Doctors Stumped? It Could Be TB

But his symptoms only worsened: He developed bloating, asthma, diarrhea, chronic vomiting, fevers, a bloody cough, inflammation of the tissues around the heart, and unforgiving pain in his stomach and back.

No one guessed what it was until 11 years after he fell ill, when a doctor tried putting him on tuberculosis medications. He felt better in three weeks.

"I don't know how I survived it, or how I didn't shoot myself," Glasberg, 49, said of what doctors ultimately assumed was a TB infection. "They can find TB in a 5,000-year-old mummy, but they can't find it in me? There's something wrong here."

Experts agree, saying cases such as Glasberg's are symptoms of a growing concern: Many doctors in the United States no longer recognize TB, one of the most dreaded diseases of the 19th and early 20th centuries.

"It's the biggest thing that bothers me in my entire career," said Dr. Lee Reichman, executive director of the Global Tuberculosis Institute at the New Jersey Medical School. "People don't think of it."

Though relatively rare in the United States today, tuberculosis remains among the most common infectious diseases in the world, having killed 1.7 million in 2004, according to the World Health Organization. And it remains a danger in the United States, especially in states such as California, with large numbers of immigrants from countries where the disease is endemic. (Glasberg, though a U.S. citizen, was raised in Chile.)

Last year 2,903 of the 14,093 cases in the U.S. were reported in this state -- more than three-quarters of them among foreign natives.

Tuberculosis bacteria can remain dormant for years, then begin multiplying, particularly if the host's immune system is weakened. The disease still is generally treatable if caught early. But if diagnosis is delayed, it can permanently harm or kill its victims and spread to others.

"Delayed diagnosis is a concern that obsesses people in TB control," said Dr. Kenneth Castro, director of the division of tuberculosis elimination at the U.S. Centers for Disease Control and Prevention.

"There are many outstanding physicians who don't see it anymore and therefore lose proficiency to promptly diagnose and treat it."

Though government officials do not track how often TB is missed or misdiagnosed, some research and high-profile cases have fueled experts' concerns.

A study of 158 patients in Maryland, published last year in the International Journal of Tuberculosis and Lung Disease, showed 45% to be undiagnosed 30 days after they first contacted a doctor, with 16% remaining so 90 days after.

Some health agencies have mobilized: The National Heart, Lung and Blood Institute has been helping to fund a TB curriculum in medical and professional schools. The CDC has sponsored four national centers for doctors to call to request diagnostic help when TB is suspected. And the California Department of Health Services is participating in a national study of delays in diagnosis of foreign-born TB patients.

Two initially misdiagnosed cases recently grabbed the attention of top health officials because of who was infected: the spouses of CDC researchers.

In 2004, Dr. Claudia Lacson, who was pregnant with her first child, fell into a coma 10 days after she was admitted to an Atlanta hospital complaining of severe headaches and a persistent fever.

Lacson, a physician married to a CDC behavioral scientist, initially went to the emergency room a week before she was admitted; doctors sent her home with sinus medication. Days before she fell into the coma, doctors had been treating her for bacterial meningitis, even though they were reminded that Lacson had tested positive for exposure to tuberculosis in the past, said her husband, Romel.

Lacson was a native of Bogota, Colombia, and had treated many TB patients while she trained as a physician there. And Lacson herself suspected TB was causing her illness, underlining "tuberculosis meningitis" in an internal medicine textbook from her hospital bed, her husband said.

But by the time doctors began TB treatment, it was too late. She died July 31, 2004, at 38, several weeks after she gave birth to a daughter, who also did not survive.

"If they treated her ... from the beginning with TB medication, I do believe she would be alive today," said Romel Lacson, who worked in the CDC's Division of HIV/AIDS Prevention at the time and now promotes TB awareness at the University of South Carolina. "Of course I do."

Castro, the TB division head, said the death was a sad example of what happens when such a case goes unrecognized too long.

"You have a young woman that died of a curable disease. Shame on us, collectively," he said.