TB Man May Have Less Deadly Form of Disease

A new round of tests show that Atlanta attorney Andrew Speaker may not be infected with the deadliest form of tuberculosis after all — but health officials maintain that they would have sounded the same public alarm.

The results of multiple tests suggest that the form of TB carried by Speaker may be the multidrug-resistant variety (MDR) rather than the extremely drug resistant (XDR) strain.

"Based on extensive testing of multiple isolates of organisms cultured from Mr. Speaker, we have been able to demonstrate that he does not have XDR tuberculosis," said Dr. Charles Daly, head of the National Jewish Hospital's infectious disease division, at a press conference Tuesday afternoon.

He said the new finding "allows us to change the way we treat him," adding that surgery will be put "on hold" for now while doctors try a strong antibiotic treatment regimen.

In a statement, Speaker said the tests vindicated him after news of his infection and subsequent airline flights prompted a public health scare.

"For the international panic that was created after my misdiagnosis and the way my case was handled, I can only hope that this news helps calm the fears of those people that were on the flights with me," Speaker wrote in a statement issued Tuesday.

But officials with the Centers for Disease Control and Prevention say they would have handled his case in the same way, regardless of whether initial tests revealed his strain to be MDR or XDR.

And it is unlikely that the change in classification from MDR to XDR will have much effect on those people Speaker shared an international flight with who were at risk of contracting his disease.

"In a sense, it is good for him, though I don't think it changes the picture for those potentially exposed," said Dr. Patricio Escalante, a tuberculosis expert at the Keck School of Medicine in Los Angeles.

"It was not certainly a tempest in a teapot, because exposure to, and potential transmission of, either MDR TB or XDR TB constitutes a serious public health event, requiring investigation and possibly prophylaxis of those infected," said Dr. Mario C. Raviglione, director of the Stop TB department of the World Health Organization.

"In other words, the change in resistance patterns only reduces slightly the seriousness of the case, which still represents a very severe risk for those potentially affected," said Raviglione.

Different Strain ... Same Response?

Three tests conducted at National Jewish Medical Center in Denver, Colo., showed that Speaker is, instead, infected with a strain resistant to many, but not all, antibiotic regimens. The results of these tests were announced at Tuesday's press conference.

CDC officials, however, are downplaying the differences between the two strains.

"If we were aware of a person with MDR TB, we would have recommended the same steps; we would have recommended that they not travel," said Dr. Mitchell Cohen, director of the CDC's Coordinating Center for Infectious Diseases, during Tuesday's press conference.

"Without question, people with these infections should not be flying on commercial airlines, and if they do, the CDC recommends follow-up and testing and testing of passengers," said Cohen.

According to CDC spokesperson Tom Skinner, the agency actively sought to contact Speaker and prevent him from traveling even before they believed he carried the XDR strain.

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