In a troubling development, at least twelve patients in Mumbai, India have been infected with a totally drug-resistant form of tuberculosis and at least one has died from a disease that, while still deadly, had hopes of stabilizing in the developing world.
Iran was the first country to report cases of drug-resistant TB three years ago. This discovery hopefully makes India only the second country to find this particularly deadly form of the disease. But, the first emergence of a totally drug-resistant TB in 15 patients in Iran included Afghani, Azerbaijani, and Iraqi immigrants, leading health workers to assume the total number of cases was higher then originally diagnoses since health care is practically non-existent along these border regions.
Worldwide only two-thirds of countries with some form of resistant TB have the labs to diagnose those strains, with only 10 percent of the multi-drug resistant TB patients receiving treatments with cure rates as low as 25 percent.
In a letter published by the Clinical Infectious Diseases (CID) last month, India health practitioners noted that at least four of the 12 Indian patients saw a number of doctors and at least three received partial, multiple courses of the wrong antibiotics. Only 5 of 106 private practitioners practicing in the Dharavi area where these patients emerged could prescribe a correct prescription for a patient with multi-drug resistant TB.
Of course the problem with prescribing the wrong medication is to amplify drug resistance, making the strain even more lethal. This puts public health practitioners in a real bind. Treating TB was already a cumbersome process that requires at least six months of pill combinations that patients must take long after they start to feel well. It is not uncommon for a course of treatment to go unfinished as a result. Yet TB is one of the most problematic of diseases, accounting for 9.4 million cases and 1.7 million deaths in 2009. And with funding for global health initiatives shaky, this is the kind of development that could spread rapidly with devastating consequence.
Photo from mckaysavage5 via flickr.