Totally drug-resistant tuberculosis (TDR-TB) in India: every dark cloud has a silver lining

摘要

In the early weeks of January 2012, a report of four cases of tuberculosis from Mumbai, India, stirred up a storm.1 India bears a giant's share of the world's multi-drug-resistant tuberculosis (MDR-TB) burden, but these cases were different even though they came from a centre (Hinduja Hospital and Research Center) which has been reporting on the alarming escalation in drug-resistant TB in Mumbai over the last two decades. The four patients described in this report were resistant to all first-line (isoniazid, rifampicin, etham-butol, pyrazinamide and streptomycin) and second-line drugs (kanamycin, amika-cin, capreomycin, ofloxacin, moxifloxacin, ethionamide and para-amino salicylic acid) to which they were tested. That the report came from Mumbai's most reputed myco-bacterial laboratory, accredited for drug susceptibility testing (DST) by the Revised National TB Control Program (RNTCP), and serving as the de facto reference myco-bacterial laboratory for the city added to the veracity of this report. The choice of the term 'Totally Drug-Resistant' for these four cases was found unpalatable by the Indian health authorities, who initially denied the very existence of 'totally drug-resistant tuberculosis (TDR-TB)'.