Rare combo of TB & leprosy rears head in Mumbai

MUMBAI: City physicians are increasingly treating patients with a

rare co-infection of TB and leprosy.

Though both the

bacterial diseases

are endemic to India, doctors say, the

co-infection

is unusual and grossly under-reported.


Two co-infection cases were recently brought to the notice of the city’s leprosy control programme officials. Both were from Baiganwadi in Govandi, a densely populated slum pocket that has, over the years, emerged as a hotbed for both

TB

and

leprosy

. In 2018-19, the biggest cluster of

leprosy cases

were detected here.

One of the affected patients was a 39-year-old man who was detected with leprosy during a follow-up for TB. The patient had been on TB drugs for three months and was put on leprosy treatment soon after. The second patient, a 47-year-old man, was undergoing treatment for extrapulmonary TB (outside lungs). In this case, TB was detected during treatment for leprosy. Swapnil Jadhav, who works with NGO Lok Seva Sangam that detected the Govandi cases, said both patients were treated for leprosy and are being observed for TB.

“Co-infections were always there, but we have been informed for the first time. With increased surveillance in leprosy programme, we may find more individuals suffering from the infections concurrently,” said Dr Raju Jotkar, incharge of city’s leprosy control programme. “The coinfection remains uncommon and is unlikely to affect in significant numbers,” he said.

In the private sector too, there is a steady stream of leprosy-TB cases. Dr Om Srivastava, an expert in infectious diseases at Jaslok Hospital, said over the last three years, he has treated close to a dozen cases of mixed infection. “TB and leprosy-causing bacteria (Mycobacterium) come from the same family. But we need to know whether the diseases interact, or if the co-infection has an impact on the treatment outcome of both or either,” he said, adding that he has treated patients from Gujarat, MP and Hyderabad.

“In several cases, patients were undergoing treatment for TB and had unexplained nerve problems,” said Dr Srivastava. Citing the example of a patient from Silvassa, he said the TB patient had a patch on his thigh and a gait abnormality. “Doctors treating him for TB couldn’t understand what caused the foot drop. We sent his samples for leprosy tests and they came positive,” he said. It also turned out to be a case of multibacillary leprosy, which means the infection was in advanced stage despite routine check-up with doctor.

Experts say the only thing common between the two infections is it predominantly affected people from lower social-economic strata. “Getting TB doesn’t predispose one to get leprosy or vice versa. But, most cases come from pockets where living conditions are sub-optimal and nutrition levels are poor,” said Dr Vivek Pai, director of Bombay Leprosy Project. He also said rifampicin, a drug used to treat both leprosy and TB, works well for the former, unlike TB where it is resistant for a significant percentage. Chest physician Dr Zarir Udwadia said, “Co-infection is rare even in countries like ours where they are both endemic.”