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Totally Drug-Resistant Form of TB Emerging in Second Country

"... just the tip of the iceberg."

Three years after the first reports in the world of a totally drug-resistant (TDR) form of tuberculosis (TB) in Iran, at least 12 cases of TDR-TB have been confirmed in India over the last few months.

According to the Times of India, cases began emerging in October 2011, making it the second country find this deadliest strain of TB among patients. The U.S. Center for Disease Control categorizes resistance levels of TB as multi-drug resistant or extremely drug resistant. TDR is not even classified yet on the CDC's website and there has been no reported cures for such a strain of this bacterium yet.

What's worrying, according to the Times of India, is that 10 of the 12 cases were of city dwellers:

"The TB bacilli have obviously mutated. The emergence of TDR-TB has grave implications for public health," said Hinduja Hospital's Dr. Zarir Udwadia, whose observations have been published in the latest issue of the US-based Clinical Infectious Diseases (CID) peer review journal.


Dr. Amita Athawale, who heads KEM Hospital's chest department, said TDR-TB was a reality in India. "The cases we clinically isolate are just the tip of the iceberg," she said. TB is one of the biggest killers in India, along with heart attack.

So far, the Times of India reports, one of the 12 patients has died. Worldwide, there are 8.8 million incidents of TB and 1.45 million deaths occurred in 2010, according to the World Health Organization.

Wired referrers to the first outbreak of TDR-TB in 2009 in Iran as "underreported" in the media. It notes that while only 15 cases of this strain were reported then, 146 of the multi-drug resistant version were cited with a high percentage of those cases being among traveling immigrants.

According to Wired, only two-thirds of countries with forms of drug-resistant TB have labs capable of diagnosing the bacterium as resistant. This means that only about one in every 10 patients with multiple drug-resistant TB gets treated. The likelihood of treatment leading to a cure ranges widely. Estimates state that for every one person with TB, 15 others could get infected.

One last thing…
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