One third TB cases go undetected in India, Doctors want better diagnostic algorithms

With increased incidents of TB cases being reported in India and especially in West Bengal, doctors under the banner of West Bengal Tuberculosis Association have advocated the adoption of better diagnostic tools to fight Multi Drug Resistant Tuberculosis

TB on rise: As per 2014 estimates, TB cases with MDR-TB range from 2-3% in new cases and 11-19 % in re-treatment TB cases with the disease spreading rampantly.

New Delhi: With multi-drug resistant tuberculosis emerging as a major obstacle in the fight against tuberculosis, doctors have advocated the need for a collective move to adopt appropriate diagnostic mechanisms that help in accurate diagnosis of drug resistant strains of TB. Leading specialists have also highlighted the growing menace of multi-drug resistant TB in West Bengal, stating that many gaps need to be addressed – from TB Diagnosis to Management – to achieve 100% diagnosis, prevent patients from dropping off treatment mid-way and ensuring that drug resistant strains are identified timely and correctly.

“The emergence of multi drug resistant TB has jeopardized global objectives of TB eradication. In India, we were already struggling with problems such as under-diagnosis and lack of completion of treatment, and drug resistance has offered an entirely new paradigm of obstacles in the struggle. Drug resistance makes treatment very difficult as second line drug regimens for treating MDR TB are toxic, costly and lengthy. This has put emphasis on better diagnostic mechanisms that can not only diagnose TB but also identify drug resistance in detail. The liquid culture tests have offered a new ray of hope in our fight against multi drug resistant TB,” said Dr R K Das, Honorary General Secretary of West Bengal Tuberculosis Association said in a statement on March 28th.

WHO statistics for 2014 suggest an estimated incidence of 2.2 million cases of TB in India out of a global incidence of 9 million, making 1 out of 5 TB patients worldwide an Indian. In the developing world, including India, the TB burden has been further aggravated by the emergence of newer, drug-resistant strains of TB (MDR-TB and XDR-TB). As per 2014 estimates, TB cases with MDR-TB range from 2-3% in new cases and 11-19 % in retreatment TB cases with the disease spreading rampantly.

Giving his opinion, Dr Sudip Roy, Consultant Microbiologist and Lab In-charge, Medica Superspeciaility Hospital, Kolkata, mentioned, “Apart from improved diagnosis, management of TB needs much better precision and enforcement. In many cases, resistant TB results from inadequate TB care and irrational use of drugs which causes the bacteria to develop drug resistance. In this light, even treatment regimen that are practices in our country across the healthcare spectrum need major overhaul to include strict protocols to prevent development of drug resistance. To improve the outcome in DR-TB cases quality supply, affordability of patients and stock out must be looked into. With this scenario, extreme care must be enforced while treating the patients. The patients ought to be monitored while on regimen and all prescriptions must be supported with accurate and complete diagnosis with WHO approved diagnostics tests.”

Diagnosing drug resistant Tuberculosis is today possible with MGIT-based TB drug susceptibility testing that effectively identify the drugs the bacteria have resistance to. This proves life-saving for many patients as it helps doctors skip undesirable drugs in their treatment protocol. The overall treatment success rate for new TB patients was estimated to be 84% in 2014 while for retreatment patients (having DR TB) the treatment success rate was only 68%.

To build the capability in understanding this technology in India, leading medical technology company BD has been working with Revised National TB Control Program for TB culture and drug susceptibility testing in laboratories across India. Under the initiative, best practices are being taught using BD MGITTM liquid culture systems, quality control and quality assurance of laboratory practices.

“It is critical that patients are placed on the most appropriate regimen early after diagnosis in order to ensure the best chance of patient recovery and to control drug resistant TB. Through our work with West Bengal State TB Association, we want to ensure that more people in India will get tested accurately, and treated appropriately from the beginning,” said Varun Khanna, managing director – India & South Asia, BD.

The BD MGIT™ system supports rapid culture and ID confirmation of TB organisms to call out critical patient mass. This system supports full range of first and second line Drug Susceptibility Testing (including newly approved drugs, like Delamanid and Bedaquiline) on resistant strains and is backed with a BD Database Management System which can enable epidemiology analytics.

It is particularly valuable in its ability not only to detect MDR/XDR-TB but also to determine which drugs can be used to treat the patient. It is far more effective than any other approaches and therefore recommended in diagnosing TB in patients co-infected with TB and HIV, pediatric TB, extra pulmonary TB, as well as smear negative TB cases.