A sizeable 36 new cases of multiple–drug resistant tuberculosis (MDRTB) have been reported in Pune district in the last 40 days.

Experts fear that MDR tuberculosis and its deadlier cousin — extensivelydrug resistant tuberculosis (XDR) — may soon pose a bigger threat than HIV/ AIDS.

Fifteen of the 36 MDR patients are from areas in Pune city, 12 are from neighbouring Pimpri–Chinchwad and nine are from the district’s rural interiors.

After the culture lab for diagnosis of MDR–TB became operational at the Aundh Chest Hospital on February 10, experts have begun demarcating the MDR cases from the regular TB patients.

Tuberculosis can become resistant if a patient is not treated long enough, doesn’t take the prescribed medication properly, or doesn’t receive the right drugs.

“Among the confirmed MDR–TB cases in Pune district, 20 patients have been put on category 4 medicines. The rest are under pre–treatment evaluation and counselling,” says Kanchan Jagtap, chief medical officer in–charge of the State TB Training and Demonstration Centre (STDC) at Aundh Chest Hospital.

Funded by the World Bank through the central TB division of the government of India, STDC is the second such facility in the state after the one in Nagpur.

Besides ascertaining MDR cases through a culture sensitivity test, the centre also aims to provide free treatment since the cost often goes up to more than Rs 2 lakh per patient per year.

While Pune city reported 1,412 TB cases in 2010, the number rose to 3,650 TB cases in 2011. Pimpri Chinchwad reported 1,445 TB cases last year. The district’s rural areas reported 4,202 TB cases in 2010 while the number came down to 3,892 in 2011.

“MDR patients constitute two to three per cent of the newly diagnosed TB cases. Earlier, there were only suspected cases of MDR–TB, but now we have been able to ascertain the exact burden of MDR–TB cases in the city,” said N D Thakur, tuberculosis officer of the Pune Municipal Corporation (PMC).

Around 85 per cent TB cases are curable. Of the remaining, deaths constitute less than 5 per cent, defaulters (those who discontinue treatment) less than 4 per cent, relapses more than 3 per cent and failures up to 3 per cent. Patients who do not respond to treatment come in the failure category, officials said.

The state started detecting MDR–TB cases in Maharashtra from September 2007. “Since then, we have reported over 1,100 MDR TB cases in the state so far,” said Pradip Gaikwad, joint director (TB), state health services.

“Mumbai accounted for the highest number of cases, followed by Nagpur. Since the culture lab has just started functioning in Pune, more cases will be detected. MDR constitutes 2–3 per cent of the newly diagnosed cases and 17 per cent among patients put on retreatment after a gap in taking anti–TB medicines.”