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Man With Dangerous TB Coming To Denver

Patient Flew Transatlantic Flights, Exposing Travelers To Disease

POSTED: 4:27 am MDT May 30, 2007
UPDATED: 10:07 pm MDT May 30, 2007

A Georgia man diagnosed with a dangerous drug-resistant form of tuberculosis will be treated at Denver's National Jewish Hospital, which specializes in respiratory disorders.

"We are expecting this gentleman to arrive here sometime in the next few days," said hospital spokesman William Allstetter. "How long he will be in Denver will be dependent on how severe his illness is."

The man is under a U.S. government-ordered quarantine because the bacteria is so dangerous, but he is probably not highly infectious, officials said.

National Jewish has been treating TB cases for more than 100 years.

"Our institution has been, de facto, the national referral center for cases of drug resistant TB for the last forty years," said Dr. Mike Iseman, the hospital's former TB program director.

Iseman said Doctors will try to select from the exotic second or third line medications used to treat resistant TB.

If drugs fail, the man could undergo surgery at nearby University of Colorado Hospital to remove the diseased tissue from the lung. Then the patient would be put on an aggressive course of antibiotics.

"It is a big challenge," said Dr. Chuck Daley with National Jewish's Infectious Disease Department.

"We're hopeful that we can find something he can be treated with," Allstetter said. "He will not go out of here until he is not a danger to anyone."

Allstetter explained that the man will be kept in isolation rooms that have negative air pressure so no air escapes the room through the doorway or the window. Air inside the room will be vented out through ultraviolet light filters to kill remaining germs.

A spokeswoman for the Health Sciences Center said she could not comment on the case because of federal privacy laws.

National Jewish treats immune and allergic disorders as well as respiratory problems.

"We've got 100 years of treating TB. We generally see a half dozen ... drug resistant cases (a year)," Allstetter said.

Allstetter said the strain the Atlanta man has was only recently defined, but he said it's possible the hospital treated a patient with it before it was identified.

Iseman said drug resistance occurs in almost every case because of human failure. "It represents either indadequate prescribing on the part of the physician, or the unwillingness or inability of the patients to take medications regularly."

Iseman added that the average stay for a TB patient used to be eight to 18 months in a hospital. With aggressive treatment and modern medications hospital stays have been reduced to 2 to 4 months. "But patients have to take medication for an additional one to one and a half years."

Doctors explained that TB is caused by a bacterium that originated in the soil. They said it has a waxy cell around it so it is very resistant to dehydration, allowing it to survive in the air longer.

Doctors said it is a very clever pathogen.

TB was known as the "white plague" because 200 years ago, nearly four in five Europeans came down with the disease.

Worldwide it is still an epidemic, claiming 2-million lives each year.

In the U.S. it is a manageable disease. 14,000 cases are reported here every year.

National Jewish sees about 12 of them.

"We are almost putting ourselves out of business," Iseman said, "but that's a business we'll happily close down when the day comes."

Man Currently Quarantined In Atlanta

The man has a form of tuberculosis so dangerous he is under the first U.S. government-ordered quarantine since 1963. The man took one trans-Atlantic flight for his wedding and honeymoon and another because he feared for his life.

Health officials have questioned the man's decision to fly from Atlanta to Paris, and later from Prague to Montreal, citing the possibility that he could expose other passengers. The man told the Atlanta Journal-Constitution that while doctors told him they preferred that he put off his long-planned wedding in Greece, they didn't order him not to fly.

He knew that he had tuberculosis, but didn't think he was a danger, he said.

"We headed off to Greece thinking everything's fine," said the man, who declined to be identified in the newspaper because of the stigma attached to his diagnosis.

Dr. Steven Katkowsky, director of the Fulton County Department of Health & Wellness, said the man was told traveling was not advised.

The man flew from Atlanta to Paris on May 12 aboard Air France Flight 385. He returned to North America on May 24 aboard Czech Air Flight 0104 from Prague to Montreal, then drove into the United States at the Champlain, N.Y., border crossing.

The man, whom officials also did not identify, is at Atlanta's Grady Memorial Hospital in respiratory isolation.

He told the newspaper he flew into Canada to avoid U.S. authorities after they told him when he was in Italy to turn himself over to officials there due to the seriousness of the disease. He said he believed he had to return to the U.S. to get the treatment he needed to survive.

According to the Atlanta Journal, the man said he and his private doctor had made plans for him to undergo treatment with specialists at National Jewish Medical and Research Center in Denver after his honeymoon.

The treatment would involve surgical removal of the mass coupled with drugs to kill the infections. The man said he's been told the course of treatment could take 18 months -- and that the only place it can be done is at National Jewish.

Health Officials To Contact Passengers On Affected Flights

Officials at the Centers for Disease Control and Prevention have recommended medical exams for cabin crew members and passengers who sat within two rows of the man.

"This is a bacteria that is really transmitted through the air, and generally to people who are in closed spaces for very long periods of time," Dr. Julie Gerberding, director of CDC, told ABC's "Good Morning America" on Wednesday.

"So long air flights can pose a risk to some passengers, but short flights, or people who go onto an aircraft after a patient has left, are not at risk," she said.

The man told health officials he was not coughing during the flights. Other passengers are not considered at high risk of infection because tests indicated the amount of TB bacteria in him was low, said Dr. Martin Cetron, director of the CDC's division of global migration and quarantine.

CDC officials said the airlines were working with health officials to contact passengers. Those who should be tested will be contacted by health officials from their home countries.

Dr. Howard Njoo of the Public Health Agency of Canada said there appeared to be little chance that the man spread the disease on the flight into Canada. Still, the agency was working with U.S. officials to contact passengers who sat near him.

Air France-KLM has been asked by French health authorities to provide lists of all passengers seated within two rows of the infected man, a spokeswoman said Wednesday.

Daniela Hupakova, a spokeswoman for the Czech airline CSA, said the airline was informed about the man by U.S. officials. The crew of the flight underwent medical checks and all are fine, she said.

The airline was contacting passengers to recommend they undergo testing, and was cooperating with Czech and foreign authorities, she said.

The man told the Journal-Constitution the CDC contacted him in Rome during his honeymoon, telling him that he had to turn himself in to Italian authorities to be isolated and be treated. The CDC told him he couldn't fly aboard commercial airliners.

"I thought to myself: You're nuts. I wasn't going to do that. They told me I had been put on the no-fly list and my passport was flagged," the man said.

He told the paper he and his wife decided to sneak back into the U.S. via Canada. When he arrived back in the United States, he voluntarily went to a New York hospital, then was flown by the CDC to Atlanta. He is not facing prosecution, health officials said.

"I'm a very well-educated, successful, intelligent person," he told the paper. "This is insane to me that I have an armed guard outside my door when I've cooperated with everything other than the whole solitary-confinement-in-Italy thing."

CDC officials told The Associated Press they could not immediately comment on the interview.

The man's wife tested negative for TB before the trip and is not considered a public health risk, health officials said. Health officials said they don't know how the Georgia man was infected.

The quarantine order was the first since the government quarantined a patient with smallpox in 1963, according to the CDC.

Tuberculosis Info

Tuberculosis is a disease caused by germs that are spread from person to person through the air. It usually affects the lungs and can lead to symptoms such as chest pain and coughing up blood. It kills nearly 2 million people each year worldwide.

Because of antibiotics and other measures, the TB rate in the United States has been falling for years. Last year, it hit an all-time low of 13,767 cases, or about 4.6 cases per 100,000 Americans.

Health officials worry about "multidrug-resistant" TB, which can withstand the mainline antibiotics isoniazid and rifampin. The man was infected with something even worse -- "extensively drug-resistant" TB, also called XDR-TB, which resists many drugs used to treat the infection.

There have been 17 U.S. XDR-TB cases since 2000, according to CDC statistics.

The CDC's statement that the patient is at the low end of communicability "provides some reassurance," said Dr. William Schaffner, chairman of the department of preventive medicine at Vanderbilt University.

The highly dangerous form is "expanding around the world," particularly in South Africa, eastern Europe and the former states of the Soviet Union, he said.

However, the TB rate in the U.S. has been falling for years because of the effective antibiotics.

Last year, it hit a record low of 13,767 cases. In 2004, 14.6 million people around the world had active TB and there were 8.9 million new cases and 1.7 million deaths, mostly in developing countries.


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