Incidence of Multidrug-Resistant (MDR) and Extensively drug Resistant (XDR) Tuberculosis among Different age Groups in Tertiary Care Hospitals of Chandigarh, India

Chandigarh has been adjudged among the top five performing states and union territories in the country by TB India-2008 RNTCP (Revised National Tuberculosis Control Programme) status report, brought out by the Union Health Ministry. In controlling TB, Chandigarh is now at par with Delhi, Rajasthan, Gujarat and Arunachal Pradesh. According to National Rural Health Mission, in 2008, 13,937 patients were examined for sputum diagnosis, out of which 1,793 were found positive and 837 new smear positive patients were put on treatment. The other smear positive patients were either referred to other states or were treated under other categories of treatment. The new sputum positive detection rate is 84 per lakh of population in Chandigarh. Up to December, 2008, 15,123 patients were put on treatment. In calendar year 2008, the total annual detection rate was 243 per lakh. There were only two per cent death among 2400-odd patients put on treatment in one year, two per cent failure rate and three per cent defaulter rate, the lowest in the country. A total of 910 cases of pulmonary tuberculosis were enrolled over four years (2008-2012). Among these, cases of MDR-TB and XDR-TB were meticulously studied for drug susceptibility, treatment, adverse effects profile and overall survival. Fifty-two (5.7%) cases of MDR-TB were identified, among which eight (15.3%) were diagnosed as XDR-TB on the basis of drug susceptibility testing, using the prescribed definition. The cases were sensitive to 2, 3, 4, 5 and more than 5 drugs in almost equal proportions. Thirtyseven (71.1%) cases were successfully cured; eleven (21.1%) patients died; and only four (7.6%) cases defaulted, indicating overall satisfactory adherence to treatment. For effective treatment of MDR-TB and XDR-TB, early case detection, improved laboratory facilities, availability of appropriate treatment regimens, and financial assistance in resource-limited settings through effective political intervention are necessary for better patient adherence and overall cure.