A Killer Returns
11/23/1992 at 01:00 AM EST
In the last century it was the Great White Plague, afflicting the likes of Keats, Chekhov, Chopin, Thoreau and the Brontë sisters. As late as 1911 it remained the leading cause of death in the U.S. Then, with development of drug therapies and good public health practice—together with growing use of the X ray—the disease was brought under control. It reached a historical low in the U.S. in 1984, and its disappearance seemed within reach. But now, alarmingly, tuberculosis is back.
In the past two years, the incidence of TB in the U.S. has increased 12 percent according to Dr. Lee Reichman, 54, a professor at New Jersey Medical School in Newark and president of the American Lung Association. "TB control is a veritable disaster," says Reichman, who has been studying the disease for 21 years. "Its resurgence was entirely predictable and largely preventable."
Reichman, who lives in Tenafly, N.J., with his wife, Rose, who heads a marketing communications firm, and their son, Daniel, 23, a paralegal in a law firm, and daughter, Deborah, 19, a sophomore at Oberlin College, discussed TB's disturbing revival with writer-reporter Toby Kahn.
What exactly is tuberculosis?
TB is an ancient infectious disease—there's been evidence of it in Egyptian mummies—that in most cases attacks the lungs. One third of the world's population test positive for tuberculosis, including 10 million Americans.
Most of these people, however, are not sick. They carry live tubercle bacilli, but their body defenses are able to contain the infection. Only 27,000 people in the U.S. have active TB, and it is only these who have enough of the bacillus in their chest cavities—100 million organisms as opposed to less than 10,000 for inactive carriers—to spread the disease.
Some doctors hare advised people to wash their hands after using public transportation or otherwise coming in contact with large groups of strangers. Is this necessary?
No. TB is very difficult to catch because it requires prolonged contact. It's almost impossible to get it by riding in elevators, buses or subways, or giving a quarter to a panhandler or from anything a TB patient has touched, smoked, used or eaten with. Even swallowing tubercle bacilli is extremely unlikely to cause infection.
TB is spread from person to person through the air. It generally takes six months of eight-hour-a-day contact with a person who has active TB and is not under treatment. It is only through coughing that an aerosol effect takes place in which the germs break up into tiny enough particles to get into the lungs. I've been treating TB since I was an intern in 1964, and I've never worn a mask. I test negative.
If it is so hard to contract, why is there a resurgence of the disease?
This disease had sort of been forgotten, but it was not gone. Until the early 1980s, most of the 10 million Americans who tested positive for TB were successfully warding off the disease. Then along came AIDS. People who were carrying the TB bacillus and whose immune systems were being attacked by HIV were suddenly at very high risk for active tuberculosis. AIDS is a major reason for the resurgence of TB—along with a breakdown of public health services.
How did this breakdown occur?
People thought TB was under control and removed funding. Scientists stopped doing research, people weren't trained about TB, and service to make sure people took their medicine stopped.
Who are at risk for catching TB?
Family members and friends in close contact with a person with active TB. Also at risk are steroid users, diabetics and the elderly whose immune systems have been weakened, as are people whose lungs have been damaged by such substances as silica dust and the homeless who share shelters with TB victims.
What are the disease's symptoms?
Anything you can name or nothing. TB is a great mimic—it can look like a cold, bronchitis, flu. So unless a doctor is thinking about TB, he or she may miss the diagnosis.
Is that a problem? Are many doctors not testing for the disease?
We see people all the time whose doctors told them they had bronchitis and to take an antibiotic. They come back four months later, and the physician finally takes a chest X ray—and it's TB. Doctors don't think about TB since they see so few cases of it.
How curable is it?
Two years ago we could cure any case of TB in six months—nine months if the patient was HIV-infected. Most of the 1,900 or so people who die of TB in the U.S. every year do so because they are never properly diagnosed with the disease. But now a new strain of drug-resistant tuberculosis is a growing problem in several areas of the U.S.—particularly in New York, Miami and Newark, N.J.
Where did the new strain come from?
We've found that, despite doctors' instructions, fewer than half of TB patients take their medicine for the full six months. Then too, at least three drugs must be taken together to be effective. When they are not taken long enough or in the right combination, the organisms they are meant to destroy can grow stronger and become drug resistant.
What needs to be done to reverse the TB resurgence?
First of all, people have to realize that TB is back—and back with a vengeance. It needs to be confronted with dedication, care and resources. We need sufficient resources to make sure that every TB patient gets the necessary medicine and takes it faithfully. Only then can TB be eradicated.