58% MDR-TB patients of region young adults: GMCH study

MDR-TB

NAGPUR: A study by the pulmonary medicine department at Government Medical College and Hospital (GMCH) has found that 58% young adults (19-39 years) were among the 1,909 patients who suffered from multi-drug resistant tuberculosis (MDR-TB). The lot also accounted for more than 50% of the total deaths due to DR-TB. The study spread over 15 years in three five-year slabs from 2007 to 2022, covered patients from the region.

The study points out at gradual rise in women suffering from DR-TB while predominance of men patients was seen across all age groups, except less than 18 years. The number of affected women touched 40% between 2018-22 as compared to 28% in 2008-12. The ratio of men and women MDR-TB patients stood at 2:1.

DR-TB is caused by TB bacteria which is resistant to at least one first-line medicine while in MDR-TB, there is resistant to more than one or at least isoniazid and rifampicin drugs.
Dr Sushant Meshram, professor and head of the department, presented the figures ahead of World TB Day. “Stress related to jobs, unemployment or  career issues may lead to low immunity among young adults. This helps the TB bacteria in causing the illness,” said Dr Meshram, who is also in-charge, nodal Drug Resistant TB (DRTB) centre at GMCH.
He said that most of the patients including children under study had MDR-TB which was concerning.

Around 40% Indian population is infected with TB due to which its elimination drive has taken a blow. Asymptomatic carriers and comorbid patients who discontinue treatment are found to be spreaders of the lung infection.

The national average of young adults suffering from MDR-TB at 38% is lower than the region’s.

The department also analyzed drug sensitive TB analysis for 926 patients at GMCH TB unit from 2018-2022. Around 69% patients were cured, 10% passed away while 3.6% lost follow-up and 3% accounted for failure and treatment regimen change.
Dr Meshram said surveillance of active cases like seen in Covid management, prevention, early treatment and capacity building hold key to eradication of the disease by the 2030 UN deadline. “Smoking, under-nutrition and comorbidity are major causes of TB. Under-nutrition is linked to poverty and slum dwelling. These factors need to be addressed,” he said.

STUDY FINDINGS
* 1,909 patients in 2007-2022 treated at the TB unit of GMCH
* Male:female ratio of MDR-TB patients 2:1 (64% males and 36% females)
* Incidence of DRTB in females increased from 28% in 2008-2012 to 38% in 2013-2017 and 40% in 2018-2022
* 58% patients young adults (19-39years), 26% middle aged adults (40-59years), 7% older adults (≥60years) and 5% children and adolescents (≤18years)
* 94% patients had drug resistant pulmonary tuberculosis, and 6% extra pulmonary tuberculosis
* 6% patients HIV positive
* 46% MDR-TB followed by Rifampicin resistant TB (RRTB) 36%, Isoniazid mono/poly resistant 15%, Extensively drug resistant (XDR) 2.20% and Pre XDR 0.21%.
* Prevalence of RRTB increased from 14% in 2007-2012 to 37% in 2013-2017 and 47% in 2018 -2022
* Prevalence of MDR-TB and XDR-TB decreased from 86% to 18%, and 5% to 2%, respectively
* 56% DR-TB patients declared cured
* Death rate decreased from 22% in 2007-2012 to 17% in 2018-2022
* 29% patients alcoholic, of them 99% males
* 352 patients (21%) died due to DR-TB
* More than 50% deaths in young adults (19-39 years)
* 15% of deceased had comorbidities, with 63% of them having diabetes mellitus