After swine flu, Pune hit by drug-resistant tuberculosis

After swine flu, Pune now has to deal with drug-resistant tuberculosis. 36 new cases of multiple-drug resistant tuberculosis (MDR-TB) were reported in Pune district in the last 40 days. Professionals fear that MDR tuberculosis and its deadlier cousin - extensively-drug resistant tuberculosis (XDR) may actually pose a bigger threat to the nation's healthcare system than AIDS.

15 MDR patients are from areas in Pune city, 12 are from neighbouring Pimpri-Chinchwad and nine are from the district's rural interiors. This has prompted the officials at the city TB Control Unit have now directed the private practitioners to report each and every case to the authorities concerned. It is imperative to have private-public coordination to thwart the MDR-TB menace. After the culture lab for diagnosis of MDR-TB became functional at the Aundh Chest Hospital on February 10, experts have begun demarcating the MDR cases from the regular TB patients. TB becomes resistant when the patient doesn't get proper treatment or the right drugs aren't given.

"Among the confirmed MDR-TB cases in Pune district, 20 patients have been put on category 4 medicines. The rest are under pre-treatment evaluation and counselling," says Kanchan Jagtap, chief medical officer in-charge of the State TB Training and Demonstration Centre (STDC) at Aundh Chest Hospital. Funded by the World Bank through the central TB division of the government of India, STDC is the second such facility in the state after the one in Nagpur. Besides ascertaining MDR cases through a culture sensitivity test, the centre also aims to provide free treatment because cost of drugs are exohbirant, costing over Rs 2 lakhs per annum. While Pune city reported 1,412 TB cases in 2010, the number rose to 3,650 TB cases in 2011.

Pimpri Chinchwad reported 1,445 TB cases last year. The district's rural areas reported 4,202 TB cases in 2010 while the number came down to 3,892 in 2011. "MDR patients constitute two to three per cent of the newly diagnosed TB cases. Earlier, there were only suspected cases of MDR-TB, but now we have been able to ascertain the exact burden of MDR-TB cases in the city," said N D Thakur, tuberculosis officer of the Pune Municipal Corporation (PMC). Around 85 per cent TB cases are curable. Of the remaining, deaths constitute less than 5 per cent, defaulters (those who don't take treatment) less than 4 per cent, relapses more than 3 per cent and failures up to 3 per cent. Patients who do not respond to treatment come in the failure category, officials said.

The state started detecting MDR-TB cases in Maharashtra from September 2007. "Since then, we have reported over 1,100 MDR TB cases in the state so far," said Pradip Gaikwad, joint director (TB), state health services. "Mumbai accounted for the highest number of cases, followed by Nagpur. Since the culture lab has just started functioning in Pune, more cases will be detected. MDR constitutes 2-3 per cent of the newly diagnosed cases and 17 per cent among patients put on re-treatment after a gap in taking anti-TB medicines."

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