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Case report
Overcoming the health system barriers to early diagnosis and management of multidrug-resistant tuberculosis in a rural setting in North India
  1. Mohammad Abu Bashar1,
  2. Arun Aggarwal2 and
  3. Sudip Bhattacharya3
  1. 1Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  2. 2Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
  3. 3Community Medicine, HIHT University, Dehradun, India
  1. Correspondence to Dr Mohammad Abu Bashar; imback20006{at}


India contributes a quarter of the global burden of multidrug-resistant tuberculosis (MDR-TB) and has inadequate diagnostic infrastructure and institutional capacities for drug susceptibility testing. Subsequently, this leads to a large number of undetected and untreated cases of MDR-TB. In this report, we describe a case of a 55-year-old man from rural North India presenting with complaints of continued symptoms of chronic cough, fever and dyspnoea despite being recently diagnosed with recurrent tuberculosis and receiving treatment from the local community health centre. MDR-TB was suspected, but confirmatory diagnostic capabilities were not available in the local setting. The patient was finally diagnosed with MDR-TB. Treatment was coordinated by the district tuberculosis programme officer. Through this case, we describe the various barriers to detecting MDR-TB in the rural regions of India. Prompt identification of patients with presumptive MDR-TB, diagnosis of the disease and initiation of treatment are crucial to preventing disease transmission and reducing morbidity and mortality.

  • global health
  • tuberculosis

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  • Contributors MAB conceived the idea, conducted the review of literature and wrote the manuscript. AA conceived the idea and edited the manuscript. SB performed the final editing and revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.