Indian Woman Being Treated in U.S. for Drug-Resistant Tuberculosis
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Version 0 of 1. Infectious diseases carried around the world by air travelers have become a fact of modern life, with imported cases in just the last year of Ebola, Lassa fever and, now, a highly drug-resistant form of tuberculosis. In the latest incident, a woman with TB flew from India to O’Hare International Airport in Chicago, landing on April 4. She traveled by car to visit relatives in Illinois, Tennessee and Missouri before seeking medical care sometime after May 18 at a hospital in Illinois. Tests there detected extensively drug-resistant tuberculosis, or XDR-TB. Doctors notified the state health department and the Centers for Disease Control and Prevention. The arduous task of contact tracing began in the three states. Health officials say the risk to the public is low. TB is nowhere near as contagious as the flu or measles. But people who had long periods of close contact with the patient, like the relatives with whom she stayed, are at risk. For people who were on the flight with the woman from India, the odds of catching TB are low but not zero. Cases have occurred in passengers on a long flight who sat near someone in advanced stages of the disease. In this case, the C.D.C. said, it will obtain the flight manifest for the woman’s trip from India and notify passengers who may have been exposed. An agency spokesman declined to reveal the airline or flight number. Visitors from other countries are not screened for TB when they arrive, but those applying for legal residency are required to have TB tests, according to the C.D.C. Even if the government wanted to screen arriving passengers, it would be difficult, because there is no rapid test for tuberculosis. On Friday, the patient from India was transferred to the National Institutes of Health in Bethesda, Md. In the past two decades, the N.I.H. has treated about 20 patients with drug-resistant TB, the most recent a year or so ago, according to Dr. Anthony S. Fauci, the head of the National Institute of Allergy and Infectious Diseases. Most came from other countries. “Our track record has been good,” Dr. Fauci said, adding that about 80 percent were cured. That success rate is higher than the figures usually cited — 30 percent to 50 percent cured — because the lower estimates include results from poorer countries that have less access to drugs and other resources. “This person is looking at a very long course of careful treatment and observation,” Dr. Fauci said. Globally, nine million people contracted TB in 2013, and one and a half million died from it, according to the World Health Organization. Nearly a quarter of all the cases occurred in India, which has the world’s largest epidemic. Over all, drug-resistant bacteria cause only about 5 percent of all cases, and XDR bacteria are a small subset of that group, causing about 48,000 cases in 2013. But XDR-TB has shown up in 100 countries, and it can be deadly, particularly in countries with weak health care systems. So far, 12 people who had contact with the woman in Illinois have been identified, according to Susan Karras, the communicable disease coordinator for McHenry County, northwest of Chicago, the part of Illinois the patient visited. They were traced in 15 to 20 hours of interviews with the patient and her family at the hospital and by phone. Some have had TB tests, but Ms. Karras declined to reveal whether any were positive. People whose initial results were negative will be tested again in about eight to 10 weeks, because the infection does not always show up on early tests. Spokesmen for the Tennessee and Missouri health departments said contacts were being traced in those states, but did not provide any details. Anyone who is infected will be treated, Ms. Karras said. In many people, TB can be latent, meaning that their immune systems keep the infection in check so they are not sick or contagious. But latent disease can become active. So even people with the latent form of the disease will be treated with whatever mix of potent drugs it takes to kill this particular strain of XDR-TB, she said. “We want to treat it before it becomes infectious,” Ms. Karras said. “That’s why we want to find them.” The woman from India is in isolation in a hospital at the N.I.H., Dr. Fauci said. She has no contact with other patients, and doctors and nurses who treat her must wear gloves, gowns, eye protection and specially fitted masks called N-95 respirators. Even though they take every precaution, health workers who treat TB patients are usually tested for the disease once a year, Dr. Fauci said. At the N.I.H., patients with this kind of TB are usually kept in the hospital for weeks or even months, until sputum tests no longer find the bacteria, indicating that the disease is not contagious anymore, Dr. Fauci said. Standard TB usually requires treatment with four drugs, which can take six to nine months. Treating XDR-TB takes longer, sometimes a year or more, and requires more drugs. The drugs have unpleasant side effects that are hard to tolerate, Dr. Fauci said. They cause nausea, weakness and other problems that make patients want to quit taking them before the full course is finished. But missing doses and quitting too soon are precisely what cause drug-resistant bacteria to develop — requiring even longer treatment with more drugs and nastier side effects. Sometimes in severe cases, surgery is needed to remove diseased and scarred parts of the lung harboring bacteria that the drugs cannot reach. The patient will not be charged for her treatment. Even if patients are citizens of other countries, Dr. Fauci said, their governments are not billed. “Everything is free at the N.I.H.,” he said. “No one pays.” Dr. Fauci said that the woman’s treatment would be expensive, given the long stay and costly drugs needed, but that he could not even begin to estimate the ultimate cost. |