Sluggish laboratory capacity expansion has impacted the early detection of Multi Drug Resistant (MDR) tuberculosis. This along with the rising incidence of HIV with TB is proving to be the biggest concerns of Indian healthcare, according to experts.

Bengaluru-based SDS Tuberculosis Research Centre and Rajiv Gandhi Institute of Chest Diseases is among the only super specialty institutions in the government sector to provide comprehensive treatment for all chest diseases.

“Majority of respiratory diseases which mainly includes TB affect mainly children and young adults leading to morbidity and mortality. Therefore government now needs to mandate broad based research activities in the field of respiratory illnesses, to find out the prevalence of the diseases, effective curative services, and early detection of lung disorders, put in place preventive measures and rehabilitation processes,” said Dr Shashidhar Buggi, Director & Prof. & HOD, Dept. of Cardio Thoracic Surgery, SDS Tuberculosis Research Centre and Rajiv Gandhi Institute of Chest Diseases.

The WHO too has said that India is home to one-fifths of the global TB cases which is mainly because of lack of laboratory capacity and sluggish technology transfer to resource limited setting.

Annually India accounts for two million new TB cases, out of which nearly 0.87 are infectious. It is estimated that about 330,000 succumb to this deadly disorder. With incidence of HIV/AIDS cases, TB has re-emerged as a major health problem, said Dr Kailash Nath, Pulmonologist from Columbia Asia Hospital, Gurgaon.

India now has the dubious distinction of having the largest number of MDR TB cases, which are resistant to the routinely available drugs. Nearly two per cent of cases are MDR and of these only 1.6 per cent are enrolled for treatment.

MDR-TB is resistant to at least two of the most potent first-line anti tuberculosis drugs - isoniazid and rifampicin, with or without resistance to other first-line drugs. This is very critical as MDR-TB shows poor response to other first-line drugs. Diagnosis and treatment of MDR-TB is costly and treatment is prolonged for at least two years. The drugs are not only expensive but toxic and difficult to treat. A case of MDR TB is about 20-40 times more expensive to manage than a case of drug-sensitive TB and patient suffering is magnified, said Dr Nath in an email interaction with Pharmabiz.

An emerging threat of extremely drug resistant TB (XDR-TB), which is a more serious form of MDR TB that responds very poorly to MDR TB treatment, is it poorly responds to rifampicin, isoniazid, plus any fluroquinolone and to second line injectables like capreomycin, kanamycin and amikacin. There are cases resistant to all TB drugs which happens due to improper prescription, unsupervised and erratic treatment. However, WHO is yet to accept this as a known entity, pointed out Dr Nath.

Therefore as responsible medical experts, we advise the population not to neglect any chest infection beginning with cough, fever and chest pain as it would require immediate investigation to prevent MDR and XDR.  If detected, patients need to follow the DOTS (directly observed treatment, short-course) regimen prescribed by WHO and the government of India’s Revised National Tuberculosis Control Programme, said Dr Nath.