The Indian Spinal Injuries Centre treated an unusual case of a banker diagnosed with tuberculosis which subsequently spread to her bones making her limp with pain that was getting progressively worse. The patient was treated by Dr. Ritabh Kumar, Senior Consultant, Orthopaedics and Trauma Surgery.
30-year-old Sudha (name changed), a banker by profession, had been on drugs for over 18 months for treatment of pulmonary tuberculosis. Her condition not only failed to improve, she also developed a progressive pain in her left hip causing her to limp. When the pain worsened consistently, she was presented to Indian Spinal Injuries Centre, where she was diagnosed as a case of drug-resistant tuberculosis that had now spread to the bones. Despite regular chemotherapy, she developed evidences of the disease spreading to other parts of her body.
“The woman was on first generation anti-tubercular drugs for over 18 months for pulmonary tuberculosis. In the face of drug resistance, the disease had started eating into her bones. The tests conducted showed erosion of the femur bone and additionally, showed frank pus surrounding the upper end of the thigh bone. Not only did she need treatment for drug resistant TB, she also required immediate surgical intervention to decompress the infection in the hip joint that was causing her the pain and limp,” said Dr Ritabh Kumar, Senior Consultant, Orthopaedics and Trauma Surgery.
Dr. Ritabh further explained that, “The disease had spread to damage the tissue in the proximal left hip region and the damaged tissue needed to be removed. Therefore surgical debridement of the hip bone was conducted to reduce the disease burden and obtain tissue material for culture of the offending organism. The tissue showed the tubercular bacteria under the microscope and the cultures grew the bacteria resistant to the two most important drugs in our fight against this disease”.
The patient showed results of recovery at post-operative stage and returned to her job. She, however, continues her consultation and regular check-ups with her doctors.
“Tuberculosis is endemic in our subcontinent and no one is immune to it. An unfortunate trend is that the incidence of drug resistance is increasing. This poses challenges to doctors to treat but additionally, escalates the cost of treatment and incidences of side-effects for the patients,” says Dr Kumar.
Doctors at Indian Spinal Injuries Centre say drug resistant tuberculosis today has become more widespread that we imagine. According to WHO, such strain has been reported in 117 countries worldwide. While TB can indeed affect various organs such as lungs kidney, lymph nodes, bones, joints, only around 5-10% of the total TB patients in India are suffering from bone TB, suggests clinical evidence. On the other hand, rarely have persons with drug-resistant tuberculosis went on to develop Bone TB, making Sudha’s case one-of-its-kind in nature.
Drug resistant TB has frequently been encountered in India, and the numbers are increasing for the last few years, suggest various studies. Although enrolment for treatment programs for people with MDR-TB had improved substantially between 2009 and 2011, the number of people getting treatment is still abysmally low in a country having one of the highest burdens of MDR-TB, reveals a report published in Lancet Infectious Diseases medical journal.
India reported an estimated 64,000 cases of notified multi-drug resistant tuberculosis (MDR-TB) in 2012. On the other hand, our country presently has the highest overall TB burden in the world, accounting for an estimated one-fifth of global TB cases worldwide, and an estimated prevalence of 3 million TB cases every year (out of which almost 2 million cases are new), according to data from Global Tuberculosis Report 2013 by WHO.
Multidrug-resistant TB (MDR-TB) is a form of TB that shows a lack of response to two most powerful anti-TB drugs. The bacteria that cause tuberculosis (TB) can develop resistance in a number of cases to the antimicrobial drugs used to cure the disease. Premature treatment interruption, inappropriate or incorrect use of antimicrobial drugs or transmission of MDR TB from person to person are factors responsible for the spread of drug resistant TB in India.