Here's a much better reporter on the TB story.

[Guest guest]

Now this reporter is asking much more appropriate questions: TB or Not TB: Isn't That the Question? Jordan Safirstein Mon Jun 4, 11:58 AM ET The only thing more confusing to me than this tuberculosis (TB) fiasco is how I am still the first to use this line for my title. The antagonist in the international bacterial brouhaha is a young personal injury lawyer who either knowingly or unknowingly flew off to his honeymoon in Greece with a multi-drug-resistant strain of TB (MDR-TB). Actually, the Associated Press reported yesterday that he had an even more resistant strain of Mycobacterium tuberculosis, called extremely drug-resistant TB (XDR-TB). Infectious disease is not my specialty but since when did we start assigning diseases cool prefixes that make them sound like luxury cars? We have heard rumors circulating that

the 2008 model will be the YF'd-TB? So the story goes that an excited newlywed personal injury lawyer goes to the doctor a few days before his honeymoon and is told that he "has TB." Speaker has also said that he was advised 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. Let's stop here for a minute. There are really two kinds of "have TB"s. There is the positive PPD test for TB in which your body has formed antibodies to Mycobacterium tuberculosis after you have been exposed to it but you are symptom-free and otherwise healthy, i.e.

latent TB (LTB). Then there is the "really have" TB in which you are symptomatic, with clinical manifestations usually associated with the pulmonary system. Patients typically present with cough, fever, chills, night sweats, weight loss, bloody sputum, anorexia, etc. etc. In this form, one is capable of actively spreading the infection. Many, many Americans, and even more internationals "have TB" in the former sense and a great deal of them are probably unaware as they have never had a PPD test to detect its presence. And if all of those fliers with latent TB were quarantined, it would probably require a holding room the size of Giants Stadium. But very few Americans with dormant TB ever develop the active form of the disease unless they become immunosuppressed, as in the case of patients with HIV/ AIDS or chemotherapy. Moreover, these carriers are not infective to anyone unless the disease becomes active. Lastly, his XDR-TB status does not make his disease any more transmissable than your run-of-the-mill TB -- it is just harder to eradicate. The fact that his new wife and he traveled to Greece makes you think (and hope) that he wasn't hacking up blood-tinged hunks of sputum during his "I do's". Thus, we are making the assumption that Speaker only had the presence of XDR-TB in his blood, making him no different from thousands of other air passengers who travel with latent TB on a daily basis. So what's the big deal? That's what we're trying to figure

out. We are guessing all the tumult is a result of him ignoring The Man who told him not to fly. But where did he get such an uncommon strain of the mycobacteria, that is found much more commonly in Asia and the former Soviet Union? Several reports have claimed that he was exposed when he visited a health clinic last year in Vietnam. We are not disputing that this is a possibility, but it turns out his father-in-law, Cooksey, is a microbiologist for the Centers for Disease Control ( CDC) who actually specialized in TB. [The plot thickens...] The same CDC that initiated Mr. Speaker's quarantine -- the first of a human being since 1968. In medicine, we have a saying that common things happen commonly and if we follow that theory than it seems less likely that one week in Vietnam accounted for his infection than his chronic and long-term exposure to his microbiological father-in-law.

This is a bold call but we're betting serious money that the wife's father will be investigated and it will turn out that he, too, has XDR-TB (*cue the Law & Order dun-dun). Oh yeah, the father-in-law is the source and he is going down for this in the very near future. Or is he? Currently, Speaker is taking up residence in a Denver hospital until he is given the green light to travel again. Perhaps we will find out that he indeed does have active TB infection but that will bring up an entire set of additional questions, like why a young, healthy man in his thirties develops active TB infection in the setting of a normal immune system. (Dun-dun) http://news./s/huffpost/20070604/cm_huffpost/050580 Penny Houle <pennyhoule@...>

wrote: What's so strange about this strain of TB? All I can find is that it is resistant to 2 drugs. Omigod! must have come from another planet. Oh wait...that's what all good bacteria do. Adapt, migrate or DIE!!!! Don't buy all the hype, a. penny pjeanneus <pj7@...> wrote: I meant to write that the

fiancee does not have TB. Yes, the man has TB. As to how he got it - it is not unusual to get TB in the US - it is very unusual to get the strain of TB this young, otherwise healthy, upper middle class man has. That is why I wonder if he got it by way of the CDC and perhaps some careless work coming out the door.I don't know, and I don't think we ever will know.a Carnes>> Yes, but 2 million people per year are dying of it. So which seems more absurd to you, the 2 million worldwide or the 2 in the U.S? Are we really that healthy in the U.S? > > It is weird that his father-in-law works at the CDC but not because that's necessarily how he got it. I think it's interesting because obviously he would have a better understanding of how to treat it. Also interesting that his father is a lawyer. I wonder what would be happening if a slightly more average citizen were dealing with

this public hazard? Probably facing the lynch mobs. > > Also, newscasters are calling it a "rare" form of TB, which really irks me. All it is, is a very resistant form of the bacteria. Doesn't make it rare at all. He's just like a lot of us walking around with resistant bacteria and the possibility of spreading it to other susceptible people, but these bugs aren't seen as threatening. Talk about foolish. This resistance is what a few doctors (and the American Academy of Pediatricians) have been trying to warn about, but no-one's listening.> > Also yes, the guy still has a "mass" in his lung but his tests are coming back negative and that makes him "probably not contagious". First off, shows how wrong tests can be. And secondly, it illustrates what usually happens if you have an infection that isn't responding to abx. Surgical removal. This is why you see so many diabetics get their feet amputated

(although they often aren't provided with all the treatment available because it's so costly). > > It's also why it's so frustrating when that infected mass is in your jaw or your sinuses, because you can't amputate those areas & surgical removal is very tricky. The docs/dentists who work on those areas are so undertrained that you wouldn't really want them to try.> > penny> > > > > > jim davis <jimd85379@...> wrote:> Did I miss something, I heard reports that the person> had a mass about the size of a golf ball, that needed> to be cut out. Is there a question, that he has TB?> --- pjeanneus <pj7@...> wrote:> > > If his fiancee wasn't infected why would folks on a> > plane be? Also, > > where did he get the infection???? There have only> > been 2 cases > > diagnosed in the entire

US, but father-in-law works> > with TB at the CDC > > in Atlanta. What is wrong with this picture?> > > > a> > > > > > >> > > Just heard the latest report on the TB patient. 2> > tests have come > > back negative and they're waiting for the 3rd. If it> > is also negative, > > they're saying that he can "probably be considered> > fairly non-> > contagious". > > > > > > Cracks me up. > > > > > > Just shows you that these tests aren't 100% and> > even if you're > > infected you can test negative for a number of> > reasons. People > > shouldn't necessarily believe the first negative> > result they get, > > especially if they've got symptoms. We have to start> > pushing doctors > > for more

comprehensive bacterial testing. Not just a> > brush off, or > > worse, no testing at all. It's irresponsible on the> > parts of doctors.> > > > > > penny> > >> > > > > > > > __________________________________________________________> Get the toolbar and be alerted to new email wherever you're surfing.> http://new.toolbar./toolbar/features/mail/index.php>