एमडीआर टीबी मरीज किसे कहते है ?(Who is the MDR TB patient ?)

एमडीआर टीबी ( multi drug rejistant ) जब टीबी के रोगी फर्स्ट लाइन की दवा  बार-बार खाता है और छोड़ देता है या दवा खाने के 6 महीने या साल दो साल बाद फिर टीबी होती है ऐसे मरीजों को MDR suspect कहते है।ऐसे मरीजों का microscopic और CBNAAT से बलगम की जाँच की जाती है तो कुछ दवाइयाँ रजिस्टेंट हो जाती है ऐसे मरीज को एमडीआर टीबी  मरीज कहा जाता है। (DR- TB) ऐसे मरीजों को IRL लेब में DST करवाई जाती है। एमडीआर टीबी सार्वजनिक रूप से और स्वास्थ्य सुरक्षा के लिए खतरा बनता जा रहा है। 

एमडीआर टीबी मरीज :

Case definition :

(1) Microbiologically confirmed TB case :

refers to a presumtive TB patient with biological specimen positive for acid fast bacilli,or positive for Mycobacterium tuberculosis on culture, or positive for tuberculosis through Quality Assured Rapid Diagnostic molecular test.

(2) Clinically diagnosed TB case :

refers to a presumtive Tb patient who is not microbiologically confirmed, but has been diagnosed with active TB by a clinician on the basis of X-ray abnormalities,histopathology or clinical signs with a decision to treat the patient with a full course of Anti-TB treatment.

Classification based on drug resistance

(1) mono-resistance(pdr) :

 A  TB patient,whose biological specimen is resistance to one first-line anti-TB drug only.

(2) poly-drug Resistance(pdr) :

     A TB patient,whose biological specimen is resistance to more than one first-line anti-TB     drug,other than both INH and Rifampicin.

(3) Multi drug Resistance(MDR) : 

A TB patient, whose biological specimen is resistance to both isoniazid and rifampicin with or without resistance to other first-line drugs,based on the result from a quality assured laboratory.  

      Rifampicin Resistance (RR) : Resistsnce to rifampicin detacted using phenotypic or genotypic methods,with or without resistance to other anti-TB drug excluding INH.patient,who have any Rifampicin resistance, should also be managed as if they are an MDR TB case.

(5) Extensive Drug Resistance(XDR) :

A MDR TB case whose biological specimen is additionally resistance to a fluoroquinolone (ofloxacin,levofloxacin,or moxifloxacin) and a second-line injectable anti-TB drug (kanamycin,amikacin,or capreomycin) from a quality assured laboratory.

TYPES OF DRUG RESISTANT TB
Drug resistant Tb	Resistance	Recommended Diagnosis
Mono resistance	Resistant to a single first line drug	GeneXpert
Poly-Resistant	Resistant to more than 1 drug but not to Rifampicin & Isoniazid	GeneXpert followed by Liquid culture
MDR TB (multi-drug resistant)	Resistance to at least Isoniazid and Rifampicin	GeneXpert followed by Liquid culture
XDR TB (extensively drug resistant)	MDR + Resistance to fluoroquinolones and at least 1 of 3 injectable drugs	GeneXpert followed by Liquid culture
TDR (totally drug resistant)	Resistant to all first and second line TB drugs	GeneXpert followed by Liquid culture

                   अलग अलग एमडीआर मरीजों को अलग अलग 8 -10  दवाई रोज  दी जाती है और साथ में kenamycine  inj. भी पहले 3 महीने तक लगाए जाते है। ऐसे मरीजों का पूरा कोर्स 9 से 11,और 24 से 27 महीने तक गोली खाना पड़ती है जो बिना पैसे के भारत सरकार के सभी प्राथमिक /सामुदायिक /जिला स्वास्थ्य केंद्र में उपलब्ध है। 

     👉   टीबी से बचा रहे बाकी परिवार बस बरतें सावधानियाँ दो चार।