Controversy Builds Over TB Case
Was the patient properly infomed about his disease?
Is this an issue of health care illiteracy? Did the patient understand what he was told?
The public health issue of Andrew Speaker, the highly publicized patient with an extensively drug resistant for of tuberculosis, could be a prime example of health care literacy issues. Health officials contend that they told him he was contagious, but he insists they did not say this.
Patient Education Issues
Did they tell him this and not verify that he understood what they meant and why they said he should not travel? It's beginning to sound like that is a distinct possibility here. Even if it turns out to not be, this is a good illustration of what can happen when health care professionals give information and instructions to a patient and expect that because he is an educated professional himself (Mr. Speaker is an attorney) that he will naturally understand the information.
Mr. Speaker's new father-in-law works for the CDC and researches TB. Clearly there was a breakdown in communication to Mr. Speaker about his disease, how it spreads and the dangers of exposure to his own family and friends as well as perfect strangers he would encounter while traveling.
Quarantine Order
To ensure public safety, the CDC issued a quarantine order for Mr. Speaker and transported him to Denver for appropriate treatment for his rare form of XDR TB (extremely drug resistant TB). There have been only 17 reported cases of XDR TB in the U.S. since 2000. TB cases in general have been on the decline in the U.S. in recent years and in 2006 hit an all-time low
Treatable and Curable
TB is completely treatable and curable even in those with AIDS or HIV compromised immunity issues. Anyone who thinks they have been exposed to Mr. Speaker or anyone else with TB should contact their health care practitioner or public health department for testing and follow up treatment if they are positive for TB.
TB testing is done first by either a Mantoux skin test or a blood test followed by chest Xray and sputum collection if indicated.
How is TB Spread?
TB is an airborne disease meaning it is spread by breathing in the TB bacilli that are expelled most commonly through a cough, or a sneeze. These bacilli enter the lungs and begin to grow there. TB is most commonly spread between people who spend long period of time together such as friends, family and co-workers.
Not everyone becomes ill from TB. Those who do not become ill from TB actually have a latent form of TB and are not contagious. However, this latent TB is still alive and can become active at some later point and then it is contagious. This often happens if their immunity is threatened from such diseases as HIV, AIDS, Diabetes, certain cancers, substance abuse, kidney disease; or from corticosteroid treatments for organ transplants.
Because latent TB is still alive, if it is discovered, it is treated prophylactically with INH (Isoniazid) or Rifampin for a course of 6-9 months to kill the bacteria and prevent it from becoming active in the future. Active TB can spread to the spine, the brain or the kidneys, but it is not infectious from these regions. Learn more about TB from the CDC website.
