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MDR, XDR, TDR tuberculosis: ominous progression
  1. Zarir F Udwadia
  1. Correspondence to Zarir F Udwadia, Hinduja Hospital and Research Center, Mumbai 400020, India; zfu{at}

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Any man's death diminishes me because I am involved in mankind, and therefore never send to know for whom the bell tolls; it tolls for thee… (John Donne, Meditation XV11)

The growing TB epidemic is no longer an emergency only for those who care about health, but also for those who care about justice. (P D O Davies)

For 2 weeks in January, India coughed and the rest of the world paid attention. Drug-resistant tuberculosis (TB), languishing from a decade of neglect by the Indian Revised National Tuberculosis Control Program (RNTCP), was headline news in every Indian newspaper and several international ones as well.

What captured local and international attention was a report documenting the isolation of the first cases of totally drug resistant TB (TDR-TB) from India.1 The Indian government's response, after initial denial, swung from the ridiculous to the sublime. The WHO response was far more measured and authoritative. Paul Nunn, coordinator of WHO's STOP TB department in Geneva, described the cases as “a wake up call for countries to accelerate provision of proper care, particularly for multi drug-resistant patients”. Within a week WHO had a TDR link on its website with answers to frequently asked questions, was planning a new consensus definition of TDR-TB, and had planned an expert meeting to rethink strategy.

TB exists on an epic scale in India. It resolutely remains India's biggest public health problem. India bears a disproportionately large burden of the world's TB, one a developing country can ill afford, with an estimated economic loss of US $43 billion and 100 million productive days lost annually directly due to this disease. The facts speak for themselves: India is the highest TB burden country in the world with 300 million Indians infected, accounting for 21% …

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