TB Outbreaks in Texas Schools Show Disease Still a
FRIDAY, Oct. 14 (HealthDay News) -- Outbreaks among young people
in Texas of the old foe tuberculosis -- often mistakenly dismissed
as a long-ago health menace now confined to the pages of a Charles
Dickens novel -- show that the respiratory disease is still easily
contracted and remains a potential threat to Americans, experts
"Tuberculosis has always been with us and probably always will be," said Dr. Len Horovitz, a pulmonary specialist with Lenox Hill Hospital in New York City.
At least 100 people have tested positive for tuberculosis (TB)
on skin tests in Ennis, Texas, about 40 miles south of Dallas,
including several students at the local high school. The testing
was done after a teacher was diagnosed with TB before the start of
the school year.
And the University of North Texas in Denton -- about 70 miles
away -- recommended that 27 people who had had contact with a
student diagnosed with a suspected case of TB also be tested,
according to local news reports.
A student at Denton High School also has suspected TB after
transferring from Ennis High, although health authorities insist
there is no link between the University of North Texas cases and
the one at Denton High.
"TB is spread by the respiratory-droplet route, so coughing, talking, singing, breathing, even sitting in front of somebody in an airplane" can put a person at risk, Horovitz explained. "It's air-borne but it has to be in a certain range. It could be in the same room. It's very easily contracted."
While it's no longer the scourge of centuries past, about 11,000
cases of TB were reported last year in the United States, the
lowest rate ever. California, Florida, New York and Texas together
accounted for half of these cases, according to the U.S. Centers
for Disease Control and Prevention.
"When looking at the populations hardest-hit by TB -- racial/ethnic minorities and foreign-born individuals -- both groups continue to be disproportionately affected despite declines," said Dr. Kenneth Castro, director of the CDC's Tuberculosis Elimination Program.
"TB rates for all racial/ethnic minorities are higher than those of whites -- seven times higher for Hispanics, eight times higher for blacks, and 25 times higher for Asians," he added. "Among foreign-born individuals, TB rates are 11 times higher than among those who are born in the U.S."
TB disease is caused by a bacterium called
Mycobacterium tuberculosis which typically attacks the lungs.
But the germ can attack any part of the body -- such as the
kidneys, the spine, and the brain. And if it's not treated with the
proper drugs, TB disease can be fatal, according to the CDC.
The highest risk for transmission is among people who live in
the same household as well as people in college dorms, barracks and
other close quarters, said Dr. Kenneth Bromberg, chairman of
pediatrics and director of the Vaccine Research Center at the
Brooklyn Hospital Center in New York City.
Children and teens in school settings are at an "intermediate
risk," he said.
Encountering people on a bus, subway or airplane is a less
common means of transmission, but it can happen.
Just because someone has a positive result on a TB skin test
doesn't mean they're infectious or even sick, however. It simply
means they've been exposed to the bacterium that causes the
disease. These people have a 5 percent chance of becoming sick over
their lifetime, Bromberg said.
And "a subset of people with positive skin tests could be
infectious," he added.
But the germ is most often spread by people who have symptoms,
such as a chronic cough or weight loss.
One recent concern has been the emergence of drug-resistant or
even multi-drug resistant strains of TB. These cases are harder to
treat. Antibiotics are the usual course of treatment for
Health experts divide infection with tuberculosis into two
categories: latent TB infection and full-blown TB disease. The CDC
estimates that more than 11.2 million people in the United States
are living with latent TB infection.
People with latent infection have the germ in their bodies, but
they don't feel sick and don't have symptoms because their immune
systems are keeping the infection in check. The only sign of
potential trouble is a positive reaction to the tuberculin skin
test or special TB blood test. People with latent TB aren't
infectious, they can't spread the disease and may never develop the
disease. But, if the germ becomes active and multiplies, TB disease
can result, according to the CDC.
TB disease, on the other hand, means the immune system can no
longer keep the bacteria under control. Symptoms can include a bad
cough that lasts three weeks or longer; chest pain; coughing up
blood or sputum; weakness or fatigue; weight loss; lack of
appetite; as well as chills, fever and night sweats, according to
People with weakened immune systems -- especially those infected
with HIV -- run a higher risk of TB infection than people with
normal immune systems.
Currently, there are 10 drugs approved by the U.S. Food and Drug
Administration to treat tuberculosis, including the first-line
medicines isoniazid, rifampin, ethambutol and pyrazinamide.
For more on tuberculosis, visit the
American Lung Association.
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