There are multiple diseases which get a significant share of media coverage due to their scale of impact on the healthcare system in the country, but there is one silent killer which affects a concerningly large number of people. Sepsis, a life-threatening organ failure, occurs when the body ends up injuring its own tissues and organs in response to an infection, leading to shock,  disability, multi-organ failure, and even death if left untreated in the early stages.  This may be a lesser known fact, but India accounts for the largest number of sepsis cases (11.3 million) and sepsis-related deaths (2.9 million) in the world, as per a global study conducted by US researchers in 2020 that covered almost 195 countries. (published in the Lancet).  That is 31,000 cases daily in the country. Despite significant measures that are being undertaken to bolster our healthcare systems and upgrade our technological prowess, India continues to battle with an enormous range of infectious diseases ranging from viral, bacterial, fungal to parasitic infections.

While adults above the age of 65, people with weakened immune systems, and those suffering from chronic medical conditions such as diabetes, lung disease, cancer, and kidney disease are at higher risk for sepsis, it continues to disproportionately affect vulnerable populations, such as pregnant women, newborns, and people in low resource settings and income groups. To add to this disparity, data and statistics on cases of sepsis remain largely unreported with only hospitals and intensive care units in high income countries reporting the majority of cases, leading to countless deaths and ailments, and a persistent knowledge gap that keeps widening due to the paucity of data from the rest of the world. 

At present, blood cultures are considered to be the gold standard for identification of pathogens, however, they are not without their limitations as the process is very time consuming ,ranging from 1-5 days, and there is also a low  positivity rate in severe sepsis. Multiple PCR tests also do not facilitate the comprehensive identification of pathogens, and currently there are no specific tests for septic response. The Universal ID test promises to eliminate the need for multiple diagnostic testing for patients with fever and infections. The current multiple test paradigm is considered experimental and hence inefficient with almost 68% of the infectious patients going undiagnosed, as per FDA sources.

[HaystackAnalytics ](https://haystackanalytics.in/)has developed a Universal Infectious Diseases test that deploys Next-Generation Sequencing (NGS) technology to give the clinician a screen of 200+ bacteria and fungi within a very short frame of time to start the right treatment at the earliestThe Universal Infectious Diseases (UID) test comes at an opportune time, as our learnings from the Covid-19 pandemic highlight the need for better diagnostic technologies, appropriate antibiotic use, and the renewed importance of infection prevention strategies. Speed and accuracy are critical in increasing survival rate of a patient. 

We have partnered with various diagnostic centers such as Apollo Hospital, Sterling Accuris, Metropolis, Thyrocare and over 20+ hospitals including AIIMS to bring these solution to enable a larger number of clinicians and hospitals to use this next generation technology to save lives. The Universal Infectious Diseases test developed by will be rolled out with their current partners in a phased manner over the next three months, and will be initially targeted at identifying and treating sepsis in ICU patients, but gradually be made available to anyone suffering from a fever of unknown origin, by eradicating the need to conduct multiple tests to diagnose the condition. 

Stressing on the need to ensure accurate and timely diagnosis of sepsis, Mr. Anirvan Chatterjee, Co Founder and CEO of Haystack Analytics, said, “Sepsis is a global health crisis, affecting approximately 50 million people every year. The introduction of Universal ID tests will bring about a rapid transformation in the diagnosis and treatment of sepsis with a quick turnaround time of 12-15 hours only.” He further added, “Genomics is expanding the equality of access to healthcare and supporting clinicians by bringing timely, contextual, and comprehensive information. Haystack is an innovator and an enabler of an ecosystem that seeks to understand current challenges and problems to create and provide technologies to the best of our abilities.” Not only will these tests offer a quick turnaround time, but they will also be extremely cost effective and approximately 40-50% cheaper than the molecular tests which are currently available.


Universal Infectious Diseases test for a faster and accurate screening in healthcare

The clock is ticking…..and we do not have much time in hand. Every moment is precious, so is detection of every Tuberculosis (TB) case. 

The count of patients is increasing by minutes, overwhelming the world. TB is the 2nd most common cause of mortality by infectious disease, in the world. Almost 1/4th of the world is infected with TB, although not all have developed the disease, a compromised immunity can trigger the disease onset. And as a clinician I experience these alarming statistics first hand. Despite the increased efforts to identify and treat TB, almost 1 death every 20 seconds is still recorded. Half a million new multi-drug resistant TB (MDR-TB) cases are added to the count every year worldwide and this threatens to claim more lives than ever and reverse the progress made over past few decades.

The TB causing pathogen *Mycobacterium tuberculosis*, has evaded our attempts to overpower it by developing resistance to at-least two of the most powerful anti-TB drugs namely Rifampicin and Isoniazid which had saved millions of lives earlier. This resistance results in what is categorized as MDR-TB (multi drug resistance TB). As clinicians we try to overcome this by changing the regimen and including other drugs which may still work effectively. The MDR-TB treatment regimen is extensive (almost a 2-year course), with drugs that can have major prolonged side effects like weakened joints, skin-discolouration, hearing loss or liver damage. It takes toll on the patient causing increased morbidity and affects the quality-of-life drastically. These treatment modalities being very expensive, often cause heavy financial burden on the patient and family. Many-a-times, these exhausting regimens, might even fail to cure the patients. In some cases the patients may be resistant to second line drugs also and are classified as XDR or extensively drug-resistant TB (XDR-TB). Drug resistance complicates and prolongs the treatment. The World Health Organization (WHO), estimated approximately nearly 500,000 MDR-TB cases and approximately 50,000 cases of XDR-TB globally last year. More than 1million people die yearly due to drug-resistant TB (DR-TB) and steps have to be taken relentlessly to avoid this.

The WHO as well as Governments of all countries devise strategic plans from time to time, to come up with ways and means to reach the TB eradication goal. The [TB National Strategic Plan (NSP) 2020 – 2025](https://tbfacts.org/tb-india-nsp-2025/) in India, by the Government of India (GoI) envisaged strategies to eradicate TB by the year 2025. The National Tuberculosis Elimination Program (NTEP) applauded by WHO, has taken up the responsibility of expanding the accredited diagnostic network; however, despite the advances, only 22% of the estimated DR-TB cases received appropriate and timely anti-TB therapy, highlighting gaps in the system. Individuals suffering from MDR and XDR-TB, experience a wide variety of resistance pattern. Delay in treatment initiation, can give rise to many more cases and thus it is very crucial to start the treatment as soon as possible.  Alas, in most of the cases, the treatment decisions are made in absence of detailed drug-susceptibility test (DST); increasing the resistance, manifold. DST is carried out to identify, which drugs can be used for treating that particular patient and to understand towards which drugs has the patient developed resistance. This can help the clinician to opt for other treatment regimen. 

A drug-resistance pattern of the pathogen strain is encoded in its gene and the recent technological revolution of whole genome sequencing (WGS) can help fathom deep within, to identify the resistance genes. Whole genome sequencing (WGS), allows screening of the entire genome identifying the causative agent and revealing the drug resistance, in a very short period of time. This knowledge can arm the clinicians with better understanding, guiding them to start the appropriate treatment at the earliest. As a clinician, it is most important to get the accurate diagnosis as early as possible, for initiating the appropriate treatment. This can save a lot of agony and valuable time for the patient, including reducing the treatment expenses.   

TB surveillance is a very important module in controlling and eliminating TB, with the surveillance data influencing the health strategies and policies and WGS can play a crucial role, facilitating a comprehensive and detailed depiction of the drug resistance. Inclusion of WGS in the private sector healthcare services along with the government controlled services, can result in speeding up the process to reach the goal of TB eradication. 

*Early and detailed diagnosis of TB and MDR-TB patients, along with their complete drug-resistance profile, can help initiate appropriate treatment regimen, thereby saving millions of lives worldwide.  *










No time to lose!

We all have heard about Tuberculosis (TB), at some time or the other. From decades, it has continued to haunt our existence. Imagine the state, when my friend was diagnosed with it! The picture that comes to our mind on mentioning this disease, is of a really sick person, coughing all the time, well, my friend was slowly reaching that state and it was devastating. 

She suffered from intermittent fever for over 3months and also developed bouts of cough, which kept on increasing in frequency. With major weight loss, she started looking a very frail of her earlier self. Eyes sunken, bones protruding…..Oh what a dreadful sight she had become! She was diagnosed with TB infection and was put on standard TB treatment. Time flew by, and although she started recovering, it was hardly worth a mention. Soon her condition deteriorated and she landed up again in the hospital, wheezing. This time, they conducted a battery of tests and found out that she had developed resistance to the drugs, she was being treated with. 

The doctors started a different drug therapy, however, she failed to respond to that too……her health slowly sinking. It was a race against time, as it was not clear which drugs to be started next? Which ones would cure her? Will she be cured or not?  To get answers for these questions, we- friends, searched a lot of literature, checked on the internet for some ray of hope. Soon we came across a diagnostic method called whole genome sequencing (WGS), that could give extensive data regarding the pathogen, the drug-resistance and sensitivities, within a very short span of time. 


The tuberculosis bacteria to survive develop certain changes in their genetic material. These changes called as mutations help the bacteria to develop resistance against the antibiotics and survive. This is like “ Survival of the fittest”. Our Dr explained that this technology called whole genome sequencing (WGS) looks at the entire genetic material determines the mutations and indicates which antibiotic will work and which will not work. This sounded like a boon to us. But if this technology was new would it work? Was it being used elsewhere? Did anybody recommend it? These questions still plagued our mind. 


Our Doctor assured us that this technology is being used worldwide and also recommended by the WHO, it is now developed in India by the same scientists who have worked in UK on this problem. 

This sounded promising! We approached Haystackanalytics, working extensively in this field, offering valuable, comprehensive whole genome sequencing  for TB diagnosis and drug resistance detection. WGS conducted, revealed that my friend was prey to extensively drug resistant TB infection. Thanks to the timely intervention, the doctors were able to start the appropriate therapy and save her. 

It is extremely important to get a rapid and complete diagnosis for TB, for starting the appropriate and timely medication, that can save lives!


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Universal Infectious Diseases test for a faster and accurate screening in healthcare

No time to lose!

My stint with drug resistant TB