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Andrew Speaker's TB Reclassified

Andrew Speaker's Tuberculosis Is Multidrug-Resistant, Not Extensively Drug-Resistant, Doctors Say
By
WebMD Health News
Reviewed by Louise Chang, MD

July 3, 2007 -- Andrew Speaker's tuberculosis is multidrug-resistant tuberculosis (MDR TB), not extensively drug-resistant tuberculosis (XDR TB), CDC officials and Speaker's doctors announced today.

Speaker, an Atlanta lawyer, was recently in the headlines when the CDC ordered him into medical isolation after he and his bride took two transatlantic flights.

At the time, Speaker was believed to have XDR TB, which resists most tuberculosis drugs. But today, that diagnosis changed to MDR TB.

Multidrug-resistant tuberculosis doesn't respond to the first preferred treatments. But it's more responsive to tuberculosis drugs than extensively drug-resistant tuberculosis.

In light of the new diagnosis, Speaker may not need lung surgery for his tuberculosis, Charles Daley, MD, told reporters today.

Daley works in Denver at the National Jewish Medical and Research Center, where Speaker is being treated.

Andrew Speaker's Statement

In a news conference, William Allstetter, spokesman for the National Jewish Medical and Research Center, read a written statement by Andrew Speaker.

Speaker says in the statement that he is "incredibly relieved" that tests show that he doesn't have XDR TB. He noted that his understanding is that he does not have -- and has never had -- XDR TB.

Speaker also indicated he hopes today's news doesn't change the attention tuberculosis has recently gotten in the media, given that tuberculosis is a serious global health problem

Speaker referred to his earlier XDR TB diagnosis as a "misdiagnosis."

Speaker's Tuberculosis Misdiagnosed?

The news conference also included comments by Mitchell Cohen, MD, director of the CDC's Coordinating Center for Infectious Diseases.

Cohen noted that the CDC has confirmed that MDR TB is Speaker's "predominant" tuberculosis bacteria.

Cohen also pointed out that Speaker's XDR TB diagnosis was based on a different sampling method than later tests.

That first sample was taken by bronchoscopy, in which doctors take a sample from the deeper part of the lungs. Other cultures have been taken by samples coughed up by Speaker.

It's possible that Speaker had a "small proportion" of XDR TB bacteria, Cohen notes. Daley agrees that that's possible, but he notes that all of Speaker's cough specimens indicate MDR TB.

The original bronchoscopy sample -- tested by Atlanta health officials and confirmed by the CDC -- is "no longer available for retesting," Cohen says.

"I don't know why the first result [from the bronchoscopy] showed XDR ... and our results do not," Daley says. Daley notes that even in state-of-the-art labs, "there is a weakness in the diagnostic algorithm" and there can be "variance in results."

Speaker's Travels

After Speaker's travels came to light, the CDC asked people on Speaker's two transatlantic flights to get tested for tuberculosis.

Cohen says the CDC's public health actions in the wake of Speaker's travel were "sound and appropriate," and he stressed that patients with drug-resistant tuberculosis "without question, should not be flying on commercial airlines."

Daley notes that if any of Speaker's fellow flyers caught his MDR TB, they have more treatment options than if Speaker had had XDR TB.

So far, no cases have been reported of travelers who caught Speaker's TB. Flyers were asked to get a follow-up test about two months after those flights, since tuberculosis grows slowly.

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