The New Face of Tuberculosis
The most drug-resistant form grabbed the spotlight last week
Andrew Speaker, who sparked a furor last week by hopscotching around Europe despite having a case of extensively drug-resistant tuberculosis (XDR TB), is likely to spend months undergoing treatment at National Jewish Medical and ResearchCenter, a leading respiratory hospital in Denver. The 31-year-old Atlanta attorney, who said that he began traveling before he knew the gravity of his condition, is asymptomatic. But federal officials isolated him after he risked exposing others to the potentially deadly bacteria on two trans-Atlantic flights. Speaker is now beginning treatment that will consist of five antibiotics and possibly lung surgery. "We don't have good drugs for XDR," says Gwen Huitt, Speaker's attending physician at National Jewish. "But it's here, and we're forced to use drugs that aren't very effective."
Officials at the Centers for Disease Control and Prevention say the likelihood that other airline passengers were infected is small, since preliminary tests suggest that Speaker is not highly contagious. Nevertheless, they are tracking down people who sat near him on airplanes to test for TB.
About a third of the world's population carries the TB bacterium; some 10 percent of those people are actively ill. The disease has become increasingly difficult to treat as the bacterium has grown resistant to available drugs (though the resistant strain does not necessarily spread more easily). The proportion of XDR, currently about 2 percent, seems to be rising. "On a global scale, XDR is a disaster," says Neil Schluger, a tuberculosis expert at Columbia University.
In America, the incidence of TB is at an all-time low, and only 49 cases of XDR have been detected since 1993. But given the frequency of international travel, experts worry about what could be in store for this country. "If we are unable to stem the tide of new patients acquiring these drug-resistant strains abroad, then the incidence will most assuredly rise and propagate in the United States," says Huitt. A few new drugs are in the pipeline. But Huitt and others warn that much faster progress is needed.
This story appears in the June 11, 2007 print edition of U.S. News & World Report.