Tuberculosis Patient Treated in Denver

Treatment May Take Months; Patient Asks Forgiveness From His Fellow Fliers

From the WebMD Archives

June 1, 2007 -- Andrew Speaker, the Atlanta man at the center of a media storm after traveling overseas with extensively drug-resistant tuberculosis (XDR), is being treated for his tuberculosis at Denver's National Jewish Medical and Research Center.

XDR TB is an infectious disease spread from person to person through the air. Unlike most tuberculosis cases, XDR TB resists the first and second preferred drug treatments.

In a news conference, Gwen Huitt, MD, who is one of the doctors treating Speaker, said Speaker is "doing very well," continues to show no obvious symptoms of tuberculosis, is starting to take new medications, and is even using an exercise bike in his isolation room.

Huitt reported "no surprises" in Speaker's chest X-rays and CT scans taken last night and that his tuberculosis continues to show a low likelihood of spreading easily to other people.

In a separate CDC news conference, CDC Director Julie Gerberding said that while the federal isolation order is still in place for Speaker, she "wouldn't be surprised" if that order is lifted "at some point in the future."

Patient's Fellow Travelers

Gerberding also updated reporters on efforts to reach people on Speaker's recent transatlantic flights.

Speaker, who is a 31-year-old lawyer, and his bride recently flew from Atlanta to Paris and from Prague to Montreal as part of their wedding and honeymoon.

Those flights are:

  • Air France Flight 385: departed Atlanta on May 12, arriving in Paris on May 13
  • Czech Air Flight 0104: departed Prague, Czech Republic, arriving in Montreal on May 24

Passengers likely to be at highest risk for tuberculosis transmission during those flights were sitting in Speaker's row and in the two rows in front or behind him, notes Gerberding.

Gerberding says the CDC has been in touch with 74 U.S. citizens and residents on the Air France flight, including all 26 passengers who were believed to be sitting in the high-risk rows around Speaker's seat.

Canadian authorities have identified the 28 passengers seated in the high-risk rows around Speaker on the Czech air flight, says Gerberding.

Those passengers -- and anyone else on those flights -- will be put in touch with local health officials in their city or state for tuberculosis testing. Since tuberculosis grows slowly, any initial tests that show tuberculosis would probably stem from infection before the flights. For this reason, the CDC recommends that passengers get follow-up tests in about two months, which will indicate whether or not any of those travelers got tuberculosis on those flights.

Passengers on those flights may call the CDC at 800-CDC-INFO for information on tuberculosis testing.

The bacterium that causes tuberculosis usually doesn't make people sick. In most cases, the bacterium stays inactive. But when it becomes active, it usually causes symptoms including fever, night sweats, cough, appetite loss, weight loss, bloody phlegm, and loss of energy.

Continued

Patient Apologizes

In an interview with ABC, Speaker said he never thought he was sick enough to infect others and said, "I'm very sorry for any grief or pain that I have caused anyone." He also asked forgiveness from his fellow passengers.

Speaker told ABC that while doctors had advised him against travel, they hadn't forbidden him from traveling.

In news conferences held earlier this week, CDC officials said that while the patient hadn't broken any laws by traveling, doctors rely on a "covenant of trust" in which patients opt not to travel so as not to put others at risk.

Speaker's father-in-law, Robert Cooksey, is a research microbiologist in the CDC's division of tuberculosis elimination. In a statement issued yesterday, Cooksey says he has never had TB and that his son-in-law's XDR TB didn't come from him or CDC labs. Cooksey says he wasn't involved in his son-in-law's decisions about traveling, and that the family is focusing on Speaker's recovery.

Speaker told ABC that when the CDC contacted him in Rome and told him to cancel his commercial flights, he was afraid to get treated outside the U.S. and wanted to get back to the U.S. for treatment with tuberculosis specialists in Denver.

Patient's Treatment

Speaker's treatment in Denver may last for months. That's how long it may take for doctors to find out if his tuberculosis responds to any antibiotic treatments.

If months of antibiotic treatment do not suffice, Speaker may also get surgery to remove parts of his lung affected by tuberculosis.

But it's too soon to know if Speaker will need that surgery, says Marvin Pomerantz, MD, director of the Center for the Surgical Treatment of Lung Infections at the University of Colorado at Denver Health Sciences Center.

Pomerantz tells WebMD if Speaker gets the surgery, it would be done at the University of Colorado Hospital.

In describing the surgery, Pomerantz says he "wouldn't call it a last resort. I'd call it part of the overall treatment of the difficult cases of tuberculosis," with more antibiotic treatment after the operation.

The surgery "should be done only in specialized units that are used to dealing with these particular problems," says Pomerantz.

Continued

Typical Tuberculosis Treatment

Today, doctors treat most people with TB outside the hospital. Gone are the days of going to the mountains for long periods of bed rest. Speaker is being treated in the hospital due to his rare and treatment-resistant strain of TB.

Doctors seldom use surgery. But when the bacteria are resistant to standard treatment, surgery is sometimes necessary to remove a pocket of bacteria in the lungs or in another part of the body.

Typically, tuberculosis treatment involves taking several special antibiotics for six to nine months. Treatment takes that long because the bacteria grow very slowly and, unfortunately, also die very slowly. Doctors use multiple drugs to reduce the likelihood of resistant bacteria emerging. Often the drugs will be changed or chosen based on laboratory results showing which antibiotics are most effective against the TB bacteria.

The most common cause of tuberculosis treatment failure is people's failure to take the medication as prescribed. This may lead to the development of drug-resistant organisms. Patients must take their medications as directed, even if they’re feeling better.

If doctors doubt that a patient is taking the medicine properly, they may have the patient come to the office for doses - called directly observed therapy.

Due to the fact that tuberculosis can be highly contagious, particularly if the patient has symptoms, such as a cough and fever, doctors or public health officials usually contact or trace the patient’s relatives and friends. Relatives and friends may need to undergo appropriate skin tests and chest X-rays to determine if they have been exposed to TB.

  • What health precautions do you take when you fly Share your ideas on WebMD's message boards.

WebMD Health News Reviewed by Michael W. Smith, MD on June 01, 2007

Sources

SOURCES: ABC News. WebMD Medical News: "Drug-Resistant TB Patient in Isolation." National Jewish Medical and Research Center: "About Tuberculosis." Statement by Robert C. Cooksey, Research Microbiologist, Division of Tuberculosis Elimination, CDC. Julie Gerberding, MD, MPH, Director, CDC. Marvin Pomertanz, MD, Director, Center for the Surgical Treatment of Lung Infections at the University of Colorado at Denver Health Sciences Center.

© 2007 WebMD, Inc. All rights reserved.

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