TB Scare Case Not As Bad As First Thought

Jul 05, 10:18 AM

Current Headlines: By Lawrence K. Altman

New tests of the Atlanta lawyer who caused an international health scare by traveling abroad with tuberculosis show that his disease is not as severe as originally thought, federal officials and his doctors said.

For the lawyer, Andrew Speaker, this is good news. He had fled Europe, where he was on his honeymoon, at the end of May when he learned of the severity of his illness, fearing, he said, that he would die if he did not return to the United States. He flew to Canada and was allowed to cross into New York, even though border guards knew that he should be held for health reasons.

The entry prompted congressional hearings on the actions by the Centers for Disease Control and Prevention and the border agents.

Although the confusion as to who knew what and when was never completely explained, one fact seemed clear. Speaker had extremely drug-resistant tuberculosis, or XDR-TB, the hardest possible variety to cure, and it had been identified by the disease center in Atlanta.

But on Tuesday, the disease center and the National Jewish Medical and Research Center in Denver, where Speaker has been a patient in isolation since June 1, said he did not have XDR-TB. A series of new tests at both institutions shows that Speaker has multiple-drug-resistant TB, or MDR-TB. The condition is still dangerous, but more drug treatments are available.

The reclassification improved his prognosis, because the cure rates for MDR-TB are 70 percent compared with 30 percent to 40 percent for XDR-TB, the doctors said in a news conference. They said he may not need the surgery to remove a diseased section of his lung, an operation planned for this month.

The test findings also raised questions about the accuracy of TB tests at the disease center, a national and reference laboratory for the disease. The center reported in May that its tests showed that Speaker had XDR-TB based on cultures from a bronchoscopy, a lung procedure, at a hospital in Atlanta.

On Tuesday, the disease center and the Denver hospital said that as a matter of routine procedure they had performed new tests using three laboratory methods on TB bacteria isolated from Speaker on three occasions. Those new tests consistently showed MDR-TB.

In a statement expressing relief that he did not have the most severe form and harshly criticizing the government's actions in his case, Speaker said he had been misdiagnosed.

In an interview, Mitchell Cohen, an official with the Centers for Disease Control and Prevention, said the institution stood by the XDR-TB diagnosis on the initial test. "Any time there is a concern or a conflict with a test result, we will automatically review those results and see if there is a clear explanation for the difference," Cohen said.

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