CHENNAI: In a country where there were about 25 lakh cases of tuberculosis and 2.2 lakh deaths from the disease in 2014, India now faces a massive threat of drug resistance. “About 8-9 decades back, there were not many effective drugs for TB and patients would be put in sanitoria and be given good nutrition. Now, we are at a crossroads. Extreme drug resistance could pull us down into the same situation again,” warns Aravind Swaminathan, a pediatrician who has worked extensively with patients in South Sudan and Tajikistan, as part of a Medecins Sans Frontieres (MSF, Doctors Without Borders) team. In India, according to WHO’s global tuberculosis report 2015, 2.2% of new TB cases and 15% of re-treatment cases have Multi Drug Resistance (MDR).
Diagnostic Challenge
Diagnosing TB, especially in children, remains a challenge, says Dr Aravind. The most common form of the disease is chest TB. “Children do not have enough pressure in the chest to bring out sputum, a fluid from the respiratory tract, for the most common method of testing — sputum microscopy (viewing the sputum under a microscope and looking for TB bacteria). So, sample collection methods need to improved,” he says. For instance, secretions from their stomach early in the morning can be used. There is also a newer test called Genexpert, which looks for the genes of the bacteria. It also gives information like sensitivity of the bacteria to a first line drug. Another plus with this method is that the results can be obtained in 3-4 hours,” he explains. This is a boon for diagnosis. However, has not been subsidised on a large scale yet. The equipment costs about $17,000. We need to work on making it available to those who need it,” he says.
Treatment & Resistance
Ensuring a continuous supply of drugs is key for treating TB. “Compliance is the crux of TB treatment. In fact, delaying the treatment is better than getting incomplete treatment,” says Dr Aravind. This is because if the drugs are stopped anytime during treatment, the bacillus develops resistance to the drug. At present, India practices a thrice-a-week treatment regimen. “It’s high time we move on to every day treatment. There needs to be more research to develop newer drugs – in the past 50 years, only one drug – bedaquiline – has been developed and even this isn’t authorised for use by the WHO for minors,” he explains.
Stigma Removal
“The image of TB in many communities is a thin man coughing blood and dying. People have to be made aware that this is not so,” says Dr Aravind. “Tuberculosis contributes to one of the biggest disease burdens and school students need to be made aware — of at least the basics. This will go a long way in removing the stigma,” he says, adding that patients who come to him with persistent cough often go on the backfoot. “The minute you ask them if they’ve heard of TB and if anyone in their family has TB, they immediately say no, nothing like that, it can’t be TB. People should understand that this is a respiratory disease that can affect anyone.”