First US case of XXDR TB identified

Until today, I hadn’t even heard of extremely drug resistant tuberculosis. There are only a handful of cases globally. The term was only defined in the last couple of years. It refers to TB bacteria that are resistant to all tuberculosis drugs and it’s almost always fatal. This is not the same as XDR TB (with one X), aka extensively drug resistant TB, which still responds to some third-line TB drugs and has a lower mortality rate.

According to WHO, there have been  two cases diagnosed of XXDR TB in Europe. Aidsmap mentions two cases in Italy in 2003, both fatal -. I assume they are the same cases mentioned by WHO. The AP reported Sunday on the first case of XXDR TB identified in the US. It was diagnosed in a Peruvian student named Oswaldo Juarez who was studying English in the US. The story is both reassuring and really, really scary.

The reassuring part is that they cured him. The process wasn’t easy. It took 19 months, and a drug regimen that left Juarez throwing up and thinking about suicide. He was transferred from regular TB care into isolation in a TB hospital in Florida, and his care cost the United States $500,000. But they did cure him of XXDR tuberculosis.

The scary part is that Juarez had never had tuberculosis before. Usually, drug resistant TB occurs when people undergo TB treatment that fails. It can fail because it’s a badly chosen treatment, the patient quits in the middle, or the drugs are expired or counterfeit. This failed treatment kills of the easily eliminated bacteria and leaves the stronger ones to thrive and develop resistance to TB drugs.

In the case of Oswaldo Juarez, he was somehow infected with XXDR TB without ever having had tuberculosis before. This is very bad. Doctors don’t even know how it happened. How did he get it? Peru has not been a major source of drug resistant TB and Juarez doesn’t recall any TB exposure.

If people are now getting extremely drug resistant TB – and without previous TB treatment – that could mean a major, extremely destructive, epidemic.

One final note – I was proud of the US government’s action here. They could have chartered a plane and deported to Juarez back to Peru. Hospitals do it all the time. Instead, they did the right thing, both morally and to protect public health. Letting Juarez spread XXDR TB in Peru would have been a death sentence for him and anyone on the plane with him, and it would have come back to the haunt the US when the disease spread here.

 

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