Drug-Resistant TB Continues in California
Experts Say Tuberculosis Continues to Be a Global Problem
June 7, 2005 -- Widespread efforts to control tuberculosis in California
have largely failed to cut rates of dangerous drug-resistant forms of the
The new report shows that tuberculosis cases have steadily declined since
1994 in the state. However, the proportion of patients with tuberculosis
resistant to multiple antibiotics held steady at around 1.5% of all cases. More
needs to be done to identify and control the illness both in the U.S. and
abroad in order to cut rates of the disease, researchers say.
"Basically it's a flat line. It's not decreasing," Reuben M.
Granich, MD, a researcher for the study, says of multidrug-resistant (MDR)
"We really can't do this in isolation. We have to do this in California,
the United States, and overseas," says Granich, a researcher with the CDC
division of tuberculosis elimination.
Tuberculosis is a bacterial infection of the lungs. Some people can carry
the bacteria in their bodies but don't have any symptoms -- and they aren't
contagious. People with active tuberculosis typically have a cough with thick
and sometimes bloody mucus for more than two weeks.
Tuberculosis is normally treated with six to nine months of multiple
antibiotics. But if patients take medication improperly or don't complete
treatment, some TB bacteria can be left in the body. When those heartier
bacteria multiply, an entire new generation of drug-resistant bacteria can
Public health departments and doctors try to combat the problem by closely
observing patients taking medication each day, in an effort to ensure complete
treatment. The treatment involves detailed testing and even interviews with
patients' personal contacts, all of which can cost hundreds of thousands of
But evidence suggests that in California, resistant disease is still a
problem, Granich says.
Researchers looked at nearly 29,000 tuberculosis cases reported in
California between 1994 and 2003. The state has the most tuberculosis cases of
any state, with approximately one-third of all the nation's patients. New York
and Texas round out the top three states for the most tuberculosis cases.
Of those cases, 407 were found to be resistant to isoniazid and rifampin,
two of the most common antibiotics used to treat tuberculosis. More than one in
five of the patients had resistance to all four drugs used to treat
Patients with drug-resistant tuberculosis are four times more likely to die
than patients with standard tuberculosis. Forty-nine of the California
patients, or 14%, died from their drug-resistant infections, according to the
study, published in the Tuesday issue of The Journal of the American
A total of 233 Americans died in 2003 from all forms of tuberculosis. That
pales in comparison to death rates in developing nations, where tuberculosis
often infects up to one-third of the population, according to the CDC.