Tb Takes a Deadly Turn

By ANDREW PURVIS

Despite its romantic reputation, tuberculosis was never a disease of just retiring operatic heroines and "sensitive" poets. It was an indiscriminate killer, taking over 100,000 lives each year in the U.S. until the middle of this century, when antibiotics brought it under control. So when TB re-emerged in AIDS patients six years ago, it was greeted with alarm. Still, most doctors believed it posed little risk to the general population, since modern antibiotics could contain the infection before it flared into full-fledged disease.

That view appears to have been overly optimistic. Last week prison authorities in New York State revealed that 13 inmates and one guard have died of a form of tuberculosis that proved impervious to antibiotic therapy. It was the sixth major outbreak of so-called multidrug-resistant TB in the U.S. in the past two years. So far, these cases have been largely confined to AIDS patients and others with weakened immune systems. But experts fear that the disease, which kills about half those it afflicts, could spread to other groups. "TB has once again become a real killer," said Dr. Michael Iseman, a TB expert at Denver's National Jewish Center of Immunology and Respiratory Medicine.

Drug-resistant tuberculosis is not entirely new. It has arisen sporadically since antibiotic therapy was introduced in the 1940s, primarily as a result of failure to maintain proper treatment. Taming the bug usually requires up to six pills daily for six months. If a patient fails to complete this regimen or if his immune system is impaired, the drugs may knock off only the weakest germs, leaving their more tenacious, drug-resistant cousins to proliferate and possibly spread to other victims.

Until the 1980s such cases were rare. But the sudden surge in TB among AIDS patients as well as the homeless and rural poor has greatly increased the odds. "These are people that have a lot more to worry about than just taking their medicine," notes Dr. Lee Reichman, president-elect of the American Lung Association. Over 20% of TB patients in the U.S. fail to complete their therapy.

The noxious bacilli are transmitted through the air, and it is possible to contract the infection in just a few days of exposure. More typically, a person must be in close contact with an ailing patient for over a month to catch the bug. Even then, infection leads to full-fledged disease in only 5% to 10% of cases, at least among those with healthy immune systems.

Many doctors are urging the government to restore funding for the old TB- control programs and even revive sanatoriums so that infectious patients may be quarantined during their treatment. Cuts in such programs may have laid the groundwork for the recent outbreaks. "We've not been too wise over the years," concedes Dr. Dixie Snider of the Centers for Disease Control. Snider points out that almost everything about the science of TB is too old or too slow. Simply diagnosing the resistant strain can take three months or more, and treatment efforts, which succeed only half the time, last an average of three years. It may therefore require a fresh infusion of research funds as well as public health measures to catch up with an old killer that has learned some dangerous new tricks.

CHART: NOT AVAILABLE

CREDIT: TIME GRAPHIC SOURCE: CENTERS FOR DISEASE CONTROL

CAPTION: Reported cases of tuberculosis in the U.S.

With reporting by Dick Thompson/ Washington