Drug-Resistant Tuberculosis

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In 2012, I reported on the appearance of a strain of drug-resistant tuberculosis in rural parts of India. In the article, I talked about the disease and the concern that it could become a pandemic if it made its way to other parts of the world. Now, it has been reported that a case of drug-resistant tuberculosis in a traveler from India has, indeed, arrived in the U.S. The patient is being treated in the NIH facility in Maryland, and, hopefully, the disease won’t spread if appropriate precautions are taken.

This story hits home for me personally, as I was exposed to tuberculosis when I worked the ER at a large city hospital in Miami during the 1980 Mariel boatlift, when Fidel Castro emptied his prisons and a large number of sick Cubans came to the United States. It wasn’t the norm to wear a mask when treating ER patients back then, and it cost me. My TB test turned positive, and I still carry evidence of it in the form of a walled-off area on chest X-ray.

Infectious disease has always been with us, and some of the most common ones involve the lungs and airways. Tuberculosis was a disease that occurred in pandemic proportions in the past. From kings (Edward VI of England) to poets (John Keats) to gunslingers (Doc Holiday), millions of people have died from complications of this disease. Evidence of TB has even been found in Egyptian mummies. But, what exactly is Tuberculosis?

What is Tuberculosis?

Tuberculosis is a contagious disease caused by a bacterium called Mycobacterium Tuberculosis. It can affect various organs, but is most commonly associated with lung damage. It is spread by air droplets from someone with the disease. TB infections are treated by specific antibiotics that must be taken for several months on a specific schedule. This causes the infection to become dormant, often for many years. Trigger events, such as a major illness or a weakened immune system, may reactivate the disease.

Primary Tuberculosis does not cause symptoms, but it is thought that a third of the world’s population has been exposed to the disease. In 2010, almost 10 million cases were reported, with 1.5 million deaths associated with the infection (mostly in third world countries). We worry about a future pandemic; here’s one that’s happening right now.

What Are the Symptoms of Tuberculosis?

If the appropriate antibiotics were unavailable to me in 1980 (as might happen if we hit hard times), I could have progressed to the symptomatic form of the disease. Symptoms of Tuberculosis include:

• Coughing and wheezing (with blood or mucus)
• Shortness of breath
• Weight loss
• Fevers and night sweats
• Fatigue
• Chest pain

In the past, a person with symptoms of Tuberculosis was known to be suffering from “consumption”, because their worsening weakness and weight loss made it appear that something was “consuming” them. This happens over a number of years before death occurs.

The 2012 reports of TB strains in India that didn’t not respond to any of the known antibiotic therapies were troubling, but now the infection is in the U.S. Previously called Totally Drug Resistant TB, we now optimistically refer to it as Extensively Drug Resistant TB. It primarily affected the poor and malnourished in India, but apparently has made it to people who can afford intercontinental travel. Imagine, a mobile disease with absolutely no proven successful treatment. Even the Ebola patients had options, though experimental, that helped to get them through the illness.

So what does this have to do with medical preparedness? It should be a warning that you need more masks (N95 respirator as well as regular face masks) and gloves than you probably have currently in your medical supplies. It might be time to ask yourself some questions: Where you would put a possibly contagious individual in your home or retreat? Do you have an effective plan to deal with epidemics of infectious diseases? What would you do with a chronically ill member of your family if highly specialized drugs were not available?

Some of the above questions can be dealt with by accumulating more medical supplies. Remember, any extras (if there is such a thing) will be extraordinarily valuable barter items in times of trouble. Other questions above are harder to answer, and some may require hard decisions.

Take some time to consider your options and plan ahead, whether it be for a pandemic, a natural disaster, or an economic collapse. You can never have too many medical supplies.

Joe Alton, MD


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