease (reactivation). The organisms can travel from the foci of infection in the lungs to other sites leading to secondary infection (TB of lymph nodes, spine etc).

2. By maintaining good health and immunity, you can prevent getting infected with tuberculosis. Nutritious food, adequate sleep, exercise and leading a life with minimal stress go a long way in helping our immunity fight any infection well including TB. Work on improving your immunity by including diet rich in antioxidants. Have atleast 4-5 servings of fresh vegetables and fruits everyday. If you cannot have it due to certain practical constraints, make sure you take your daily dose of antioxidants/multivitamins after consulting your doctor. Anti-oxidants help fight free radicals produced in the body due to any kind of disease/stress and help in cell repair.

3. Fresh air and sunlight can help prevent TB. The microbes in TB thrive in cold, damp places. Whether you are at home or office, remember to open all your windows for a major portion of the day to let the sunlight and air in.

4. Tuberculosis primarily affects the lungs but can affect other organs too. Cough that lasts for more than 3 weeks, streaks of blood in the sputum (phlegm), low-grade fever, difficulty in breathing and unexplained weight loss are the commonest symptoms of TB of the lungs. TB of other organ systems present with varied symptoms. For example: TB of the skin could present with a non healing ulcer, TB of the spine could present with backache, stiffness or even swelling in the back/groin, TB of the intestines could present with abdominal distension and  absolute constipation. Even a non-healing anal fistula could be due to TB. TB of the lymph nodes can present with swellings at multiple sites of the body. TB of the covering of the brain and spinal cord can cause TB Meningitis, especially in children.

5. With the BCG vaccine, you cannot be resistant to TB throughout your life. It also doesn’t help in secondary forms of TB. That said, one still needs to get the BCG vaccine soon after birth.

6. TB is a fully treatable disease if the full course of medications are taken properly and regular follow-ups are done with the doctor. The TB control program in India, was started as RNTCP (Revised national tuberculosis control program) in 1993. The program has made great progress over the last two decades. Having collaborated with private hospitals and medical colleges the reach of the program is 100% in India. The mainstay of the program is prompt diagnosis (by sputum testing and X ray of the chest), commencing the treatment as early as possible and making sure that the patient is compliant with the treatment (Directly observed treatment-DOTS). The main drugs used for TB are Isoniazid, Rifampicin, Pyrazinamide, Ethambutol and Streptomycin. But always take these medicines under the doctor’s supervision because indiscriminate use can lead to jaundice and liver failure, kidney failure.The duration of the treatment varies from case to case and is at least for 6 months. Testing and treatment is available free of cost at all government hospitals, primary and community health centres.

7. Not taking the full course of TB medicines as per the doctor’s prescription is one of the major hurdles faced by the TB prevention programs. It can lead to the organisms developing resistance to the first-line drugs used in treatment causing MDR-TB (multi-drug resistant TB).

8. Multi-drug resistant TB does not respond to standard TB drugs, is difficult and costly to treat.  The MDR-TB prevalence is estimated to be 2.3 per cent among new cases and 12-17 per cent among re-treatment cases. One of the best ways to prevent it is by completing the entire course of anti-TB drugs in the dosages prescribed by the doctor.

9. One of the major causes of infertility among women from the lower socio-economic conditions is genital TB. When latent bacilli in the lungs get reactivated, they often spread to different parts of the body including the genital tract. It can infect either the uterus and/or the fallopian tubes and usually does not show any symptoms. A very difficult disease to diagnose, only the culture from a tissue sample obtained from a genital tract can help.

10. Children including babies can suffer from TB, but often go undiagnosed. According to the WHO, around half a million babies and children get ill with TB every year and 70000 die due to it. Children under three years of age, especially those who are malnourished and with compromised immune systems are particularly prone to the disease. However, the symptoms often go unnoticed causing higher mortality rates. To prevent TB in children, get them immunized with the BCG vaccine soon after birth. People in your family, including house-help, who would come in close contact with the children need to be screened. Also, breastfeeding the baby for at least six months increases their immunity against all infections including TB.

According to the BMC, 1,497 of those who tested positive for MDR-TB have been put on treatment. ‘In all, 106 are from outside Mumbai, 88 are seeking treatment in private hospitals, 68 are not traceable and 135 should be put on treatment in the next two weeks,’ said Manisha Mhaiskar, Additional Municipal Commissioner (health). 

MDR-TB has grown by 40 times in the last two years. Mhaiskar said that better diagnostic techniques in the city have helped in better detection of the disease. ‘MDR-TB has always been prevalent. But after the introduction of criteria ‘C’ by the central government, new diagnostic facilities like gene expertise and data collection from all hospitals and laboratories have ensured that there is better diagnosis of the strain,’ she said. 

Criteria ‘C’ which ensure free treatment to patients include patients suffering from MDR-TB under the government-run Revised National Tuberculosis Control Programme (RNTCP). It also includes those previously on private treatment.

‘It was only earlier this year, when the extra-extensively drug resistant (XXDR) TB strain was brought to the notice of the authorities, did the government become alert towards MDR-TB. Prior to this, most doctors tried various drugs and would then come to a conclusion on if the strain was multiple drug-resistant. By the time the correct treatment was found, the patient would die. What’s more, MDR-TB+ cases were hardly reported and deaths would be marked as TB deaths,’ said a senior chest doctor from a private hospital as reported by TOI.

With TB no longer being a poor man’s disease, doctors in the city feel that the trend of the BMC to reach out to people from the lower strata of society should change.

‘TB can affect even a rich person as it is a contagious, air-borne disease. We are seeing more and more patients from all sections of society. One has to be more cautious as there are no new medicines available for totally drug-resistant (TDR) tuberculosis patients,’ said Dr Yatin Dholakia, secretary and technical advisor, Maharashtra State Anti-Tuberculosis Association.

‘People have always hesitated to approach government facilities for a disease like TB. Social stigma associated with the disease will reduce only through awareness. People, irrespective of their class, have to come forward if they are diagnosed with the disease,’ added Dr Dholakia.

According to World Health Organisation Global Tuberculosis Report 2012, India has only 37 laboratories to test the growing number of deadly multiple-drug resistant tuberculosis (MDR-TB) patients which means there is one specialised laboratory for every five crore Indians. As per WHO standards, it should be one for 50 lakh people.

From 2010, Centre has scaled up infrastructure for testing facilities, but states such as Uttar Pradesh and Bihar that are low on infrastructure are doing poorly, according to Dr KS Sachdeva, chief medical officer, Central TB division. Mumbai has three of the seven laboratories to test MDR-TB in Maharashtra.

Directly observed treatment, short course (DOTS can be availed for free only by a patient tested in an accredited laboratory for MDR-TB. A two-year treatment costs between Rs. 2 lakh to Rs. 5 lakh. We want patients to avail of free DOTS because there is a specific treatment protocol not followed by private practitioners, says Dr BD Nanavare, state TB officer, Directorate of Health Services (DHS).

According to Blessi Kumar, vice-chairman of Stop TB Partnership, there is a need for mechanism to ensure that a patient can access the available facilities. In Mumbai, laboratories accredited for drug susceptibility testing are Hinduja Hospital at Mahim and Super Religare. JJ hospital laboratory conducts the line probe assay test. The laboratory at Sewri TB Hospital has applied for accreditation. 

Photo source: bangordailynews.com