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According to the 2010 World Health Organization (WHO) data, the number of TB cases in India (3 million infected) far exceeds that of any country in the world. More than 100,000 of these cases are caused by drug resistant strains that continuously mutate into more resistant forms, which comprise at least 20% of multi drug-resistant tuberculosis (MDR-TB) cases globally. Because cases treated in the private sector do not require government notification in India, TB statistics are considered seriously under-reported.
MDR-TB first appeared in the 1990s and was followed by cases of extensively drug-resistant tuberculosis (XDR-TB) at Mumbai’s Hinduja Hospital and Research Center in 2006. A report of totally drug-resistant tuberculosis (TDR-TB, otherwise known as XXDR-TB) came from Italy in 2007, then reports of 15 similar patients from Iran in 2009. Zarir Udwadia, MD, director of the Hinduja National Hospital in Mumbai, published four cases of Indian patients, which added to the total of twelve assumed TDR-TB cases by 2012.
These cases were noted as totally resistant to all the available anti-TB drugs (eg, first- and second-line anti-TB therapy), as described by Dr Udwadia in correspondence to the journals, Clinical Infectious Diseases and Respirology. The patients had received unsupervised treatment for MDR-TB with second-line drugs, added separately, often with incorrect dosages, for periods of 18 months.
Dr. Udwadia reported that the appearance of TDR-TB resulted from selective resistance (by the bacillus) to incorrect antibiotic treatment/dosage and poor follow-up of the patients’ previous MDR- and XDR-TB. They had failed two standard treatment programs through public health, then were subjected to inappropriate treatment by private physicians for another year before they were seen at Hinduja Hospital, where they received salvage or experimental drugs and in some cases, surgical removal of a lung.