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CHENNAI: From two deaths every three minutes to having the highest tuberculosis burden in the world, most surveys related to TB in India throw a startling number. And here is one more: Close to 9% of all paediatric tuberculosis patients are resistant to rifampicin, one of the first-line drugs used in the treatment of the infectious disease. This is 6% more than what was previously estimated, a study covering four metros in the country has found.The project, initiated last year by the Revised National TB Control Programme (RNTCP), found that 8% of the 22,000 suspected paediatric TB cases (0-14 years) tested positive, of which nearly 9% were resistant to rifampicin. The study covered four cities - Chennai, Hyderabad, Kolkata and Delhi.Drug sensitivity test on every new TB patient in Maharashtra"The result of the survey came as a surprise," said Dr Amar Shah, National consultant for HIV/TB for RNTCP. Estimates so far have showed that the prevalence of multi-drug resistance (MDR) in new TB cases, of which children comprise a large portion, is between 2% to 3%."Our survey showed a staggering 9%, which is quite high. It's surprising because many of them haven't been exposed to antibiotics before, which means they are acquiring the infection in the MDR form at the time of transmission," he said.Among the four metros, TB incidence was highest among children in Delhi at 12.2% and the least in Chennai at 5.4%. Rifampicin resistance was seen most in Kolkata at 12%. Chennai had the least number of cases at 2.9%.Diagnosis of TB in children is complicated as the bacteria, Mycobacterium tuberculosis,can mimic many other common childhood diseases, including pneumonia, general bacterial and viral infections and respiratory infections. "Children also find it hard to cough up the sputum for the samples. They tend to swallow instead," said Dr K Sachdeva, Additional Deputy Director General, Central TB division . "So accuracy in the traditional tests is often ambiguous," he said.The study was initiated to test the efficiency of a WHO-endorsed automated real-time DNA amplification technology that identifies the DNA of Mycobacterium tuberculosis. Clinicians say the technology has helped diagnose TB in infants and children, in particular, as they face difficulty expectorating the sputum needed for analysis. It was done free of cost through samples sent from different hospitals in the four metros, both private and government.India records largest number of Tuberculosis cases in 2014"While the traditional smear test requires at least 10,000 bacilli in one ml of sputum to be detected under the microscope, in the present test even 50 bacilli can be detected," said Dr Shah. Although the test costs more than the smear test, experts say this is only need-based and doesn't have to be used for all TB patients.The tests found that between the 0-14 years age group, resistance to rifampicin was highest for children between 5-9 years, followed by 10-14 years and less than 5 years.Doctors said the study was just the tip of the real tuberculosis scene in India. "Definite diagnosis in children with the infection is hard and takes a long time. We need more in-depth surveys to assess the real burden of the infection among children," said TB specialist Dr Manjula Datta. Experts say rapid diagnosis of TB, followed by the correct treatment, is critical in stopping progression in the individual and spread to others.