Banned TB diagnostic tests continue

• Serological blood tests banned for inaccurate results in 2012

• Risk of falling prey to prescription of TB-resistant drugs

• Rs 20% patients wrongly diagnosed with TB’

Hyderabad: Are some private doctors playing with the lives of patients of tuberculosis (TB)? It appears so, going by the indiscriminate prescription of blood tests, which were banned a year ago, for diagnosing the dreaded disease.

The serological tests, which were banned in 2012, are still being prescribed by the private practitioners, especially in private hospitals. “Those tests were declared imprecise and highly inconsistent which can finally lead to risk of life of a healthy patient also,” some senior city doctors have warned. “Moreover, inaccurate tests in TB diagnosis produce inaccurate results and with wrong diagnosis, there is a risk of patients falling prey to drug resistant TB,” they expressed concern.

“Every day we experience 20 per cent of TB cases wrongly diagnosed at our hospital,” said a senior doctor in Government Chest Hospital, Hyderabad.

Nexus between physicians and diagnostic centres in the city are blamed for this. To earn extra and higher commission, the medical practitioners are prescribing costly, obsolete and banned tests.

The tests approved by the Revised National Tuberculosis Control programme (RNTCP) for diagnosis of TB include sputum microscopy, X-ray chest, solid and liquid culture methods and rapid molecular tests. However, Dr Subhakar, Chairman, zonal task force, TB Control Programme, says, “Many private medical practitioners prescribe the banned IGG and IGM tests (Serological tests) for TB detection. About 1.5 million TB suspects in our country are undergoing these serological tests every year. Thus nearly Rs 750 crore is being wasted on these tests. Also these tests do not diagnose TB accurately. Due to lack of awareness among patients, several people fall prey to such costly blood tests and also putting their lives at risk.”

In a country where for every one lakh people 185 new TB cases are recorded per annum, at least 70 per cent of them approach a private doctor for diagnosing and 90 per cent of private doctors prescribe these tests.

“Tuberculosis (TB) is a contagious disease infected by Mycobacterium tuberculosis. It infects human body organs including lungs, bones, kidney, spine, brain, etc. In India 40 per cent of the population is infected with latent TB (infection only and not active TB). There is a huge difference in treatment for latent TB and progressive TB. In fact, as in western countries, here we are not treating latent TB cases with right medications to prevent the infection.

The TB Gold Test (Quanti Feron Gold) should be used in specific latent TB cases only. It should not be used for diagnosis of TB. But such a situation hardly prevails here. Doctors prescribe it for TB testing indiscriminately. Its cost is Rs 2,500. It is not only financially burdensome but also harmful to the patient” Dr Subhakar elaborated. “Mantous or Tuberculin test is meant for detecting latent TB. It costs only Rs 50. Fluor Quinolines test is also not prescribed for everybody. It is used for second line of TB patients. If it is prescribed indiscriminately it will lead to drug resistant TB in the patients. RISE-ESR is the treatment procedure meant for direct TB treatment,” he said.

“If TB is not treated properly by using the correct diagnostic tests carefully, it can turn fatal. Under the new ‘Intiative for Promoting Affordable Quality TB tests’ (IPAQT), the latest advances like Zene Expert test and CBNAAT for TB diagnosis are taken up. And LED Microscope is another more effective one in diagnosing TB and in a very short time. Liquid cultures will be prescribed in diagnosis of difficult TB cases. All these test procedures were approved by World Health Organisation. They are potential diagnostic methods as well as cost effective which are available within the reach of common man,” Dr Subhakar added.