The New White Plague: Tuberculosis Re-emerges

Connie Wilson By Connie Wilson, 13th Sep 2014 | Follow this author | RSS Feed
Posted in Wikinut>Health>General Health>Public Health

This is a fact-based look at the re-occurrence of tuberculosis in the world.

Drug-Resistant Diseases Return

In the United States in 2009, what disease killed more people than prostate cancer and breast cancer combined? This disease ranks as the single biggest infectious killer of adults worldwide. According to the World Health Organization, one in three people is a carrier, with the disease lying dormant within their body. Ten percent of those who carry this dormant disease will eventually develop an active form of it. Over two million people annually will die from it.

Did you guess heart disease? Diabetes..., which, itself, is reaching epidemic proportions in this country? AIDS? Ebola? You would be wrong.

"It is time to close the book on infectious diseases and declare the war against pestilence won." (U.S. Surgeon General William Stewart, 1970).
The silent killer--- described as "a time bomb" by Dr. Masae Kawamura (who heads up the Francis J. Curry National Tuberculosis Center in San Francisco)--- is none other than tuberculosis, which, forty years ago, U.S. Surgeon General William Stewart pronounced to be cured, saying (at that time), "It is time to close the book on infectious diseases and declare the war against pestilence won."

Maybe. Maybe not.

Nearly all the infectious diseases on the planet are coming back with a vengeance, including TB, malaria and the newest scourges, HIV-AIDS and the Ebola virus. Although a $10 course of antibiotics can wipe out tuberculosis if the pills are taken in specific combinations for six months, when the treatment is stopped before the series is completed (or never undertaken at all), TB learns to fight back. Sometimes, cost is an issue in these hard economic times. Sometimes, drugs are given free of charge to the poor, but there is no one monitoring how they are taken. Sometimes, unethical drug counterfeiters sell worthless knock-off drugs to unsuspecting victims in Third World countries. Sometimes, every quarantine center in the entire country, save one, is closed and then this silent killer comes back, stronger than ever.

When 19-year-old Oswaldo Juarez of Peru entered the United States in 2007 to study English, he was the first case of a contagious, aggressive, drug-resistant form of TB. Juarez's strain had never before been seen in the United States and has been dubbed XXDR, which means extremely drug-resistant TB.

One of the nation's leading experts on tuberculosis, Dr. David Ashkin,
is quoted in an Associated Press article by Margie Mason and Martha Mendoza entitled "When Drugs Stop Working" this way: "He (Juarez) is really the future. This is the new class that people are not really talking too much about. These are the ones we really fear, because I'm not sure how we treat them."

Oswaldo's symptoms began with a cough. The persistent cough progressed to the point that, one morning at 4 a.m., Oswaldo ran to the bathroom sink coughing up blood.

TB is a disease that seems to have been with us since the dawn of time. Wikipedia says TB was found in a bison 18,000 years ago . Tuberculosis has been found in the spines of mummies from 4,400 years ago. In the 1600s TB was dubbed "the great white plague."

This was, in part, because of the pale coloration of the victims and the reddened eyes they displayed. Called "consumption" because it appeared to "consume" the body from the inside, victims were usually thin and pale. There were even legends of vampirism associated with those who suffered from the disease, which Wikipedia tells us has been called many things, including phthisis, phthisis pulmonalus, scrofula, lupus vilgaris, and Pott's disease. The disease is so old that Ibn Sina wrote a book on its treatment in the 1020's entitled The Canon of Medicine.

The list of those who have suffered, died or are still suffering from TB reads like a "Who's Who" of the famous, including Honore de Balzac; Anne, Emily and Bramwell Bronte, (who died within 2 years of one another); Elizabeth Barrett Browning; Albert Camus; Stephen Crane; Dashiell Hammett; Robert A. Heinlein; Washington Irving; Samuel Johnson; Franz Kafka; John Keats; D.H. Lawrence; William Somerset Maugham; Guy de Maupassant; Moliere; Eugene O'Neill; George Orwell (who died of it at age 46 in 1950); Alexander Pope; Sir Walter Scott; Robert Louis Stevenson; Dylan Thomas; Henry David Thoreau; Voltaire; Chopin; Stravinsky; Simon Bolivar; Eleanor Roosevelt; Ho Chi Minh; Louis Braille; Immanuel Kant; and, (still living sufferers), Judy Collins and Cat Stevens. I could add that my Norwegian immigrant grandfather died from tuberculosis.

Records show that TB had been on the decline. Britain, for instance, had 117,000 cases in 1913, which dropped to 5,000 in 1987. Unfortunately, those numbers have been on the rise since then. In 2000 the number of TB sufferers in Britain rose to 6,300. By 2005, the number was up to 7,600. (Wikipedia figures.)

But Britain is not where the problem is the most acute. According to records from 2007 (Wikipedia), the numbers per 100,000 were 15 in the United Kingdom in 2007; 30 in Portugal and Spain per 100,000; 98 per 100,000 in China; 48 per 100,000 in Brazil; but only 4 per 100,000 in 2007 in the United States. Swaziland, however,---the worst country reporting--- had 1200 cases per 100,000 peoople and India has been reporting 2 million new cases annually. The Philippines ranks 4th in the world with the highest number of cases per head in Southeast Asia and two-thirds of Filipinos have been diagnosed with TB, up to 5 million people a year. (All figures from Wikipedia).
The World Health Organization declared TB to be a world health emergency in 1993 (Wikipedia) and the story of Oswaldo Juarez of Peru indicates why.

When Dr. David Ashkin, one of the nation's leading experts on TB was interviewed by Margie Mason and Martha Mendoza of the Associated Press about Oswaldo's case he said this: "When Oswaldo first came in, we really had to throw everything but the kitchen sink at him. It was definitely cutting edge and definitely somewhat risky because it's not like I can go to the textbooks or journal articles to find out how to do this." Ashkin said he had never seen a case so resistant in his 17 years of treating TB in the brain and spine and thought he was going to have to remove part of Juarez's lung. When he spoke with Oswaldo's father in Peru he told Mr. Juarez that Oswaldo was one of only two people known to have contracted this particular drug-resistant strain of tuberculosis.

"What happened to the other one?" Oswaldo's father asked.

"He died."

Oswaldo spent a year and a half quarantined in the long, dark halls of this country's last remaining sanitarium, receiving treatment and relying on a poster of Mt. Everest for inspiration. He was isolated from his Peruvian family. He had to wear a mask when he left his room. He missed his father, siblings, mother, dog and parrot, but had to swallow at least 30 pills a day, some that turned his skin a darker shade of brown. He took the pills with applesauce, yogurt, sherbet and chocolate pudding, but they still caused him to vomit when they reached his stomach and he would have to take them all over again, plus having drugs (similar to chemotherapy administration) pumped into his bloodstream intravenously three times a day.

Happy Ending for Oswaldo Juarez.

Oswaldo Juarez did recover (although his lungs are scarred and he will have to remain vigilant for life). Oswaldo was able to check out of A. G. Holley State Hospital in Fort Lauderdale in July, 2009, 19 months after he voluntarily entered for treatment. His treatment cost taxpayers $500,000.

As Dr. Lee Reichman (New Jersey Medical School Global Tuberculosis expert) has commented in "When Drugs Stop Working" (1/3/2010 DesMoines Register, p. 2AA), "You're really looking at a global issue." To that statement we can add the words of TB expert Dr. David Ashkin who said, "This is an airborne spread disease, so when we treat that individual, we're actually treating and protecting all of us. This is truly homeland security," ("When Drugs Stop Working," Margie Mason and Martha Mendoza, 1/03/10 Des Moines Register).

Even back when TB sufferers were sent to sanitariums to recover, the recovery rate was only 50%. (The first TB sanitarium was established in 1854 in Gorbersdorf, Germany, which, today, is Sokolowsko, Poland., according to Wikipedia.) I remember when there was a local sanitarium on the outskirts of Iowa City, Iowa, near Coralville, Iowa. Apparently this facility is no more.

My brother-in-law's parents, Audrey and Bob Nelson, met while both were receiving treatment for TB in a sanitarium. In her final years, his mother, a nurse, was on oxygen, as part of her lung was removed during her treatment. Even the man who is the director of the U.S. Centers for Disease Control and Prevention contracted TB while caring for patients in New York in the early 1990s.

That man, Dr. Thomas Frieden, said ("When Drugs Stop Working," Margie Mason and Martha Mendoza, 1/3/10 Des Moines Register): "Drug resistance is starting to be a very big problem. In the past, people stopped worrying about TB and it came roaring back. We need to make sure that doesn't happen again. We are all connected by the air we breathe, and that is why this must be everyone's problem." Echoing this sentiment was Dr. Laurie Hicks, an epidemiologist with the CDC, who said in the same article, "We have seen a huge upsurge in resistance."

About 60 million foreigners annually visit the United States. If we aren't worrying about foreign-born passengers possibly carrying explosives in their underwear, (such as the Al Quaeda suicide bomber on a flight from Amsterdam to Detroit), we should be worrying about better screening for diseases such as TB (and Ebola) for entering visitors, since 82% of the cases identified in 2007 came to us courtesy of other countries. Maybe it's not enough just to screen for explosives. Maybe we need to require proof that a visitor is disease free (TB skin test; X-ray, etc.) before those visitors enter our country? This is particularly relevant now, with the recent Ebola outbreak in Africa.

I'm not a doctor, so I'm asking those who are, and I'll report their responses (if any).
Cambodia has confirmed the emergence of a new drug-resistant form of malaria. Wikipedia reports that, in Africa, 363 per 100,000 people have signs of TB, versus 32 per 100,000 in the Americas. Chronic active cases in 2007 numbered 13.7 million, with 9.3 million newly diagnosed and 1.8 million deaths, 80% of which were in Asia and Africa. Only 5 to 10% of these cases were in the United States, but, since tuberculosis is so easily spread (sneeze or cough and you expose others), affects 1/3 of the people in the world and a new case is diagnosed every second, it is easy to see why the invention of the Guerin vaccine (Bacillus Calmette) has not eradicated the disease, after all.

It is necessary to isolate a person whose TB is active for 2 weeks. Drugs must be given in certain sequence and dosages. There are many caveats when treating "regular" TB and the newly drug resistant XXDR strain is rewriting the book on treating infectious diseases.

In the United States, 65,000 people died from drug-resistant infections, whether TB, malaria, or AIDS. Another 19,000 died from a staph infection that has been eliminated in Norway, where antibiotics are stringently limited.

As a former teacher in the public schools, I remember the year I started teaching (1969). Teachers were required to have both a tuberculin skin test and a TB X-ray annually before being allowed to teach students in the Illinois/Iowa schools. That was 41 years ago. If you remember the earlier quote from U.S. Surgeon General William Stewart highlighted earlier, it appears he declared the battle against pestilence won prematurely.

I sent e-mail queries to highly placed infectious disease specialists, such as Dr. Vicky Foster at Washington University in St. Louis and to the University of Iowa. The question: What should we, as a nation, do about this emerging worldwide problem ( officially declared a worldwide emergency by the WHO in 1993, over 10 years ago)?

What should do to head off the resurgence of the white plague and other infectious diseases that, like the Terminator, just won't stay dead.


Deadly Diseases Becoming Resistant To Antibiotics, Famous People Who Died From Tb, Tuberculosis

Meet the author

author avatar Connie Wilson
Author - 27 books. Yahoo Content Producer of Year (2009); MWC Writer of the Year (2010); IWPA Silver Feather winner (Chicago), 2012 & 2014. Professor: 6 IA/IL colleges.

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