Tuberculosis Remains a Concern; Disease Rates Low across U.S. but Higher in the District

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Byline: Christian Toto, THE WASHINGTON TIMES

Dr. Shmule Shoham says the District provides a "perfect storm" of circumstances for the potentially deadly disease tuberculosis to thrive.

The city's high number of HIV-infected residents, combined with impoverished persons without access to consistent medical care makes an ideal climate for contracting the disease.

"We are very concerned about TB in the city," says Dr. Shoham, an infectious disease specialist with the Washington Hospital Center.

Tuberculosis, a respiratory infection marked by incessant coughing and fevers, once ranked first in causes of death in the United States. The bacteria that causes tuberculosis typically hits the lungs hardest, but it also can spread to the kidney, spine and brain, according to the Centers for Disease Control and Prevention.

Nationwide, TB is at an all-time low, the CDC says, based on a 2004 report. Yet progress in fighting the disease may be slipping. Between 2003 and 2004, the rate of TB declined by just 2.3 percent, the smallest such slip in more than a decade.

Closer to home, the news is more grim.

The District, Dr. Shoham says, has one of the highest HIV rates in the country, which is like "adding gasoline to the fire" when it comes to TB.

"The cells which are the most important to keeping TB cells under control are the ones most affected by HIV," he says. "If they're on HIV therapy, their ability to control it is better."

The CDC says the District reported 81 cases of TB in 2004, its most recent survey, and that the city's population had a rate of 14.6 cases of TB per every 100,000 persons in the population. (In 2003, the rate was 14.2 cases.) Nationwide, the rate was 4.9 cases per 100,000 in 2004, or 14,517 total cases.

A person's immune system is critical to keeping TB at bay. Many people exposed to the disease never develop it or have it in its "latent" stage. That means it could flare up if untreated, especially if the person's immune system is compromised later by illness. Someone with a latent form of TB can't spread the disease.

Dr. Mary Young, an infectious disease specialist at Georgetown University Department of Medicine, says tuberculosis is one of the few organisms that is "truly airborne."

"It can suspend in the air for a period of time after a cough," Dr. Young says.

Yet doctors still work with "archaic" methods for detection and treatment, she says, despite the ease with which it is inhaled and its inherent dangers.

No new drugs have been developed over the past 20 years, Dr. Young says. The existing medicines work, but they require significant treatment time, which, if not kept up, can hamper the patient's recovery.

The initial test is equally antiquated, she says.

The PPD test, which stands for purified protein derivative, is a skin test that requires patients to wait up to 72 hours for a diagnosis. That gap can be crucial when District doctors are trying to treat lower-income patients who may not be able to return right away for diagnosis and treatment options, she says. …