Posted on the Pediatric SuperSite on January 11, 2010
Florida TB case highlights emerging strains of “XXDR-TB”
The 19-year old patient with extremely drug-resistant tuberculosis
reported in December most likely caught the infection
from someone else, David Ashkin, MD, the patient's attending physician,
told Infectious Diseases in Children.
The patient, a citizen of Peru who was attending school in Florida, was
resistant to all first- and second-line therapies commonly used to treat TB and
spent about two years in treatment at the A.G. Holley State Hospital in
Lantana, Fla. The case, which has drawn much media attention in recent weeks,
highlights the escalating issue of drug resistant TB strains.
This patient was unique because he had not previously had TB, according
to Ashkin. “This was primary acquisition. Patients sometimes develop
resistance to TB drugs after having TB in the past. This patient had never been
treated for TB in the past, but was resistant to many drugs used to treat of
TB.”
The patient was asymptomatic when he arrived in the United States,
Ashkin said, but began to develop symptoms of TB several weeks after his
arrival in Florida. “Multidrug resistant strains of TB are becoming more
endemic to Peru. The patient most likely contracted the disease while still in
country, but did not know it until he began to develop symptoms much later when
he was living in the United States.”
Six months have passed since the patient completed therapy, according to
Ashkin. “He appears to be healthy and has shown no further signs of
TB.”
The case has not yet been reported in a peer-reviewed journal, but
Ashkin and colleagues have presented information about the case at several
conferences, including last year’s meeting of the National TB Controllers
Association. – by Jay Lewis
What is most significant about this case is that it is primary MDR-TB
occurring in an otherwise healthy young man (i.e., he got this organism from
somebody else in Peru before coming to the United States). This is not a total
surprise since both MDR-TB and XDR-TB have been reported in Peru.
We need more and better data on the true prevalence of drug-resistant TB
on a global basis. WHO has sponsored several excellent surveys of
drug-resistant TB since 1994, but this has not yet been implemented in enough
countries. Also, we need better tools to diagnose MDR-TB. There is a lot of
work going on in this area now.
Finally, this patient is lucky to be alive and well. It is a tribute to
the very specialized, excellent and prolonged care he received at A.G. Holley
State Hospital.
– David Cohn, MD
Denver Department of
Public Health
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