Friday, June 1, 2007

More questions on Timing of Speaker's TB Diagnosis

Update: Mike Stobbe has sketched out some of the early dates in Andrew Speaker's odyssey with tuberculosis in a June 4 report from the Associated Press. It still doesn't give a sense of how long it takes to diagnose tuberculosis, in any form, in the first place.

What did Andrew Speaker's doctors know and when did they know it? That's what I keep asking myself as more details filter out about why an Atlanta lawyer with a dangerous form of tuberculosis felt it necessary to elude federal health authorities earlier this May.

Something Dr. Ken Castro of the CDC said at today's TB session at the annual meeting of the Global Health Council underscored the point. Castro was speaking via a video hookup from Atlanta. "It was only after he [Speaker] left and was in Europe that we learned he had XDR-TB," Castro told the gathering of public health and development staffers, activists and business people.

Now, here's the curious thing: Dr. Castro went on to say that it took 18 days for the first culture to be positive (which proved the lawyer had TB). "Then it was several more days, months to learn the drug sensitivity," Castro said.

Was that a simple slip of the tongue or did it really take months to learn Speaker's TB was highly drug resistant? Was he getting treatment in that time?

In any event, the delay shows why a rapid diagnostic test is needed for TB in all its forms. If a rapid test had been available, doctors would have known before Speaker left for his wedding that he had extensively drug-resistant TB and likely would have been able to keep him from going.

1 comment:

Larry said...

Andrew Speaker is, potentially, the poster child for TB. He's not poor, doesn't live in the squalid conditions that most TB patients in the developing world live in, and was travelling globally. this is a completely different picture of the TB patient. He makes it possible for us to put ourselves into the picture. After all, I could have been sitting next to him on the airplane.
We in the U.S. tend to think of TB as something in our past, not as a contemporary threat. Mr. Speaker puts the disease into the reflection in our mirror. It could be me.
Your point--that earlier, faster detection could have prevented much of this--is correct. And beyond that, addressing the conditions that breed poverty and its diseases is the only long-term preventive response, no matter how long it takes. all else is interim.