Tuberculosis: On the Rise In a Neighborhood Near You

With the recent news of an air traveler infected with Tuberculosis being isolated, TB is much in the news. I thought some of you may want a little background on the disease.

TB has been around for a millennia or more.  It has been found in the spinal columns of Egyptian mummys from 2400BC. It is even mentioned in the Bible. When I was a child, I knew it  is as having "the Consumption", others have known it as "The White Plague". My own father was confined for six months in the ealy sixties, yet I have never tested positively.

Until the 1840's or so, it was thought to be a hereditary disease, as many members of the same family would contract it, and eventually die, from this now curable disease. The reason whole families contracted it, was due to breathing the same air as an infected person, thus contracting it also.

We now know it is transmitted through the AIR, by breathing in the bacteria(bacilli). 

Many persons of note died from this disease, including Edgar Allen Poe, Robert Browning, Louisa May Alcott, Frederic Chopin, Franz Kafka, and, in 1963, Vivian Leigh, star of "Gone With the Wind."

Leigh's death was particularly tragic, as drugs which could eradicate the disease has been around for twenty years at the time of her death. She was BiPolar, and refused to take her medication. Sad.


In 1943, the drug Streptomycin was invented, which effectively killed the bacteria. It was during this time we saw worldwide opening of "TB Sanatorium", places where infected people were sent for treatment, away from the general population. The patient's stay was generally six months to a year.

Yes, it takes time to cure Tuberculosis. Even today, with all the new drugs to combat it, treatment remains at six months to a year or more. The earliest drugs used remain the most effective on the more common strains. Streptomycin, Isoniazid(called INH)m and Rifampin remain the most common treatments. A Combination of the drugs is generally given, due to the fact that when one takes an antibiotic for an extended period, they tend to develop resistances. With two or more, when one becomes resistant, there is another to "step up"


The TB sanatorium were mostly closed by the mid 1960's, as the TB rate was almost nil. It was thought that eventually TB would go the way of Small Pox, Extinct. They even stopped teaching TB education in the schools.  Then there came AIDS.

With AIDS, in the mid '80s, TB started becoming problematic once again.
Those with AIDS generally become infected much more quickly than the rest of the population, due to their lowered immune systems.

Immigration was also an issue, even bigger than the AIDS problem.  There were many third world countries where TB was pandemic, and those people were immigrating in droves to not only the U.S., but Europe and Asia as well. I am speaking of African countries as well as some Central American countries.

The immigrant issue goes back to many people living under one roof, breathing the same air. IT is also becoming a problem in other places where people live in close quarters, prisons, and homeless shelters most commonly.

Even today, it has not been  unheard of for someone diagnosed with active TB to be isolated until they have been cured. People have been placed in jail for treatment, if they would not do it on their own. I suspect this is the case with Andrew Speaker.

Tuberculosis IS treatable. All healthcare workers are required to have a TB test annually. The test is known as a "PPD" for Purified Protein Derivative" or "Mantoux" test.  The test for TB involves injecting  small amount, 0.1cc, or 1/50th of a teaspoon of the dead TB bacteria between the layers of skin on the forearm, raising a welt.Then we wait 48 to 72 hours. The appearance of the area then indicates infection or not. What we are looking for is a raised, hard, reddened area, known as "induration".

The redness is moot. I tell those who I personally test that they can become reddened to their armpits, and it would not signify TB. Some people have an allergic reaction to the serum, which causes redness.

The area of induration indicating the presence of TB varies, depending on several co-morbidities. In the general population, 20mm would indicate a positive, healthcare workers: 10mm, Immunocompromised people(ie:HIV positive or recipients of organ transplants who take immunosuppresive drugs): 5mm.  

 Merely having a positive TB test is not indicative of having the active disease. It merely means that at sometime, someplace, you were exposed to it. 1:10 people exposed to TB never become ill, and ONLY those who have active symptoms are contagious. However, a person with the LATENT disease (tested positive but no symptoms), can become ill 30 to 40 years after exposure, or maybe never. 

Generally, it taked REPEATED exposure to contract the bacteria, unless it is an extremely virulaent case, as in MR. Speaker. You will not contract TB by standing next to a victim in K-Mart. This is why it is becoming more prevalent in prisons, shelters and in homes with many occupants. They all breathe each others'  air, day after day.   

Symptoms include: a productive cough, night sweats, cloudy or sometimes bloody sputum, weight loss, and anorexia.  

There are now several "SUPER" strains of TB, such as the one infecting Mr. Speaker. These strains are known as "extensively drug-resistant pulmonary tuberculosis" (XDR TB). What this means is, that the drugs usually effective on TB do not work on these strains, and it is extremely hard to treat, thus his isolation.

Below is a copy of the letter I received from the CDC:

Dear Healthcare Professional,

A person with recently diagnosed culture-confirmed, extensively drug-resistant pulmonary tuberculosis (XDR TB) traveled on the following two extended flights (more than 8 hours in duration) in May 2007:

Date            From                            To                                  Airline / Flight#

May 12/13   Atlanta, Georgia           Paris, France         Air France #385/Delta #8517

May 24       Prague, Czech Rep.    Montreal, Canada          Czech Air #104

XDR TB is defined as a subtype of multi drug resistant TB (MDR TB) (i.e., an isolate resistant to at least isoniazid and rifampin), with additional resistance to at least two of the most important second-line antibiotics (i.e., a fluoroquinolone and an injectable agent [amikacin, kanamycin, or capreomycin]).

The patient is currently in respiratory isolation in a hospital in the United States, and is receiving medical therapy for XDR TB. He has remained relatively asymptomatic, and his sputum smear results were negative for acid fast bacilli (AFB), both before and after his travel; however, his sputum culture results are positive for XDR TB.

This is the first investigation of a case of XDR TB during air travel. Due to the serious nature of this strain of TB disease, CDC is recommending that all U.S. residents and citizens on these two flights receive evaluation, testing, and follow-up for TB infection.

We are requesting your assistance to perform TB evaluation and testing on any person identified as a contact on one of these flights. The XDR TB Contact Investigation Form is enclosed. Please keep a copy of this completed form for your records, give a copy to the person tested, and also please contact your State or Local TB control office via: 

http://www.cdc.gov/tb/pubs/tboffices.htm.

For inquiries related to this investigation, please call your State or Local Health Department. For more information about XDR TB, please see this link:

http://www.cdc.gov/tb/XDRTB/default.htm.