Hyderabad: Initial treatment for TB has become a cause of concern as a large number of patients are showing resistance to the first line of antibiotics and physicians are not able to identify this early, said experts ahead of World TB Day that is observed on March 24.
Drug-resistant TB strains are found to emerge when the antibiotic fails to kill all the bacteria that it targets. According to the TB India 2015 annual report, AP and TS have the third highest burden in the country with 1,07,293 new patients registering for treatment.
“The major concern is the failure of commonly used drugs for treatment. Bacteria have developed resistance to commonly used isoniazid and rifampin. The bacteria are also showing resistance to newer antibiotics like fluoroquinolones and injectable medications including amikacin, kanamycin and capreomycin,” said Dr Yughandhar Bhatt, consultant pulmonologist.
The problem being seen at the ground level is that when patients start showing resistance in the first six months of treatment, it is important to evaluate the resistance to the drugs. Experts find that most of them continue the same drugs for another one year, making the bacteria stronger.
“The failure of early identification of drug resistance prolongs avoidable suffering and morbidity of the patient. It enhances severity of the disease and also increases the chances of transmission of the bacteria to the close family members who are living with the patient,” said Dr Gopi Krishna, senior pulmonologist at Yashoda Hospitals.
At the same time, there are many tests that have hit the market which are not required. A senior pulmonologist on condition of anonymity explained, “There are TB Gold, TB Silver and also skin tests being done which are not the right yardsticks for diagnosing the disease. The market is flooded with these unregulated tests which need to be stopped as they are adding to the existing burden.”
Being cautious
Tests that go wrong:
The TB skin test isn’t perfect. Sometimes, it suggests that people have TB when they really don’t. It can also indicate that people don't have TB when they really do.
A false-positive test may happen if you’ve been vaccinated recently with the Bacillus Calmette-Guerin (BCG) vaccine. This vaccine is seldom used in the United States but is widely used in countries with high TB infection rates.
False-negative results may occur in certain populations — including children, older people and people with AIDS — who sometimes don’t respond to TB skin test. A false-negative result can also occur in people who have recently been infected with TB, but whose immune systems haven't yet reacted to the
bacteria.
Many overseas Indian students sent back for Tuberculosis treatment
A large number of student expatriates from the US, Europe and Saudi Arabia are being sent back to seek treatment for tuberculosis. Every month five new students are being examined for the treatment of TB, city pulmonlogists say.
“These students have to take a break of six to eight months and get certified that they are free of TB and only then are they allowed back to the foreign country for education,” said Dr N. Rao, senior chest physician. Many private hospitals are seeing these student patients in the city. “Due to the change in weather conditions, eating outside food and also not finding food of their choice, latent TB is found to become active in these students,” said Dr Gopal Krishna, senior chest physician.
As most of these countries do not want to bear the burden of expatriates, they send them back till they are certified as completely cured. “After certification from the treating doctor there is also another clinical evaluation carried out by independent doctors who are attached to the embassy. Only after they clear the test are the travel permits given,” said Nagesh Reddy (name changed), a student who contracted the disease.
