Thyrocare TGS Profile For Multi Drug Resistant Tuberculosis Treatment

Taking antibiotics when they are not needed can cause some bacteria to become resistant to the antibiotic and these resistant bacteria are in fact stronger and harder to kill. They stay in the body and are capable of causing severe illnesses that are almost incurable. One such illness is Multidrug resistant tuberculosis (MDR-TB) which is difficult to treat and has indeed become a man-made problem. While tuberculosis is hundred percent curable, often mismanagement of tuberculosis paves the way to drug resistant tuberculosis.

This particularly dangerous form of TB caused by mutant form of tubercle bacilli is resistant to two of the most powerful anti-TB drugs, isoniazid and rifampicin. A random mutation occurs in the bacterial chromosome and facilitates the bacteria with drug resistance property. These mutations occur at a low rate, which varies depending on the drug. If large numbers of TB bacilli are present and the patient is treated with one drug, it eliminates the organism susceptible to that drug but organisms resistant to that drug remain unaffected. Eventually resistant bacilli make up a substantial proportion of bacterial population and clinical drug resistance occurs.

MDR-TB develops due to error in TB management such as the use of single drug to treat TB, the addition of a single drug to a failing regimen, the failure to identify preexisting resistance, the initiation of an inadequate regimen using first line anti tubercular drugs and varaitions in bioavailability of anti-TB drugs predispose the patients to the development of MDR- TB. Most of the problems from which drug resistance originates are related to length of treatment. The longer time required to treat MDR-TB clearly implies an additional risk of poor treatment adherence and consequently of treatment failure. TB control program implemented in past has also partially contributed to the development of drug resistance due to poor follow up and infrastructure . Newer anti-TB drugs, immunotherapy, nutritional Cyclic , enhancement, surgery, Mycobacterium vaccae Peptides vaccination and cytokine therapy are also helpful for the management of MDR-TB.

Direct observation therapy strategy (DOTS) is key ingredient in the TB control strategy. But the emergence of drug resistant strains is known to reduce the efficacy of treatment. The outcome of treatment of patients infected with organisms resistant to rffampicin and isoniazid (MDR) have a high rate of treatment failure. Based on an awareness of the multiple difficulties faced by any large scale intervention aimed at fighting MDR-TB, a special initiative has been launched within the frame work of the global TB strategy worldwide called DOTS-Plus. The DOTS-Plus strategy of identifying and treating patients with MDR-TB appears to have the potential to be effectively implemented on a nationwide scale .

Tuberculosis is easy to diagnose but diagnosis of MDR-TB depends on reliable and expensive culture and sensitivity test that are not available in most parts of the world. The second line drugs used in cases of MDR-TB are often less effective, more likely to cause side effects and are expensive. Isoniazid and Rifampicin are the key stone drugs in the management of TB. TB patients must take these standard drugs alongwith pyrazinamide and ethambutol daily for six months. As observed some may begin to feel better after a month, which tends to lead them to skip doses, but if they stop taking the drugs for any reason, the drugs may become ineffective and multi-drug resistant TB may result. MDR-TB can be cured with lengthy treatment of second-line drugs, to be continued for 18 months along with a monthly repeated sputum culture. But, about 90% discontinue the treatment as it is expensive.

While resistance to either of the two drugs can be managed with other first line drugs, MDR-TB demands treatment with second line drugs that have limited sterilizing capacity and are more toxic. The research being expensive, slow and difficult, and requiring specialized facilities for handling Mycobacterium tuberculosis, no new drug except rifabutin and rifapentine has been marketed for TB in the last 40 years after the release of Rifampicin.

Multidrug-resistant tuberculosis is a challenge to TB control due to its complex diagnostic and treatment requirements.

According to the WHO, almost 50 per cent of patients affected by the multidrug-resistant form of TB will die because no drugs are strong enough to treat them. India is supposed to have about one lakh patients suffering from MDR TB. In order to counter the threat of such a global epidemic, Indian government is taking several measures like focused clinical radiological and bacteriologic follow-up, judicious use of anti-TB drugs, availability of high quality second line drugs, implementation of DOTS-plus for intensive diagnostic and therapeutic management of MDR-TB and many more.

Last but not the least, the latest scare is about the occurrence of extreme drug-resistant strains of TB (XDR -TB), which have stopped, responding to not only the first line of anti-TB drugs but also to the second line as well and a new deadlier form, Totally Drug- Resistant TB (TDR-TB) which is more feared and virtually untreatable form of the killer lung disease. It appears that mankind and bacteria are competing against each other in trying to 'get smart'. And as the theory of evolution teaches us, we must realize that in the end it is going to be the survival of the fittest or shall we say, smartest ?

Thyrocare is India's first lab to bring in TGS (Tuberculosis Genome Sequencing) technology with DST (Drug sensitivity test) analysis. With state of the art Lab providing with Accurate Reports. TGS profile is an alternative to TB Gold test. Infact TB Gold test can't be even compared with TGS profile since TB Gold is a serology test whereas TGS is a Genome Sequencing test which checks the DNA of TB.