Indian health ministry to investigate drug resistant TB cases
New Delhi, Friday, Januray 20, 2012:  The Union Ministry of Health and Family Welfare, Government of India, has sent a central team of doctors to Mumbai to ascertain facts about the reported cases of Drug Resistant Tuberculosis cases. The central team comprising senior chief medical officer, Central TB Division (CTD), GOI; consultant (drug resistant TB), CTD, and national program officer (Lab), WHO-India, reached Mumbai on Januaray 16, 2012.

According to the release issued by the ministry, the team is in touch with the health authorities of Maharashtra and Mumbai Corporation, apart from involving experts from concerned stake holders, including Hinduja Hospital, Mumbai.

Casting doubt on the earlier report from Hinduja Hospital, the ministry also pointed out in its statement that the hospital laboratory is not accredited by the Revised National Tuberculosis Control Programme (RNTCP), GOI, for culture and sensitivity for second-line drugs to diagnose Extensively Drug-Resistant (XDR) / Totally Drug Resistant (TDR) cases and is only accredited for conducting drug susceptibility testing (DST) by liquid culture and sensitivity for first line drug only. Recently, a proposal for accreditation of Line Probe Assay test (LPA) has been received and is under process.

According to the ministry, the revised National TB Control Programme has accredited only following three labs for conducting quality-assured second-line anti-TB drug susceptibility testing of flouroquinolones and injectables, viz National TB Institute (NTI), Bangalore; LRS Institute of TB and Chest Disease, New Delhi, and National Institute of Research in Tuberculosis, Chennai.

Terming the term TDR-TB as non-standardized and misleading, the minsitry said the testing for resistance beyond XDR-TB is not advocated by WHO and poor clinical response to treatment has not yet been correlated with diagnosis of drug resistant TB without Laboratory conformation from Accredited Labs. Any type of drug resistant TB can only be diagnosed by laboratory test and not by clinical examination alone. Preliminary results of second-line DST for MDR-TB patients from DOTS Plus sites and also isolates collected from Gujarat and Maharashtra drug resistance surveys show that there is not yet any XDR-TB amongst new cases and ~0.5 percent amongst re-treatment cases.

According to WHO definitions, the term "totally drug resistant" tuberculosis is neither recognized by the WHO nor by RNTCP. Multi-Drug Resistant (MDR-TB) is defined as resistance to at least isoniazid and rifampicin (two of the most potent first line anti-TB drugs), with or without resistance to other first-line drugs; XDR-TB is defined as resistance to at least Rifampicin, Isoniazid (i.e. MDR-TB) plus resistance to any fluoroquinolone, and to any of the three second-line injectable drugs (capreomycin, kanamycin and amikacin).

Defining the cases as XDR-TB, the minsitry mentioned that it can be managed by national XDR-TB treatment guidelines. Current WHO recommendations advise against the use of the Drug Susceptibility Testing (DST) results for second line drugs beyond those used to identify XDR-TB to guide treatment.

Ref: biospectrumasia
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