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Atlanta man's TB diagnosis downgraded

THE NATION

Tests show that the attorney's strain is less severe, more treatable than initially thought.

July 04, 2007|Nicholas Riccardi | Times Staff Writer

DENVER — The Atlanta tuberculosis patient whose transatlantic voyage in May sparked an international public health incident has a less severe form of the disease than was initially diagnosed, health officials said Tuesday.

The Centers for Disease Control and Prevention said in late May that Andrew Speaker had the most dangerous form of the illness, known as extensively drug-resistant tuberculosis, and had left the country against the advice of medical authorities.

The CDC asked the Department of Homeland Security to bar him from flying back into the United States, and, for the first time in 44 years, used its quarantine power to order him into isolation should he return.

Speaker traveled to Europe for his marriage and honeymoon and returned via Canada. He persuaded a U.S. border inspector to let him drive back into the country despite his name being on a watch list. He surrendered to medical authorities in New York.

But on Tuesday, the CDC and the Denver hospital where Speaker was being treated, National Jewish Medical and Research Center, announced that Speaker actually had multiple drug-resistant tuberculosis. Unlike the more severe form, this type of TB can be treated with some drugs, and its survival rate is twice as high as that of the extensively drug-resistant strain, though still far lower than normal TB.

Speaker's doctors have postponed lung surgery scheduled for this month. They said at an afternoon news conference that they were optimistic for him and any people he may have exposed to the disease in his flights.

"These new tests results are good news for Mr. Speaker," said Dr. Charles L. Daley. "If someone has been infected by Mr. Speaker, we now have some drugs available to try to prevent them from developing TB."

The CDC said it would not know until at least the end of the month whether anyone was infected by Speaker, and defended its handling of the case. It said the public health protocols on handling extensively and multiple drug-resistant cases were identical.

"The patient has MDR, which is a significant public health concern," said Dr. Mitchell Cohen, director of the Coordinating Center for Infectious Diseases. "The public health actions CDC took in this case and is continuing to take are sound and appropriate."

In a statement, Speaker, a personal injury attorney, chided the CDC for its initial misdiagnosis and the way it handled his case. "In the future, I hope they realize the terribly chilling effect they can have when they come after someone and their family on a personal level," Speaker said. "They can, in a few days, destroy an entire family's reputation, ability to make a living and good name."

Speaker's father-in-law, Dr. Robert Cooksey, is a microbiologist at the CDC.

Using a sample collected in Atlanta, CDC tests on May 22 showed that Speaker had the most drug-resistant form of TB. But National Jewish retested Speaker in early June, using three different, fresher samples and another testing technique. Those tests found him to have multiple drug-resistant TB. The CDC replicated those results with remnants of its original sample and agreed with the new diagnosis.

Medical officials said they were not certain why the initial test showed the more virulent form, but warned that tuberculosis testing was an imperfect process.

"This discordance among results happens all the time in laboratories," Daley said.

nicholas.riccardi@latimes.com

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