TIME: Almanac 1993/TIME Almanac 1993.iso/time/120291/1202350.000

Text File | 1992-08-28 | 4KB | 80 lines

                                                                                MEDICINE, Page 85

TB Takes a Deadly Turn


Doctors thought tuberculosis was under control. But now a drug-
resistant strain is on the loose.


    Despite its romantic reputation, tuberculosis was never a
disease of just retiring operatic heroines and "sensitive"
poets. It was an indiscriminate killer, taking over 100,000
lives each year in the U.S. until the middle of this century,
when antibiotics brought it under control. So when TB re-emerged
in AIDS patients six years ago, it was greeted with alarm.
Still, most doctors believed it posed little risk to the general
population, since modern antibiotics could contain the infection
before it flared into full-fledged disease.

    That view appears to have been overly optimistic. Last
week prison authorities in New York State revealed that 13
inmates and one guard have died of a form of tuberculosis that
proved impervious to antibiotic therapy. It was the sixth major
outbreak of so-called multidrug-resistant TB in the U.S. in the
past two years. So far, these cases have been largely confined
to AIDS patients and others with weakened immune systems. But
experts fear that the disease, which kills about half those it
afflicts, could spread to other groups. "TB has once again
become a real killer," said Dr. Michael Iseman, a TB expert at
Denver's National Jewish Center of Immunology and Respiratory
Medicine.

    Drug-resistant tuberculosis is not entirely new. It has
arisen sporadically since antibiotic therapy was introduced in
the 1940s, primarily as a result of failure to maintain proper
treatment. Taming the bug usually requires up to six pills daily
for six months. If a patient fails to complete this regimen or
if his immune system is impaired, the drugs may knock off only
the weakest germs, leaving their more tenacious, drug-resistant
cousins to proliferate and possibly spread to other victims.

    Until the 1980s such cases were rare. But the sudden surge
in TB among AIDS patients as well as the homeless and rural
poor has greatly increased the odds. "These are people that
have a lot more to worry about than just taking their
medicine," notes Dr. Lee Reichman, president-elect of the
American Lung Association. Over 20% of TB patients in the U.S.
fail to complete their therapy.

    The noxious bacilli are transmitted through the air, and
it is possible to contract the infection in just a few days of
exposure. More typically, a person must be in close contact with
an ailing patient for over a month to catch the bug. Even then,
infection leads to full-fledged disease in only 5% to 10% of
cases, at least among those with healthy immune systems.

    Many doctors are urging the government to restore funding
for the old TB-control programs and even revive sanatoriums so
that infectious patients may be quarantined during their
treatment. Cuts in such programs may have laid the groundwork
for the recent outbreaks. "We've not been too wise over the
years," concedes Dr. Dixie Snider of the Centers for Disease
Control. Snider points out that almost everything about the
science of TB is too old or too slow. Simply diagnosing the
resistant strain can take three months or more, and treatment
efforts, which succeed only half the time, last an average of
three years. It may therefore require a fresh infusion of
research funds as well as public health measures to catch up
with an old killer that has learned some dangerous new tricks.

    -- By Andrew Purvis. With reporting by Dick Thompson/
Washington