TB Traveler Exposes Diagnosis Problems
RENEE MONTAGNE, host:
Experts are anxious about the case of a man from the Atlanta area who brought back a deadly new strain of tuberculosis from his Asian travels. He later exposed others to the disease on flights to Europe and back. Health officials are worried because the drug-resistant strain is so hard to diagnose.
NPR's Richard Knox reports.
RICHARD KNOX: Ken Castro says the problem is with the TB bacterium itself.
Dr. KEN CASTRO (Centers for Disease Control and Prevention): Tuberculosis is a very slow-growing organism and that adds a layer of complexity.
KNOX: Castro is the chief TB expert at the Centers for Disease Control and Prevention. On a telephone conference call yesterday, he pointed out that it takes two or three weeks for doctors to see if the TB germ will grow to detectable numbers in a lab dish containing sputum from a suspected patient.
Dr. CASTRO: Then if it's positive, you add another couple of weeks for drug resistance testing, so you can see already a month interval easily going by before you have any result where you can hang your hat on.
KNOX: In that month or six weeks, the patient may feel perfectly well. He may even travel around the world spending hours packed into crowded airplanes with unsuspecting fellow passengers. That's bad enough with regular TB or with strains that are resistant to two or three mainline drugs used to treat the disease. But it's a potential public health catastrophe with the new strain called XDR-TB, for extensively drug resistant tuberculosis.
The strain is impervious to a wide array of first and second-line drugs. That's why 30 percent or more of its victims die. And that's why people like Lawrence Gostin are rethinking what public health authorities should do about people with suspected XDR-TB in the weeks before the diagnosis is in.
Professor LAWRENCE GOSTIN (Georgetown University Law School): It's a really significant problem. You need to act quickly in order to protect the public, but you don't have enough scientific information to make sure that you're not needlessly depriving somebody of their liberty.
KNOX: Gostin is a professor at Georgetown University Law School who advises the CDC and World Health Organization on health law. Over his career, he's been very concerned about the civil liberties of patients with HIV and other infectious diseases. But he takes a hard line toward people with drug-resistant TB.
Prof. GOSTIN: You shouldn't allow them to travel. You should take them out of a nursing home or a homeless shelter. You should encourage them not to use mass transit and the like. And I think that you should be able to back that public health advice up with the law.
KNOX: Now, we should keep drug-resistant TB in perspective. A few thousand people in this country have been diagnosed with TB that's resistant to some second-line drugs, and a recent look-back found only 49 cases of extensively resistant TB among 190,000 American patients diagnosed between 1993 and 2006. But experts agree the number of XDR-TB cases is growing.
The WHO says 37 countries have now reported cases.
Prof. GOSTIN: I think we're bound to see more cases. We're seeing outbreaks in different parts of the world and we know with international travel it's only a matter of time before we see outbreaks in the United States.
KNOX: So we're also likely to see more tests of the law that U.S. authorities tried to use unsuccessfully to prevent the infected Atlanta man from flying off on his European honeymoon.
Richard Knox, NPR News.
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MONTAGNE: And you can read more about why TB remains a serious global health issue at npr.org.
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