First there was multi-drug resistant tuberculosis (MDR TB), followed by an extensively drug resistant strain (XDR TB), and now a totally drug resistant form (TDR TB) has emerged. At least 12 patients in one hospital in Mumbai, India (at the P. D. Hinduja National Hospital and Medical Research Centre) have been confirmed to have the new totally drug resistant type of tuberculosis (TB). This means that their infections are resistant to all drugs known to treat the bacterial infectious disease (to include the three first-tier drugs and the nine second-line drugs).
This is not the first report of TDR TB cases, as Iran reported fifteen cases in 2009 and Italy reported the deaths of two women in 2003 due to TB that was resistant to all tested drugs. The report of TDR TB in Mumbai is particularly worrisome as, according to the World Health Organization’s global TB database, India has an extremely high burden of TB with an incidence rate of 185 per 100,000 people and nearly 15% of all deaths in Mumbai in 2009 were due to TB.
Resistant strains of tuberculosis bacteria (Mycobacterium tuberculosis) are man-made; they develop when the medications used to treat the disease are not used or managed correctly. Adding to the problem and facilitating further spread of resistant strains, is that only two-thirds of countries with drug resistant TB epidemics have the appropriate laboratory capabilities to detect resistant types of TB. Most areas of India do not have the capability to detect TDR TB. If the infection is undetected, people can continue to spread all forms of tuberculosis – resistant or not.
Dr. Amita Athawale, who is in charge of the King Edward Memorial Hospital’s chest department told the Times of India that the TDR TB cases that have been identified are “just the tip of the iceberg.”
While the threat of totally drug-resistant tuberculosis is clear, doctors and health care workers should not forget that this is a disease that can be managed better through adherence to drug regimens.