TB is not easily spread

The frenzy over tuberculosis spawned by a single "extensively drug-resistant" case is capturing headlines. But most people exposed to the airborne bacteria will never develop active disease.
The Atlanta attorney's case has health officials concerned because his TB falls into a class of infections that resists two first-line TB drugs and some second-line drugs — one of only 49 other extensively drug-resistant cases reported in the United States between 1993 and 2006. There's also a class called multidrug-resistant TB, which is easier to treat than cases like this one but more difficult than typical TB.
Although it's harder to kill, it's no easier to spread than any other tubercolosis, according to Carrie Taylor, an infection control practice nurse at LDS Hospital. "You have to breathe in air that's coughed."
Doctors treat an average of 38 active TB cases each year in Utah, according to the Utah Department of Health. The disease usually settles in the lungs, although it can affect the kidneys, spine, brain and other organs.
The disease is caused by Mycobacterium tuberculosis, which spreads person-to-person but only through close contact. Taylor and her colleague Vickie Anderson, also an infection-control practice nurse at LDS Hospital, describe it as passing from one person's lungs directly into another's. It's not like a cold that is easily spread and fairly hardy. In fact, sunlight kills it.
Unless the individual has a drug-resistant TB strain — "not common in Utah," said Taylor — it's very treatable, although it takes a long time and several medications. Left untreated, it can kill. At least initially, patients are isolated to avoid spread of the disease.
Both chicken pox and measles are more contagious, said infectious disease specialist Dr. John Kriesel of University Hospital. As an example, when a Provo High School student was recently diagnosed with tuberculosis and health officials asked 250 of the student's school contacts to be tested for it, Kriesel predicted "not one of them will test positive for TB."
People in casual contact are extremely unlikely to get the disease. Just being exposed doesn't mean you could pass it on, Taylor said. Without symptoms, you can't spread it, even if you have a positive skin test. People who live with a patient are at higher risk, but most won't get it, either.
As for folks who sit by someone on a plane, spread is unlikely unless the individual is coughing directly into the faces of seatmates.
TB symptoms include coughing that lasts three weeks or more, pain in the chest, blood in sputum, weight loss, night sweats, fever and fatigue, in various combinations.
In some people who breathe in the mycobacterium, it is "inactive but alive" in the body, Anderson said. That person has no symptoms, doesn't feel sick and can't spread it. At some later point, though, it can become active, so Kriesel said those with a positive skin test for TB are treated.
Treatment for TB that's not drug-resistant consists of pills containing antituberculosis agents, similar to antibiotics, but effective specifically against the mycobacterium. A patient is given the four recommended drugs seven days a week or five days a week for eight weeks, then two of them are dropped and the other two continue for another six months.
Tuberculosis is relatively uncommon in young people compared to older people, who are also more likely to have reactivation disease, although the risk is still low.
Salt Lake Valley Health Department infectious disease expert Kyle Cannon said they see "bumps" in the numbers in the very young, the very old, and late teens and early 20s.
While risk of spread is relatively low, health officials take it very seriously. They actually watch someone with TB take the needed medication, Cannon said. And people who refuse treatment can be forcibly quarantined and treated under court order.
Taylor said health-care providers have to notify the state when they find TB in a patient, then coordinate treatment.
Andrew Speaker, the Atlanta man quarantined with a dangerous strain of tuberculosis, will likely spend up to two months in a hospital while he receives a battery of antibiotics and is evaluated for possible surgery, his doctors said.
Speaker is the first infected person quarantined by the U.S. government since 1963. In a TV interview Friday, Speaker apologized to airline passengers and crew members he may have exposed to the infection while on a trans-Atlantic flight.
Twenty-six students and two faculty members from University of South Carolina Aiken were aboard the May 12 flight from Atlanta to Paris. Many on the flight are now anxiously awaiting the results of their TB tests, though two people have tested negative, South Carolina health officials said.
Health officials have contacted 74 of the 310 U.S. citizens who were on the flight, according to the Centers for Disease Control and Prevention. That count includes all 26 who sat in the five-row area around Speaker — the ones considered at greatest risk.
None is exhibiting symptoms, CDC officials said.
Speaker, 31, said he, his doctors and the CDC all knew he had TB that was resistant to some drugs before he flew to Europe for his wedding and honeymoon last month. But he said he was advised at the time by Fulton County, Ga., health authorities that he was not contagious or a danger to anyone.
Officials told him they would prefer he didn't fly, but no one ordered him not to, he said.
source:deseretnews.com