Debate rages over TDR-TB

WHO is currently holding a consensus meeting to decide on how and when to use the terminology TDR-TB

By Pratibha Masand & Malathy Iyer I TNN

When Dr Zarir Udwadia addressed the World Health Organization (WHO) on Wednesday, he mentioned a term that has become a taboo in India’s public health field—totally drug-resistant, or TDR, TB.

It was his letter to the Clinical Infectious Diseases journal in early January mentioning TDR-TB cases for the first time that sparked off one of the biggest medical debates in India in recent times. He and his colleagues in Hinduja Hospital, Mahim, diagnosed 12 patients with totally drug-resistant TB strains; three of them have died since. The WHO is currently holding a consensus meeting to decide on how and when to use the terminology TDR-TB.

In an email reply on Wednesday, Dr Udwadia wrote, “No one doubts the accuracy of the Hinduja Hospital data. The only question is whether the WHO can create a new c at e g o r y based on the data from just a handful of patients. The debate continues.”

The term TDR-TB was first coined in Italy, which reported two cases in Miglori in 2007. Then, in 2009, an Iranian team reported TDR-TB in 15 patients. “There was no further mention of TDR-TB for three years till our publication of the first four Indian cases,” Dr Udwadia wrote in an editorial in a peer-reviewed medical journal, Thorax, in March. “The 12 patients (mean age 32 years; six are men) had seen an average of four doctors, and received a mean of 9.33 drugs for an average duration of 26 months prior to being labelled TDRTB by us.”

In January, when the first article was reported in the local and international press, the Indian government sent down a high-level team from Delhi. The team said there was no such entity as TDR-TB and the Hinduja Hospital cases could at best be labelled XXDR-TB (extensively and extremely drug resistant TB).

But his March article, titled ‘MDR, XDR, TDR Tuberculosis: ominous progression’, lists steps that India should take to stop the march of TB across the country. After all, TB kills 300,000 Indians annually—a statistic that doctors say works out to one death every two minutes.

Dr Udwadia has recommended that laboratory capacity be immediately increased. “It is one of those sad TB paradoxes that India, which bears the lion’s share of the world’s TB burden, has only one of 26 supranational reference laboratories, while the majority are concentrated in the European Union and the US, despite only 1% of the 9 million new TB cases in 2007 occurring in these regions.” The supranational reference laboratories have machines to diagnose the most drug resistant strains.

Source: Times of India

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