Extensively Drug-Resistant (EDR) Tuberculosis (TB) Patient

It’s big news here in North America and worldwide. Here are a few links:

1. Search on for those exposed to TB-infected man on flights
2. Drug-Resistant TB Patient in Isolation
3. TB Patient Was Advised Not to Fly

Tuberculosis used to be called Consumption, and for those cued in to movies, was what Nicole Kidman’s character Satine died of in Moulin Rouge. Left untreated, it has a mortality rate of >50%. Furthermore, pulmonary tuberculosis is one of the few real airbourne diseases. Most respiratory tract diseases like SARS, commonly thought of as airbourne, are actually droplet spread. Unless one of these droplets have direct contact with the eyes/nose/mouth routes, there’s no real risk.

Fortunately, TB is treatable with a combination of medications. The drugs that are used inclue Rifampicin, Isoniazid, Pyrazinamide and Ethambutol. They aren’t all fantastic, and Rifampin has the amusing side effect of turning your urine orange. Hoho!

Ooh, wait! EDR-TB doesn’t really respond to these medications! Fun times.

Now here’s the strange thing, why does a healthy 31-year-old North American lawyer have EDR-TB? They don’t know.

Nonetheless, the main issue here is that as the 3rd link above says, “Officials of the centers said at a news conference today that they had begun to make arrangements with the Italian authorities to isolate and treat the man in Rome. But instead of cooperating with the plans, the man traveled to the Czech Republic and took a flight from Prague to Montreal.”

On late night TV shows in the US, the focus has been on the Customs and Border Patrol (CBP) and the Centers for Disease Control and Prevention (CDC) and Mr Speaker himself to find out where the system has failed. Andrew Speaker and family have reiterated that at no time during his time in the US (including a meeting with CDC officials on May 10) prior to flying to Europe was he conveyed the information that he was infectious or was a threat to him wife/children/family.

Maybe the fault lies with all of them. What Andrew Speaker has to take responsibility for, however, is that after being contacted by the CDC in Italy and being told in no uncertain terms not to fly commercial and to turn himself in to Italian healthcare professionals, he, as mentioned above, flew commercial back to Canada and drove back to the US.

This is irresponsible.

In his defence, he was scared that he would not be able to reach this TB facility in Denver where he believed his only chances of survival lay:
Quarantined TB patient: ‘I hope they forgive me’

It’s not difficult to imagine that in a similar situation, one might easily have done the same. Of course, given that one dares to go gallivanting about thee globe because he’s not contagious and hasn’t had an infective status change in one and a half years, and did not seek further information and instead put hundreds of passengers of risk because of a “Me, me, me” mentality, the defence is hard to stomach.

Regardless, further investigations into the matter are under way, contact tracing is being undertaken, regular screening of people with potential exposures is taking place, so we’ll have to wait and see what happens next. A lot of people are unhappy. A lot.


3 responses to this post.

  1. I found your blog on google and read a few of your other posts. I just added you to my Google News Reader. Keep up the good work. Look forward to reading more from you in the future.


  2. Posted by Sharon on January 12, 2010 at 5:37 am


    My name is Sharon Jones and I am the assistant editor of Tuberculosis.net. I am contacting you today in hopes of developing a relationship with your website; we have seen your site and think your content is great. Tuberculosis.net is a purely informational site dedicated to the general Public.

    I hope you show some interest in building relationship, please contact me at sharon.tuberculosis.net@gmail.com.


  3. Posted by shubhesh on February 12, 2011 at 9:49 am

    i am a chest physician working with TB patients including MDR-tb, XDR-TB, TB with PLHA. i hope ur update will help me lots in my work.


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