Quarantined TB Patient Said CDC Should Apologize

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Main Category: Tuberculosis
Also Included In: Public Health
Article Date: 05 Jul 2007 - 0:00 PDT

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Andrew Speaker, the TB patient who was quarantined in the US because he was misdiagnosed as having an extreme drug resistant form of the disease known as XDR-TB said the Centers for Disease Control and Prevention (CDC) who ordered the quarantine and alerted worldwide authorities about him when he went abroad should apologize, he said in an interview with CNN on Tuesday night.

The case roused international public interest because in May this year, the CDC in Atlanta issued a rarely used order under the Public Health Act (the last one was in 1967) to put Speaker in quarantine because they said a test revealed he had XDR-TB. Speaker was travelling in Europe when the announcement was made.

However, a more recent test shows that the 31 year old lawyer from Atlanta does not have XDR-TB but MDR-TB, a multi-drug resistant strain of the disease. It is still a serious disease to have, but not as dangerous as the extreme drug resistant form, according to the physician who is treating Speaker, Dr Charles Daley at the National Jewish Medical and Research Center in Denver, Colorado, in a press conference earlier the same day.

Speaker said the CDC's actions created an international panic and "scared millions of people around the world".

But the federal agency said the actions it took then, and is taking now in this case are "sound and appropriate", according to Dr Mitchell Cohen of the CDC. Speaking at the same press conference, he said the public health response should be the same for both forms of TB.

Dr Daley said the news that it was MDR-TB and not XDR-TB is good for both Speaker and the people he may have infected during his travels. MDR-TB, while still drug resistant, can be treated with a wider range of antibiotics. This includes the fluoroquinolones like levofloxacin (Levaquin) and moxifloxacin (Avelox) and others such as amikacin, capreomycin, and kanamycin.

Also, it is possible that the surgery scheduled for later this month to remove part of Speaker's infected right lung may no longer be necessary, said Daley.

Speaker said that effectively his condition was now no different to early May, before the health scare. The samples show that he does not have, or has ever had XDR-TB, he said, and he hoped the news would help to allay any fears in passengers and air crew he may have been in contact with on his various flights to and from and within Europe and Canada.

Asked about how such an initial misdiagnosis can arise, Daley said that he didn't know why the first diagnosis concluded it was XDR-TB and subsequent ones did not. He said it was not uncommon for this to happen with TB testing.

Sometimes what happens when a sample is taken and then raised as a culture for testing, what is initially a smaller proportion of a less populous bacteria grows more than the much larger proportion of the main bacteria. This could happen where some XDR-TB outgrows MDR-TB in the culture giving a false result of the main agent of infection. This was the possibility suggested by Cohen of the CDC.

It appears that the original sample was discarded after the culture was grown (this is not uncommon) so it is not possible to check the original results from scratch.

Asked how reliable the latest test result is, Daley said they were sure it was right because they used an extra test called MIC determination as well as the Agar culture tests performed before by the CDC.

Defending the CDC's actions, Cohen said there was no difference from a public health point of view between XDR-TB and MDR-TB, the "public health interventions are the same and we would take the same steps," he said.

Speaker was nevertheless critical of the government's actions:

"In the future, I hope they realize the terribly chilling effect they can have when they come after someone and their family on a personal level. They can in a few days destroy an entire family's reputation, ability to make a living and good name."

Health officials won't know until later this month and early next month whether anyone has been infected by being in contact with Speaker. If they have, they will be easier to treat than if they had contracted XDR-TB, said Daley.

Click here for full transcript of the press conference by National Jewish Medical and Research Center and the CDC.

Written by: Catharine Paddock
Writer: Medical News Today
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today