Despite Stubborn Strain, Prognosis Good For Traveling Tuberculosis Patient

Monday, June 4th 2007, 8:19 am

By: News On 6

DENVER (AP) _ Doctors are hopeful that Andrew Speaker's tuberculosis can be cured because it is not widespread, he is otherwise healthy and young, and his hospital has extensive experience in removing stubborn, drug-resistant infections.

``He has a number of features that make us optimistic about the potential outcome of his treatment,'' said Dr. Michael Iseman, senior staff physician at National Jewish Medical and Research Center.

Speaker, 31, of Atlanta, was found to have multidrug-resistant TB, which can withstand two mainline drugs used to treat tuberculosis. While in Europe last month, tests revealed he had extensively drug-resistant tuberculosis, or XDR-TB, which can withstand more drugs.

Speaker's strain has so far resisted at least 10 of 14 drugs available for treating TB, according to tests performed in Georgia, Iseman said. Surgery to remove infected lung tissue about the size of a tennis ball is one option. The infection's relatively small size increases the chances of success of any surgery.

Dr. Philip C. Hopewell, professor of medicine at the University of California, San Francisco, said it was good news that Speaker's infection occupies only about a sixth of one of his lungs. That and Speaker's resistance to drugs would appear to make him a good candidate for surgery, Hopewell said.

Surgery to eradicate TB is one of National Jewish's specialties, noted Dr. Neil Schluger, a professor of medicine at Columbia University Medical Center.

``In particular, they've had more experience operating on patients with drug-resistant TB than just about any other hospital in the United States,'' Schluger said.

Surgery is an old approach that used to be more common before better TB drugs appeared in the 1960s. It became needed again after the emergence of drug-resistant strains. National Jewish has worked closely with experienced surgeons at nearby University of Colorado Hospital, who learned the practice in the 1960s.

A study of 205 patients treated for multidrug resistant TB at National Jewish between 1983 and 1998 showed that those who underwent surgery had a 90 percent cure rate, Iseman said. About 20 of those patients are believed to fall into the newly created XDR category, and doctors are trying to find cure and survival rates for those patients, he said.

Of all 205 patients, 9 percent died of TB, Iseman said.

Speaker's TB was caught early by chance. It was discovered in January when he had a chest X-ray for a rib injury. Otherwise, Speaker hasn't shown any other symptoms of the disease _ coughing, loss of weight or a fever.

Speaker has had two negative tests for the bacteria in his sputum. Results of the third test were expected late Monday or Tuesday, hospital spokesman William Allstetter said in a statement.

If the third test is also negative, Speaker would be considered ``relatively noncontagious'' and could be allowed brief, escorted trips outside his room wearing a mask, Allstetter said. But such a finding would not mean that Speaker cannot transmit the disease, and the bacteria could still grow in Speaker's lungs and sputum, Allstetter said.

Drug-resistant TB patients who do venture outside are kept far from patients and anyone else in the community, so they pose no risk of infecting others.