Doctors in India are reporting the country's first cases of what they're calling "totally drug-resistant tuberculosis," a form of the lung disease that they say resists all forms of treatment.
The doctors say they have found 12 patients who have failed to respond to as many as a dozen medications normally used to treat the lung disease. Three of the patients have died. The rest are not expected to live long.
Infectious diseases experts have long lamented that tuberculosis is becoming increasingly difficult to treat in many parts of the world, particularly the developing world.
The number of cases of multi-drug-resistant (MDR) TB has been growing for some time now, with more than 600,000 cases of MDR tuberculosis a year worldwide.
In 2003, the first cases of extensively drug-resistant (XDR) TB were discovered. This form of the disease, while still rare, is highly resistant to all first line antibiotics and second line drugs normally used to treat the disease.
XDR-TB patients have been documented throughout India, Iran and even the U.S. and Canada, though experts believe there could be many undocumented cases.
Then, last month, doctors in Mumbai described in the medical journal Clinical Infectious Diseases the first four cases of what they called "totally drug-resistant tuberculosis."
The number of cases has now grown to 12. Doctors treating these patients said they tried a dozen medicines to try to cure the illnesses; none of them worked.
The World Health Organization doesn't yet accept the term "totally drug-resistant tuberculosis" or TDR-TB, and considers the cases to be XDR-TB.
Ordinary TB is usually cured with antibiotics for six to nine months. But if patients don't take their medications consistently or if treatment is interrupted, the bacteria are not killed off and can "learn" to grow stronger.
The TB bacteria in MDR and XDR have mutated into a tougher strain that can no longer be killed by standard antibiotics.
Both forms of the disease can eventually be treated in some cases, but it takes much longer and the costs are significantly higher. In patients with other conditions, such as HIV, the prospects are much dimmer and most die.
The Mumbai doctors treating the TDR-TB patients have blamed private doctors for the problem, saying that too many of them do not understand how to properly treat TB and prescribe inappropriate drugs that then spark greater drug resistance.
"These three patients had received erratic, unsupervised second-line drugs, added individually and often in incorrect doses, from multiple private practitioners," wrote the doctors in the Clinical Infectious Diseases article.
One of the doctors who described the first four cases, Dr. Zarir Udwadia, told The Associated Press in an interview that the Indian government's TB program is partly to blame for the problem.
"It was a given that this would happen," Udwadia said. "They have had no help from the Indian TB system. They are the untouchables, so no one is making a fuss. They don't have the power to vocalize."
Udwadia worried that all the patients documented so far have been poor slum dwellers who are living in the community, where they could spread the disease to family members.
"There's going to be more family contacts. It's going to spread for sure," he said.
Tuberculosis is transmitted through close personal contact though it isn't nearly as contagious as the flu. Most of the cases of this new form of TB were not from person-to-person infection but were in patients who were poorly treated for TB and then developed this more resistant form.
