Health
XDR TB case renews call for better diagnosis, medications
■ The ease with which the infected person traveled internationally highlights gaps in infection control and border security systems.
By Victoria Stagg Elliott — Posted June 18, 2007
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The case of a man with extensively drug-resistant tuberculosis who traveled to Europe and through Canada before reporting to public health officials for treatment in New York has renewed calls for better technology to diagnose this disease and determine more quickly if it is drug resistant.
This process currently takes weeks or even months. The individual, 31-year-old Atlanta lawyer Andrew Speaker, traveled to Europe knowing he had TB but not that he was infected with a highly resistant strain.
"We need to be able to detect it rapidly and not wait another four to eight weeks to develop a sensitivity profile," said Richard Wenzel, MD, MSc, president of the International Society for Infectious Diseases.
From 1993 to 2006, 49 XDR TB cases were recorded in the U.S. Many more have been noted around the world. The American Medical Association has policy calling for significant increases in federal funding for tuberculosis control and research to curtail its spread and encourage development of new and effective diagnostics, drug therapies and vaccines. The AMA also is a liaison member of the federal Advisory Council for the Elimination of Tuberculosis.
Experts say there is an urgent need to develop new medications to address increasing drug-resistant infections.
This incident also triggered the issuing of a federal order of isolation, something that has not occurred since 1963. Isolation was invoked because the patient was in Italy when Centers for Disease Control and Prevention officials realized the nature of his infection and wanted to prevent him from flying commercially again. Reports are unclear as to whether he was told he was contagious or that he should not travel before his European trip.
"When someone has TB, we influence them through a covenant of trust so that they don't put themselves in situations where they could potentially expose others. In this case, the patient had compelling personal reasons for traveling and made the decision to go ahead," said CDC Director Julie Gerberding, MD, MPH. "We felt that it was our responsibility to err on the side of abundant caution and issue the isolation order."
The CDC is urging passengers who sat near Speaker on the longer flights to be tested for the illness.
