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2 Infected With Virulent Strain of Tuberculosis : Health: A boy, 18 months, and a woman, 25, are first in the county to become ill with a dangerous, drug-resistant form of the disease.

October 04, 1994|MARY F. POLS | TIMES STAFF WRITER

At least two people in Ventura County have been infected and five others likely exposed to a dangerous strain of drug-resistant tuberculosis, the first cases reported in the county, health officials said Monday.

The virulent form of tuberculosis, which began surfacing in large numbers in this country during the late 1980s, does not respond to the usual line of drugs physicians use to treat the lung-ravaging disease. It can be fatal if not treated properly, and it is highly contagious.

An 18-month-old Fillmore boy and a 25-year-old Oxnard woman are the first Ventura County residents infected with the disease, which has struck hundreds in Southern California in the past few years.

Medical experts believe the strains developed in foreign countries where tuberculosis is so prevalent that drugs to treat it are given out indiscriminately. With so much exposure to the drugs, the bacterium that causes the disease eventually becomes impervious to them.

Because the common treatments for the drugs are available across the counter in some countries--including Mexico--people often take only enough of the drugs to temporarily ease their symptoms, then stop. But the bacteria breed on, leaving the patient with a new, drug-resistant strain of the disease. The patient can then pass that virulent strain on to others.

Ventura County health officials, who have been keeping a wary eye out for an outbreak of the new strain of tuberculosis, said their fears are now being realized by the two cases reported in Fillmore and Oxnard.

"I'm concerned," said Dr. Chris Landon, director of the Pediatrics Diagnostic Clinic at the Ventura County Medical Center and the physician who is treating the 18-month-old child from Fillmore. "This is scary."

Officials believe the boy contracted the disease during extended visits to Fillmore by his grandmother, a resident of Los Angeles County who has the disease.

"What we are looking at in this county is 40 to 60 contacts with the grandmother alone," Landon added. "Every time you go to the gas station, or to the store to shop, that's a contact."

The boy's mother, father and two siblings have also tested positive for exposure to the disease and are being monitored to see if they develop symptoms.

County Public Health Nurse Marilyn Billimek said a second patient, a 25-year-old woman in Oxnard who recently moved here, had the drug-resistant tuberculosis when she arrived in the county.

Both patients are being treated with "second-line" drugs, more toxic and less effective medications used as a last resort when a patient does not respond to any of four "first-line" drugs, Billimek said.

The infected residents will be visited on a daily, or several times weekly, basis by health officials to make sure they receive proper medications. One of the most common problems with treating tuberculosis, Billimek added, is ensuring that patients take their medicine for its entire cycle, which can last up to two years.

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The California Department of Health Services reported 5,173 new cases of tuberculosis in the state in 1993; 55 of them were in Ventura County.

Dr. Sarah Royce, chief of health services statewide Tuberculosis Control Branch, said about 19% of those patients are resistant to one or more drugs. Only 1.6% are resistant to isoniazid and risampin, the two most successful drugs.

Both Ventura County patients are resistant to those two drugs. "This tuberculosis is resistant to four out of the six drugs we have," Landon said of the strain the Fillmore boy is fighting. "We're just making our best guesses at this point."

The age of the child makes him particularly vulnerable, Landon said. Within three months physicians will know whether the treatment they are using is working. The disease could spread throughout his body, affecting his brain, his kidneys, his bones and his spine.

The boy's chances of recovery are further complicated by his family's inaccessibility to good health care, Landon said.

The boy's father is a migrant worker, and in all likelihood, the family will return to Mexico when the growing season comes to a close this winter, making it impossible for public health officials to track his disease.

Landon said he believes the county is in danger of an outbreak of tuberculosis and other infectious diseases if Proposition 187, a ballot initiative that would bar illegal immigrants from public schools and deny them non-emergency health benefits, passes in November.

"With Proposition 187 people have no idea what they are fooling around with," Landon said. "If it passes, you are going to reap enormous health problems."

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Billimek said there is no cause for panic over the two cases. Although the disease is contagious, she said people must have shared close quarters or platters of food for it to be passed.

"You've gotta get a cough right in the face," she said. "And you've probably got to get it more than once."

Beside monitoring the patients and testing those who have come in contact with them, Billimek said the county plans outreach and educational programs in the communities considered most susceptible to the disease: cities with high concentrations of immigrants and poorer populations who have trouble getting adequate health care.

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