HEALTHXDR TB case renews call for better diagnosis, medicationsThe ease with which the infected person traveled internationally highlights gaps in infection control and border security systems.By Victoria Stagg Elliott, amednews staff. June 18, 2007. 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. ADDITIONAL INFORMATION:The travels of XDR TBMay 12: Andrew Speaker, a 31-year-old man infected with extensively drug-resistant tuberculosis, travels from Atlanta to Paris for his wedding and honeymoon. He was not aware of his illness' resistance profile. May 14: He flies from Paris to Athens, Greece. May 16: He flies from Athens to Thira (Santorini), Greece. May 21: He flies from Mykonos, Greece, to Athens and then to Rome. May 24: He learns about the nature of his infection, and the Centers for Disease Control and Prevention issues an isolation order, the first one since 1963. He flies from Rome to Prague, Czech Republic. May 24: He flies from Prague to Montreal and then drives across the border into the U.S. May 25: At the CDC's request, he reports to an isolation facility in New York. May 28: He travels on a CDC airplane to Atlanta to continue treatment; he is quarantined at Grady Medical Center. May 31: He arrives in Denver for further therapy at the National Jewish Medical and Research Center. Source: CDC; news reports WeblinkCenters for Disease Control and Prevention on extensively drug-resistant tuberculosis (XDR TB) (www.cdc.gov/tb/xdrtb) Copyright 2007 American Medical Association. All rights reserved.
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