Our Story
From phage patient to phage entrepreneur : Establishing phage therapy in India
In the summer of 2016 at the age of 33, I contracted a debilitating condition called Chronic Bacterial Prostatitis along with Chronic Epididymitis – inflammations of the prostate gland and the epididymis, usually caused by a bacterial infection. I had never heard of these conditions, and had always assumed prostate problems to be something one deals with in old age.
It all started in May 2016 with a pulling pain in the right side of my groin. Initially, I assumed it was due to a muscle pull, and that it would go away with time and stretching. Days turned into weeks, but the pain persisted. For almost 6 weeks, this was my only symptom. By end of June however, I began to develop additional symptoms. I developed an unusual sensitivity to cold – sitting in an air-conditioned room started becoming uncomfortable, even though we were in the middle of summer. Along with that I also started getting a low-grade fever everyday – by afternoon, my temperature would rise to 99.8-100.5 degrees Fahrenheit. This persistent low-grade fever led to weakness, and some anxiety as to why this was happening.
It all started in May 2016 with a pulling pain in the right side of my groin. Initially, I assumed it was due to a muscle pull, and that it would go away with time and stretching. Days turned into weeks, but the pain persisted. For almost 6 weeks, this was my only symptom. By end of June however, I began to develop additional symptoms. I developed an unusual sensitivity to cold – sitting in an air-conditioned room started becoming uncomfortable, even though we were in the middle of summer. Along with that I also started getting a low-grade fever everyday – by afternoon, my temperature would rise to 99.8-100.5 degrees Fahrenheit. This persistent low-grade fever led to weakness, and some anxiety as to why this was happening.
This was really unusual, and I started searching for my symptoms online, to get an idea of what was going on with me. That’s when I first came across the terms “epididymitis” and “prostatitis”. I got diagnostic tests done for the most common pathogens that cause these and other, possibly related conditions, as per my research. I received the test results in a few days, and they were all negative for these pathogens. I should have been relieved, but what I felt was a deeper sense of worry – if not this, then what was causing my persisting symptoms?
Chronic Bacterial Prostatitis - I had never heard of this condition, and always assumed prostate problems to be something one deals with in old age.
Doctor Visits and Antibiotics
Since my symptoms were not getting any better, I went to see a urologist in mid-July to get a diagnosis. He did a physical examination, and told me that I had “chronic bacterial prostatitis”. I was prescribed a single dose of Azithromycin, followed by a 10-day course of Doxycycline, both oral antibiotics. I had the medicines, and ended the course with no change in my symptoms. After the course, the doctor changed the antibiotic to Ofloxacin, a different oral antibiotic, for a period of 4 weeks. He assured me that this was an effective drug for prostatitis, and it would clear up my symptoms.
I started this antibiotic, but through the course of the medicine, my condition showed no sign of improvements. In fact, my symptoms were only worsening. I started getting chills and shivers, and now had to wear a sweater all day long in the middle of a hot and humid Indian summer. I started getting pelvic pains. The persistent weakness and lack of energy began to get worse – where earlier I could get through the day after a hearty morning breakfast, I now needed to eat every 3-4 hours to keep my energy levels up. I started to feel the need for an afternoon nap to be able to get through the rest of the day, something I had never felt in my life till that point.
Since my symptoms were not getting any better, I went to see a urologist in mid-July to get a diagnosis. He did a physical examination, and told me that I had “chronic bacterial prostatitis”. I was prescribed a single dose of Azithromycin, followed by a 10-day course of Doxycycline, both oral antibiotics. I had the medicines, and ended the course with no change in my symptoms. After the course, the doctor changed the antibiotic to Ofloxacin, a different oral antibiotic, for a period of 4 weeks. He assured me that this was an effective drug for prostatitis, and it would clear up my symptoms.
I started this antibiotic, but through the course of the medicine, my condition showed no sign of improvements. In fact, my symptoms were only worsening. I started getting chills and shivers, and now had to wear a sweater all day long in the middle of a hot and humid Indian summer. I started getting pelvic pains. The persistent weakness and lack of energy began to get worse – where earlier I could get through the day after a hearty morning breakfast, I now needed to eat every 3-4 hours to keep my energy levels up. I started to feel the need for an afternoon nap to be able to get through the rest of the day, something I had never felt in my life till that point.
I began to feel a sense of hopelessness - my symptoms showed no improvements, whether I was on antibiotics or off them.
I spoke to the doctor about my worsening symptoms, but he could not reasonably explain why this was happening to me. His only response was to put me on another 3 weeks of Ofloxacin. This was at the end of August 2016. I needed to get better answers, so I went to another urologist – the head of urology at one of Delhi’s leading private hospitals, this time with a recommendation from my family GP. This doctor understood the progression of my symptoms over the last 4 months, did a physical exam to check my prostate and confirmed that I had prostatitis and possibly epididymitis as well. He explained that because I had a persistent low-grade fever, my problem was most likely due to a bacterial infection. He prescribed a urine culture to diagnose my condition. This was the first time that I was asked to get a culture test done and I was glad that the doctor was following a scientific approach to diagnosing the cause of my prostatitis. The culture result, however, came back sterile. Because I had a persistent fever – a symptom of an infection, the doctor recommended that I take a 10-day course of an oral antibiotic called Ciprofloxacin combined with an intravenous antibiotic, Amikacin. He referred to these as “heavy artillery” and reassured me that these two together would clear up the infection and give me relief from my symptoms. I decided to go ahead with his advice and took both the antibiotics, hoping that this time, I would really be free from this condition which was making me so weak and unwell.
However, despite these strong antibiotics, my symptoms stubbornly refused to go away. My pelvic pains stayed exactly the same, my low-grade fever persisted, the chills and shivers continued, and I was becoming weaker by the day. This weakness began to pervade into all spheres of my life. My work was getting impacted now because I did not have the energy to work beyond a few hours. I couldn’t even sit for more than a few hours, as it would exacerbate my pelvic pains. I felt really frustrated at my condition.
When I went back to my doctor after finishing the course of Ciprofloxacin and Amikacin, he was surprised to see that my condition had only worsened. He had no answers to explain this. He told me that some people have infections that don’t respond to antibiotics and just have to live with their conditions, with a lifelong regimen of symptom management. He then suggested that I stop “thinking too much about this problem”. This really frustrated me because the intensity of my symptoms was only increasing, and not allowing me to live my life. This encounter with the urologist made me realise I needed to look at treatment options beyond antibiotics.
I decided to stop taking antibiotics altogether, and started researching alternative solutions for a persistent bacterial infection. It was difficult for me to accept that a problem that affects 8-10% of men had no solution, despite all the advances modern medicine has made. It seemed ridiculous to me that medical science could harvest whole organs from stem cells, but could not successfully treat a bacterial infection in the prostate gland! My research revealed that men from all over the world, from young college students to retirees, were afflicted by prostatitis and were looking for alternative solutions since antibiotics seemed to give very poor treatment outcomes. It was depressing to find so many people suffering from this problem without a cure in sight. I began to feel a sense of hopelessness – my symptoms showed no improvements, whether I was on antibiotics or off them, and my research threw up no promising answer to this problem.
Phage Therapy
Then, one day in September, I came across the words “bacteriophage therapy” in relation to treating bacterial infections. I had no idea what this therapy was, and researched it online to understand it. I learned that phage therapy is a treatment that was used to cure bacterial infections since it was discovered a hundred years ago. It was simple; in the way that nature has simple answers to complex problems. Bacteriophages are naturally occurring viruses that feed on bacteria – they are the solution that nature has devised to keep bacterial overgrowth in check. This was my Eureka! moment. As I researched and understood phage therapy further, the science behind it seemed solid, and it looked like a promising option. Had I finally hit upon a plausible answer to my problem – could phage therapy be the light at the end of the tunnel?
Then, one day in September, I came across the words “bacteriophage therapy” in relation to treating bacterial infections. I had no idea what this therapy was, and researched it online to understand it. I learned that phage therapy is a treatment that was used to cure bacterial infections since it was discovered a hundred years ago. It was simple; in the way that nature has simple answers to complex problems. Bacteriophages are naturally occurring viruses that feed on bacteria – they are the solution that nature has devised to keep bacterial overgrowth in check. This was my Eureka! moment. As I researched and understood phage therapy further, the science behind it seemed solid, and it looked like a promising option. Had I finally hit upon a plausible answer to my problem – could phage therapy be the light at the end of the tunnel?
Could Phage Therapy be the light at the end of this very long tunnel that I was going through?
My wife and I had a lot of questions about this treatment – Is there a clinic that provides this therapy? Does it actually work? Is it safe for humans? Does it have any side effects? How will the phage medicine reach the site of infection? How will the medicine be administered? These, and lots more. To get these answers, I got in touch with scientists who had worked with phages at research institutions like the Tata Institute of Fundamental Research (Mumbai, India), Pasteur Institute (Paris, France) and Texas A&M University (College Station, USA). I got some answers about phage research, but no one seemed to have any experience with human use of phage therapy. I started searching through medical journals and platforms like Frontiers, PubMed and NIH to try and find details about treatment of infections in humans using phage therapy. Gradually, I started discovering details about the use of phage therapy to treat human infections in countries like Georgia, Poland and Russia. Each study that detailed successful use of phage therapy to treat human infections was like an additional ray of light breaking through the darkness that had engulfed me in the last few months.
After 8 weeks of intensive research, building an understanding of phages, and interacting with phage scientists from around the world, I was fairly convinced that phage therapy could be a credible option to help me eradicate the infection from my prostate and epididymis. Every research paper mentioned the pioneer of bacteriophage therapy – the Eliava Institute in Georgia, a century-old institute dedicated to bacteriophage research and application. I learned that medicinal preparations made by them are used as regular anti-bacterial medication in the country of Georgia, and some other European countries as well.
With great hope as well as apprehension, I got in touch with the Eliava Institute’s clinic. I explained to them my problem, and asked if they could cure this kind of infection, in a difficult-to-reach gland of the body. I asked them all the questions that I had regarding the safety and efficacy of the treatment; how the clinic would do lab tests to identify exactly what bacteria were causing my infection; the standards of hygiene followed by the clinic; what methods of treatment they would use; the qualifications of the doctors; the length of the treatment, and many more.
They answered all my questions patiently and to my satisfaction. I was getting more convinced about phage therapy with every passing day. But my family was not so sure, and not easy to convince. I was bombarded with all kinds of statements and questions – “This is Georgia in erstwhile USSR! You know nothing about the place! What language do people speak there? How will you interact with the doctors? What medical standards do they follow there? Have you personally spoken to even one person who has undergone phage therapy and had a successful treatment?”
These were difficult questions to answer. And I knew these were genuine worries from people who wished me well. I tried to get as many answers as I could, but as the date of my departure drew near, I still had many unanswered questions. What made me most uncomfortable was that there was not a single person I could talk to who had undergone phage therapy. I had searched long and hard to find someone who had taken phage therapy and could share his or her personal experience, but unfortunately, I couldn’t find anyone.
With great hope as well as apprehension, I got in touch with the Eliava Institute’s clinic. I explained to them my problem, and asked if they could cure this kind of infection, in a difficult-to-reach gland of the body. I asked them all the questions that I had regarding the safety and efficacy of the treatment; how the clinic would do lab tests to identify exactly what bacteria were causing my infection; the standards of hygiene followed by the clinic; what methods of treatment they would use; the qualifications of the doctors; the length of the treatment, and many more.
They answered all my questions patiently and to my satisfaction. I was getting more convinced about phage therapy with every passing day. But my family was not so sure, and not easy to convince. I was bombarded with all kinds of statements and questions – “This is Georgia in erstwhile USSR! You know nothing about the place! What language do people speak there? How will you interact with the doctors? What medical standards do they follow there? Have you personally spoken to even one person who has undergone phage therapy and had a successful treatment?”
These were difficult questions to answer. And I knew these were genuine worries from people who wished me well. I tried to get as many answers as I could, but as the date of my departure drew near, I still had many unanswered questions. What made me most uncomfortable was that there was not a single person I could talk to who had undergone phage therapy. I had searched long and hard to find someone who had taken phage therapy and could share his or her personal experience, but unfortunately, I couldn’t find anyone.
Tbilisi, Georgia
The departure date arrived, and with fingers crossed I flew to Tbilisi. I arrived in Tbilisi on 14th November, on a cold and windy evening. I hoped and prayed that being here would finally give me the answer to my problems.
The departure date arrived, and with fingers crossed I flew to Tbilisi. I arrived in Tbilisi on 14th November, on a cold and windy evening. I hoped and prayed that being here would finally give me the answer to my problems.
The next morning was my first appointment at the clinic. My first impression was that the clinic was neat, clean, and efficient. This was a big relief. I met the international patient coordinator, and was introduced to my treating doctor. Language would have been a problem in communicating with the doctor, but the patient coordinator was at hand to understand all my symptoms and explain them to the doctor in Georgian. I found the doctors at the clinic to be patient – the first consultation where I explained my symptoms and progression of my condition and they studied my ultrasounds lasted more than half an hour.
Next, the urologist tested my prostate fluid and semen for bacteria, fungus, parasites and other microbes. I had read in a few online forums that a prostate fluid culture is a must in cases of prostatitis, but this was the first time a doctor had conducted these tests on me. They found multiple bacterial strains in my samples – Staphylococcus aureus, Staphylococcus haemolyticus and Streptococcus mitis in my prostate secretion, and Enterococcus faecalis in my semen, along with elevated levels of WBCs in the samples. Based on these results, the urologist started treating me using phage medications that the bacterial strains were sensitive to.
Next, the urologist tested my prostate fluid and semen for bacteria, fungus, parasites and other microbes. I had read in a few online forums that a prostate fluid culture is a must in cases of prostatitis, but this was the first time a doctor had conducted these tests on me. They found multiple bacterial strains in my samples – Staphylococcus aureus, Staphylococcus haemolyticus and Streptococcus mitis in my prostate secretion, and Enterococcus faecalis in my semen, along with elevated levels of WBCs in the samples. Based on these results, the urologist started treating me using phage medications that the bacterial strains were sensitive to.
My discussions with the urologist at the clinic revealed why my antibiotic treatment had failed – there were three main reasons. The first was that the prostate is a gland with very little blood flow, and an outer membrane that makes it difficult for antibiotics to get absorbed in the gland, so minimal amounts of medicine are able to get inside the prostate. Second, once a bacterial infection becomes chronic, it develops bacterial biofilms which protect the bacterial colony, and antibiotics are unable to penetrate these biofilms. And to top it off, the antibiotics that can enter the prostate – the ones I was prescribed in heavy doses during my treatment – were completely ineffective against my infection because the bacteria was resistant towards those antibiotics. It was no wonder that I suffered so acutely with prostatitis and never saw any symptomatic relief, despite the heavy doses of antibiotics I consumed. But thankfully, phages do not have the limitations of antibiotics when it comes to treating chronic prostate infections.
Recovery
The first sign of success came in 4 days, when my low-grade fever disappeared. I was elated – after having a fever for nearly 5 months, something had finally worked and gotten rid of it! The next sign of success came over the next 3 weeks as my energy levels started increasing. I started going to the hotel gym – I had the energy to start exercising again! The pains and sensitivity to cold continued to bother me, but the doctors explained that these would take time to go, because the bacteria were still there and the body was still fighting them.
The first sign of success came in 4 days, when my low-grade fever disappeared. I was elated – after having a fever for nearly 5 months, something had finally worked and gotten rid of it! The next sign of success came over the next 3 weeks as my energy levels started increasing. I started going to the hotel gym – I had the energy to start exercising again! The pains and sensitivity to cold continued to bother me, but the doctors explained that these would take time to go, because the bacteria were still there and the body was still fighting them.
What if I had not stumbled upon it, or it was too late by the time I did?
My visit to Georgia lasted 4 weeks, and I came back home with my symptoms significantly improved. My phage medication continued over the next 3 months in oral and suppository forms. My symptoms continued to improve – the sensitivity to cold gradually went away and the pains started to get better. I went back to the clinic twice after my first visit – in March 2017 and then again in November 2017 – for two more courses of treatment. One of the bacterial pathogens – Streptococcus mitis – was resistant to all the standard Eliava phage preparations, so the Eliava Institute developed a custom phage preparation for treating it. My third and last course of treatment finished in the summer of 2018, which, as I write this today, is almost five years ago. During this time, I have not had any symptoms of my prostatitis and epididymitis condition anymore. I have undergone testing five times in this interval, and the results have confirmed that the pathogenic bacteria that were causing my condition have cleared completely.
Today
It has been almost five years since my last course of phage therapy finished. It was a long treatment and needed three courses of phage therapy since my infection was multi-pathogenic, and in a part of the body that is difficult to reach. The road to curing prostatitis or similar chronic infections, as I have come to learn, is a long and winding one.
It has been almost five years since my last course of phage therapy finished. It was a long treatment and needed three courses of phage therapy since my infection was multi-pathogenic, and in a part of the body that is difficult to reach. The road to curing prostatitis or similar chronic infections, as I have come to learn, is a long and winding one.
Where antibiotics failed, bacteriophage therapy came to my rescue and saved me from an endless and debilitating battle with this disease. There have been times in this journey when I have wondered – Why is it that I knew nothing of this treatment before my desperation led me to it? After all, it was the sole answer to my hardship. What if I had not stumbled upon it, or it was too late by the time I did? What if I did not have a network of contacts that enabled me to reach out to phage scientists around the world who could answer my questions about phage science? And what if I did not have the resources that enabled me to travel repeatedly to another country to undergo treatment?
These questions, and the sense of hopelessness that I felt before I discovered phage therapy, stayed with me through my phage treatment experience and drove me and my wife Apurva to establish Vitalis Phage Therapy. It is our endeavour, through Vitalis Phage Therapy, to ensure that no one else who is suffering from a chronic, persistent or recurrent infection and has run out of treatment options with antibiotics, ever needs to struggle in finding and accessing phage therapy. Since we established Vitalis, more than 200 patients suffering from antibiotic-resistant infections have been able to take phage therapy with a success rate of more than 75%, which is a source of satisfaction and encouragement for us. As our phage therapy initiative expands with tie-ups with medical institutions, and publication of case reports in top medical journals like Frontiers in Pharmacology, we look forward to making phage therapy available and accessible to each patient suffering from an antibiotic-resistant, chronic, or recurrent infection.
Pranav Johri
Founder, Vitalis Phage Therapy
April 22, 2023
Pranav Johri
Founder, Vitalis Phage Therapy
April 22, 2023
Our Journey of Developing Access to Phage Therapy in India
Pranav suffered from a multi-pathogenic antibiotic-resistant infection and underwent phage therapy at the Eliava Institute in Tbilisi, Georgia. He was the first known patient from India to take phage therapy.
Pranav and Apurva founded Vitalis Phage Therapy, the first-of-its-kind initiative in India to enable phage therapy for patients and combat antibiotic resistant infections/chronic or recurrent infections through phage therapy. Vitalis Phage Therapy is the official India partner of the Eliava Phage Therapy Center, Eliava Institute of Bacteriophages, Microbiology and Virology located in Tbilisi, Georgia.
Vitalis enabled local phage treatment for patients in India as compassionate phage therapy (cPT) in line with the World Medical Association’s Declaration of Helsinki, thus eliminating the need to travel internationally to undertake phage treatment.
Vitalis established diagnostic phage sensitivity testing in India to reduce cost and turn-around time (TAT) for diagnostic testing with phage sensitivity. This enabled quicker access to phage therapy for patients in India. Till date, 300+ bacterial isolates have been tested for phage sensitivity at our partner lab in Delhi.
Vitalis is working with doctors and medical institutions across India to facilitate phage therapy for their patients suffering from antibiotic-resistant and hospital-acquired infections.