Tuberculosis: Current strategies to control MDR

Saroshe S1, Gedam DS2

1Dr Satish Saroshe Assistant Professor, Department of Community Medicine, M.G.M Medical College, 2Dr D Sharad Gedam, Professor of Pediatrics, L N Medical college, Bhopal.

Address for correspondence: Dr Satish Saroshe, Email: drsatishsaroshe@gmail.com

Abstract

Tuberculosis caused by Mycobacterium group of organism, is one of the ancient disease known to mankind. Despite the long known history of TB, treatment modalities are still not well understood and fully developed. Govt of India declared Tuberculosis a notifiable disease on 7th May 2012. India has introduced PMDT (Programmatic Management of Drug-resistant TB) services in all 35 states on 24th March 2013. Despite this entire claim made, we are very far from our MDG and RNTCP targets to achieve. In the 45th Union World Conference on Lung Health in Barcelona, Spain, in October 2014 the then Union Health Minister announced the TB-Mission 2020 to eliminate TB from India.

Key words: Direct observation therapy, Tuberculosis, drug resistant tuberculosis.

Tuberculosis (TB) is one of the most ancient diseases of mankind and has co-evolved with humans for many thousands of years or perhaps for several million years [1]. In spite of newer modalities for diagnosis and treatment of TB, unfortunately, people are still suffering, and worldwide it is among the top 10 killer infectious diseases, second only to HIV [2]. In 1882 Robert Koch was awarded Nobel prize in medicine for the discovery of Mycobacterium tuberculosis in 1905[3]. In India, historically speaking, fight against TB can be broadly classified into three periods: early period, before the discoveries of x-ray and chemotherapy; post-independence period, during which nationwide TB control programs were initiated and implemented; and the current period, during which the ongoing WHO-assisted TB control program is in place. [2] Today, India's DOTS (directly observed treatment-short course) program is the fastest-expanding and the largest program in the world in terms of patients initiated on treatment; and the second largest, in terms of population coverage[2].

In spite of newer modalities for diagnosis and treatment of TB, unfortunately, millions of people are still suffering and dying from this disease. TB is one of the top three infectious killing diseases in the world: HIV/AIDS kills 3 million people each year, TB kills 2 million and malaria kills 1 million [4]. Directly observed treatment-short course (DOTS) is an internationally recognized strategy for delivering the basics of TB case-finding and cure. It is not simply a clinical approach to patients, but rather a management strategy for public health systems, including political commitment, case-detection through quality-assured bacteriology, short-course chemotherapy, ensuring patient adherence to treatment, adequate drug supply and sound reporting and recording systems. Without treatment, TB mortality rates are high. In studies of the natural history of the disease among sputum smear-positive/HIV-negative cases of pulmonary TB, around 70% died within 10 years; among culture-positive (but smear-negative) cases, 20% died within 10 years [5].


Epidemiology

As per WHO estimations, Tuberculosis prevalence per lakh population has reduced from 465 in year 1990 to 230 in 2012. In absolute numbers, prevalence has reduced from 40 lakhs to 28 lakhs annually [7]. Incidence per lakh population has reduced from 216 in year 1990 to 176 in 2012. Tuberculosis mortality per lakh population has reduced from 38 in year 1990 to 22 in 2012. In absolute numbers, morality due to TB has reduced from 3.3 lakhs to 2.7 lakhs annually [7].

Achievements during 2013
1. India has introduced PMDT (Programmatic Management of Drug-resistant TB) services in all 35 states on 24th March 2013. As on February 2014, PMDT services are available in all 35 states of the country across 704 districts covering the entire population (100%) of the country.

2. 110 DR (Drug-resistant) TB wards established with airborne infection control measures by end of 2013.

3. The country has shown an accelerated progress in scale up of PMDT diagnostic services as compared to the early implementation years from 2007 – 2012. A total of 51 C-DST (Culture and drug susceptibility testing) labs were established using various technologies- 37 Solid culture labs, 12 Liquid culture labs and 41 LPA (Line Probe Assay) labs.

4.181021 MDR-TB suspects were tested for MDR-TB and 20763 patients were initiated on MDR-TB treatment during 2013.

As per article by Nigam et al. [8] in this issue DOTS therapy is still most effective with conventional drugs and almost 82 to 86 % 0f patients in non diabetic and diabetic groups completely recovers.

Funding: Nil Conflict of interest: Nil
Permission from IRB: Yes

References

1. Hirsh AE, Tsolaki AG, DeRiemer K, Feldman MW, Small PM. Stable association between strains ofMycobacterium tuberculosis and their human host populations. Proc Natl Acad Sci USA. 2004;101:4871–6.

2. Sandhu GK. Tuberculosis: current situation, challenges and overview of its control programs in India. J Glob Infect Dis. 2011 Apr;3(2):143-50. doi: 10.4103/0974-777X.81691. [PubMed]

3. Nobelprize.org [Internet]. Sweden: The Nobel Prize in Physiology or Medicine 1905: Robert Koch. c2010. [Last cited on 2010 Oct 15]. Available from: http://nobelprize.org/nobel_prizes/medicine/laureates/1905/koch.html

4. Geneva: WHO; 2010. [Last cited on 2010 Oct 15]. World Health Organization. Fact Sheet No.104: Tuberculosis. Available from: http://www.who.int/mediacentre/factsheets/fs104/en/print.html .

5. Tiemersma EW et al. Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIVnegative patients: A systematic review. PLoS ONE,2011,6(4):e1760. [PubMed]

6. Raviglione M, Uplekar M. WHO’s new Stop TB strategy. The Lancet, 2006, 367: 952–5. [PubMed]

7.  Website http://www.tbcindia.nic.in/pdfs/TB%20INDIA%202014.pdf accessed on 12-12-2014.

8. Nigam P, Baghel PK, Jain MK, Kandamble S. Efficacy of DOTS therapy in Pulmonary Tuberculosis with Diabetes Mellitus. Int J Med Res Rev 2014;2(6):585- 591. 

How to cite this article?

Saroshe S, Gedam DS. Tuberculosis: Current strategies to control MDR. Int J Med Res Rev 2014;2(6):515- 516.doi:10.17511/ijmrr.2014.i06.01