Associated Press

LUBBOCK, Texas - Concerned that about 2,800 people may have been exposed to tuberculosis at a West Texas hospital, state health officials are mailing warnings encouraging testing for the disease.

The possible exposure at Lubbock's University Medical Center occurred between September and November of last year, but the hospital was not alerted until last month. Privacy laws don't allow the hospital to name who caused the possible exposure to TB.

Hospital employees are tested for TB each year, hospital spokesman Greg Bruce.

The Texas Department of State Health Services said only people who receive the letter should be tested. The agency stressed this was not an outbreak.

"There's no immediate danger," Bruce told the Lubbock Avalanche-Journal for Thursday editions.

TB is caused by bacteria that can attack the kidney, spine and brain, according to the Centers for Disease Control and Prevention. The disease can be fatal if left untreated.

Letters are standard procedure whenever TB is reported, state health services spokesman Barry Wilson said. He noted that officials were very liberal in compiling the list of people who may have been exposed.

"Unless they've been coughing for three weeks or more, it's not something they should be overly concerned about," Wilson said. "This is really a routine procedure for us."  Thats like a Monty Python movie { only a flesh wound }

Dr. Richard Lampe, the hospital's chairman of infection control, said it was doubtful that anyone exposed at UMC would show symptoms yet.

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This week's news that a second East Gadsden High School student had been discovered with tuberculosis was a shock to county residents. But officials say they're taking an aggressive approach to the health problem.

"Testing is ongoing," said Sylvia Byrd, administrator for the Gadsden County Health Department, which is reporting an abundance of phone calls from concerned residents, "and precautions are being taken to ensure transmission remains at a minimum."

"Common symptoms of TB include fever, cough, night sweats and weight loss," he noted. "Tuberculosis is treatable, and medicines can help a person fully recover."

The two students have been isolated from other students and given medication, he said. Department officials declined to comment on their current condition.

According to the Mayo Clinic's Web site (www.mayoclinic.com), TB symptoms take several weeks to develop. It also stated that there are differences between TB infection and active TB. With TB infection, the bacteria remain dormant within the lung for a long time. The patient may not even feel sick.

If the disease is active, it can be transmitted to others by coughing, sneezing or even talking.

Byrd said that if you or someone you know needs to be tested, you should tell your primary health-care provider or the Gadsden County Health Department. The Health Department charges $10 for the TB skin test.

TUBERCULOSIS, EXTENSIVELY DRUG-RESISTANT - CANADA (ONTARIO)
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail, a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 24 Jan 2007
From: Mary Marshall <tropical.forestry@btinternet.com>
Source: Chronicle Herald (Nova Scotia) [edited]
<http://thechronicleherald.ca/Canada/554590.html>


A Toronto hospital is treating several cases of extensively drug 
resistant tuberculosis, with one of the patients being held in 
isolation under court order, the doctor overseeing the treatment said 
Mon 22 Jan 2007.

Public health experts fear the dangerous strain of tuberculosis, 
which is susceptible to very few of the anti-tuberculosis medications 
normally used to treat TB, is a global health crisis in the making. 
Dr. Monica Avendano, the physician in charge of the tuberculosis 
service at West Park Healthcare Centre, said since 2004, her unit has 
treated 5 or 6 patients with XDR TB, as it is called. All the 
patients were either infected abroad or infected by a family member 
who picked up the highly resistant strain elsewhere, she said.

"Currently, I am treating 3," said Avendano. "All of them have a 
previous history of tuberculosis that was not well managed."

Multi-drug resistant TB and the more difficult extensively drug 
resistant TB can arise one of 2 ways. A person with tuberculosis can 
fail to take all their medication, as in the case of the "not-well 
managed" patients to which Avendano referred. This spotty treatment 
allows the bacterium to survive the assault of the drugs and develop 
resistance to them. Or a person can be infected by contact with a 
person sick with XDR TB. Two of the cases Avendano has treated fall 
into this latter category.

"Both of the cases are young women who went to their country of 
origin to look after their ailing grandmothers. And the ailing 
grandmothers gave them TB. And it was XDR TB," she said.

She did not identify the countries involved. XDR TB has been found in 
a number of places, including China, South Africa, and many republics 
of the former Soviet Union. It is believed to have spread, still at 
low levels, from these jurisdictions to developed countries.

The Public Health Agency of Canada currently doesn't know the scope 
of the problem in this country. The last time Canadian TB statistics 
were gathered, the provinces and territories were not asked to report 
XDR TB cases. The TB statistics for 2006 -- which will be reported 
sometime in 2007 -- will include XDR TB figures, agency spokesperson 
Alain Desroches said in an e-mail.

Where such cases arise, they are treated in isolation, either with 
the consent of the patient or with the help of the courts. "All 
provinces and territories will use their public health legislation if 
necessary to ensure treatment of XDR TB," said Dr. Edward Ellis, 
manager of tuberculosis prevention and control with the public health 
agency. "With TB, in my experience, there's never a problem getting a 
court order if necessary. And nobody stands there saying: 'Oh, no, 
let them go.'"

Avendano said treatment with alternative drug regimes is effective, 
but it can take months of in-hospital care. Even then, it's not clear 
whether these patients -- who will be required to be seen on an 
ongoing basis -- are cured for life. That's because the strain hasn't 
been around long enough, and the treatment regime being used is too 
new to gauge its long-term efficacy.

[Byline: Helen Branswell]

--
ProMED-mail
<promed@promedmail.org>

[ProMED thanks Mary Marshall for this posting. A relevant discussion 
on the XDR problem in tuberculosis can be found at: CDC: Emergence of 
_Mycobacterium tuberculosis_ with Extensive Resistance to 2nd-Line 
Drugs --- Worldwide, 2000-2004. 2006;55: 301-305. Parts of the report 
are found below:

"17 690 isolates from the period 2000-2004 were tested for 
susceptibility to at least 3 of the 6 2nd line drugs (SLD) classes. 
Of these, 11 939 were from South Korea, of which 1298 (11 percent) 
were multidrug-resistant (MDR, defined as resistance to at least 
isoniazid and rifampin). From the other Global Supranational TB 
Reference Laboratory (SRLs), 2222 (39 percent) of 5751 isolates were MDR.

Of the 3520 MDR isolates, 347 (10 percent) were XDR (defined as cases 
in persons with TB whose isolates were resistant to isoniazid and 
rifampin and at least 3 of the 6 main classes of SLDs 
(aminoglycosides, polypeptides, fluoroquinolones, thioamides, 
cycloserine, and para-aminosalicyclic acid), including 200 (15 
percent) of 1298 from South Korea and 147 (7 percent) of 2222 from 
other SRLs. The drug-susceptibility testing results were tabulated by 
year and geographic region (on the basis of the country of origin of 
the isolates) (Table 1; for table, see original URL. - Mod.LL).

XDR TB was identified in all regions but was most common in South 
Korea (n = 200; 15 percent of all MDR TB isolates) and countries of 
eastern Europe/western Asia (Armenia, Azerbaijan, Czech Republic, 
Republic of Georgia, and Russia, n = 55; 14 percent of all MDR TB 
isolates). The total number and proportion of XDR TB isolates 
observed worldwide (excluding South Korea) increased from 14 (5 
percent of MDR TB isolates) in 2000 to 34 (7 percent of MDR TB 
isolates) in 2004. Year-specific proportions were stratified by 
geographic region. Increasing proportions of XDR TB were found among 
isolates from countries of eastern Europe/western Asia (n = 5 [9 
percent] in 2000; n = 11 [17 percent] in 2003) and the group of 
industrialized nations (Australia, Belgium, Canada, France, Germany, 
Ireland, Japan, Portugal, Spain, UK, and USA, n = 3 [3 percent] in 
2000; n = 25 [11 percent] in 2004).

USA national TB surveillance data included 169 654 patients with 
drug-susceptibility testing results. During 1993-2004, a total of 
2689 (1.6 percent) MDR TB cases were identified, of which 1814 (67 
percent) had results reported for 3 or more SLD classes. Of these, 74 
(4.1 percent) had resistance to 3 or more SLD classes and thus met 
the criteria for XDR TB. Despite an overall decline in MDR TB 
incidence in the USA, the proportion of XDR TB increased slightly, 
from 37 (3.9 percent) of 944 cases during 1993-1996 to 20 (4.1 
percent) of 489 during 1997-2000, to 17 (4.5 percent) of 381 in 
2001-2004 (chi-square test for trend = 0.20; p = 0.66). During 
1993-2002, patients with XDR TB were 64 percent more likely to die 
during treatment (relative risk [RR] = 1.6; 95 percent confidence 
interval [CI] = 1.2-2.2) than patients with MDR TB.

Among 605 MDR TB patients in Latvia who initiated therapy during 
2000-2002, 115 (19 percent) had XDR TB. The proportion with XDR TB 
increased from 30 (15 percent) of 204 in 2000, to 46 (21 percent) of 
215 in 2001, to 39 (21 percent) of 186 in 2002 (chi-square test for 
trend = 2.57; p = 0.11). Patients with XDR were 54 percent more 
likely to die or have treatment failure (RR = 1.5; CI = 1.1-2.2)."

A map of Ontario, Canada showing the location of Toronto can be found at:
<http://us.i1.yimg.com/us.yimg.com/i/travel/dg/maps/a2/750x750_ontario_m.gif>.
  - Mod.LL]
http://www.promedmail.org/pls/promed/f?p=2400:1000
[see also:
2006
----
Tuberculosis, multiresistant - Hungary 20061110.3233
Tuberculosis, multiresistant - South Africa (KN)(04):nationwide 20061019.3003
Tuberculosis, multi-drug resistant - South Africa (KN) 20060904.2514]
........................................................................ll/msp/jw