Now Totally Drug Resistant TB?  
From Patricia Doyle PhD
Hello Jeff - I have heard of MRD TB and XDR TB and even XXDR TB but now TDR TB?  Totally Drug Resistant TB evidently was first diagnosed in Iran in a set of patients three years ago. Now, India has discovered and diagnosed TDR TB in a set of patients in Mumbai hospital.
As I stated many times on the program, we are entering a stage where TB, like 60 years ago, is going to be incurable. We have arrived now with TDR TB.
The best method of protection is PREVENTION. We must be very very careful not to get exposed to TB. This will mean that healthcare workers will have to take infection control very seriously.
I remember going to a clinic and being on of three patients treated by one doctor. One of the patients had TB and I noticed the doctor going back and forth between myself, the TB patient and another patient and noticed the doctor did not wash his hands. This is unacceptable behavior.  
Detection of TDR TB will be of utmost importance and people with resistant TB will have to abide by public health guide lines for the sake of themselves, their families and friends and the greater community.
TB has now become one of our worst nightmares.
Mumbai hospital reports first set of 'total' drug-resistant TB cases
Almost three years after the first set of patients were diagnosed with Totally Drug-Resistant Tuberculosis (TDR-TB) in Iran, researchers at the P D Hinduja National Hospital and Medical Research Centre here said today they have detected India's first set of TDR-TB patients - 12 over the past two months.
In a paper published in the international journal Clinical Infection Diseases, Zarir Udwadia and his team have described how they detected the first four TDR-TB patients.
"Prior to TDR, XDR or extensively drug-resistant TB was the furthest stage patients had been diagnosed with in India. After drug susceptibility testing was performed on four TB patients present at the hospital, it was seen that all four patients were resistant to both first line as well as second line treatment," said Udwadia, adding that there was no treatment for them.
According to Udwadia, the drug-resistant nature of the TB-causing mycobacterium tuberculosis increases with mutations of the strain often catalysed by incorrect and erratic administration of second-line drugs. "An audit of the patients' prescriptions showed that three of the first four patients received unsupervised second-line drugs often in incorrect dosages by private practitioners in an attempt to treat their multi-drug resistant TB (MDR-TB). By the time they were referred to us, they had moved from the MDR stage and the XDR stage to TDR-TB," he said.
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In a study a few years ago, it was seen that only five of 106 private practitioners in Dharavi could prescribe a correct prescription for a hypothetical patient with MDR tuberculosis. The majority of prescriptions were inappropriate and amplified resistance, converting MDR-TB to XDR-TB and finally TDR-TB. 
WHO estimates that India accounts for 20% of the world's total load of MDR-TB.
"The Revised National TB Control program (RNTCP) might have been a success but only a very small percentage of MDR patients actually have access to Directly Observed Treatment Short-course (DOTS, the globally standardised short-course chemotherapy cure for TB). It's probably time we rethink our TB control policies" said Udwadia.
"I don't know the details of the report but a few new cases doesn't mean that the success of DOTS can be disregarded. The nature of the TB bacterium is such that rapid mutation takes place making it drug-resistant. It is premature to say that the report is an indicator of TB spread in the community," said A Thomas, Director of the National Institute for Research in Tuberculosis, Chennai.
Patricia A. Doyle DVM, PhD Bus Admin, Tropical Agricultural Economics Univ of West Indies Please visit my "Emerging Diseases" message board at: Also my new website: Zhan le Devlesa tai sastimasa Go with God and in Good Health
Benjamin Franklin said, "They that can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety." 
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