Health Experts Fear Possible Tuberculosis Resurgence

June 8, 2005 -- -- Tuberculosis may seem like a disease of a bygone era, but experts are concerned that budget cuts and slackening vigilance now threaten to undermine eradication efforts in the United States.

"Many, many, many states are cutting their tuberculosis programs," warned Ed Nardell, a tuberculosis researcher at Brigham and Women's Hospital in Boston. Nardell said such cutbacks were dangerously short-sighted, given the risks of the disease.

Until the advent of antibiotics, TB -- a bacterial infection that can cause coughing, scarring of the lungs, neurological problems -- was one of the biggest killers in America.

The disease, along with its even more deadly counterpart, Multi-Drug Resistant Tuberculosis, still affects almost 15,000 Americans every year.

But detection and treatment is very labor intensive and expensive, and crucial early intervention is particularly costly.

When a case of TB is identified, all of the people with whom that patient has had contact must be tested for TB and then retested a few months later. Directly Observed Therapy -- the best way to prevent the spread of TB -- requires that a health-care worker watch as a patient takes his or her medication.

Health-care workers must be vigilant about TB flare-ups in at-risk populations such as the homeless, AIDS patients and inmates.

Last year, former U.S. Surgeon General David Satcher described the battle against TB in stark terms.

"We have two choices in the United States. We can continue the path toward neglect and experience another unnecessary, expensive resurgence of tuberculosis. Or we can take the necessary steps to continue progress toward tuberculosis elimination," he said in a 2004 report to Congress.

But one of the major problems in the fight against TB is the expensive, lengthy treatment needed for patients who become resistant to the usual medications. Multi-Drug Resistant TB occurs when people have incomplete tuberculosis treatment, allowing resistant TB bacteria to flourish. It is four times more deadly than normal tuberculosis.

Two main drugs, isoniazid and rifampin, become useless in cases of Multi-Drug Resistant TB, said Reuben Granich, of the Office of the U.S. Global AIDS Coordinator and author of one of the JAMA studies.