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Florida TB case highlights emerging strains of “XXDR-TB”
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The 19-year-old patient with extremely drug-resistant tuberculosis reported in Decembermost likely caught the infection from someone else, David Ashkin, MD, the patient's attending physician, told Infectious Disease News.
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