Along with HIV and malaria, tuberculosis (TB) is one of the most dangerous diseases in the world. According to the World Health Organization, there were 8.8 million new worldwide cases of TB, along with 1.4 million deaths in 2010. TB is difficult to treat, usually taking over six months with antibiotics that sometimes have difficult side effects.
Also, because of low patient compliance, misdiagnosis, and other issues, multi-drug resistant (MDR) and extensively drug-resistant (XDR) versions of TB can arise in a population. MDR is resistant to the first-choice drugs, requiring treatment with a larger cocktail of one or more of the nine different “second-line” antibiotics, which are less effective, have more adverse effects, and can take much longer to effect a cure, up to 2 years or more. XDR TB is resistant to the three first-line drugs and several of the nine antibiotics usually considered as second line choices.
As the article states:
The vast majority of these unfortunate patients seek care from private physicians in a desperate attempt to find a cure for their tuberculosis. This sector of private-sector physicians in India is among the largest in the world and these physicians are unregulated both in terms of prescribing practice and qualifications. A study that we conducted in Mumbai showed that only 5 of 106 private practitioners practicing in a crowded area called Dharavi could prescribe a correct prescription for a hypothetical patient with MDR tuberculosis. The majority of prescriptions were inappropriate and would only have served to further amplify resistance, converting MDR tuberculosis to XDR tuberculosis and TDR tuberculosis.
The spread of this disease could be quicker than some other infectious disease (like HIV), because of how easily it’s spread (one patient can infect up to 15 others before diagnosis and treatment), and, of course, the lack of viable antibiotics for XDR TB.
Right now, the infection seems to be in a small subgroup of TB patients in India (and Iran) in a border region that has poor medical care. However, given the lack of effective antibiotics means that we’re all in this together.
The interesting fact about the title of the article–the authors seem to have invented a new subset of TB, Totally Drug Resistant.