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Andrew Speaker's TB Reclassified

Andrew Speaker's Tuberculosis Is Multidrug-Resistant, Not Extensively Drug-Resistant, Doctors Say

Medically Reviewed by Louise Chang, MD on July 03, 2007

July 3, 2007 -- Andrew Speaker's tuberculosis is multidrug-resistanttuberculosis (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 CDCordered him into medical isolation after he and his bride took twotransatlantic flights.

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

Multidrug-resistant tuberculosis doesn't respond to the first preferredtreatments. But it's more responsive to tuberculosis drugs than extensivelydrug-resistant tuberculosis.

In light of the new diagnosis, Speaker may not need lung surgery for histuberculosis, Charles Daley, MD, told reporterstoday.

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 JewishMedical and Research Center, read a written statement by Andrew Speaker.

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

Speaker also indicated he hopes today's news doesn't change the attentiontuberculosis has recently gotten in the media, given that tuberculosis is aserious 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, directorof 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 adifferent sampling method than later tests.

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

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

The original bronchoscopy sample -- tested by Atlanta health officials andconfirmed by the CDC -- is "no longer available for retesting," Cohensays.

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

Speaker's Travels

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

Cohen says the CDC's public health actions in the wake of Speaker's travelwere "sound and appropriate," and he stressed that patients withdrug-resistant tuberculosis "without question, should not be flying oncommercial airlines."

Daley notes that if any of Speaker's fellow flyers caught his MDR TB, theyhave 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.

Show Sources

SOURCES: Charles Daley, MD, National Jewish Medical and Research Center, Denver. Statement by Andrew Speaker (read by William Allstetter, spokesman, National Jewish Medical and Research Center). Mitchell Cohen, MD, director, Coordinating Center for Infectious Diseases, CDC. WebMD Medical News: "TB Patient to Get Lung Surgery."

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