This TB is whipping me.
December 2, 2004 7:03 AM   Subscribe

With a newly indurated PPD in my arm, I went looking for tuberculosis resources. According to the WHO over 2 million people a year die of tuberculosis. About a third of the 40 mil. people infected with HIV worldwide are also infected with TB. Successful treatment takes 6-9 months of powerful antibiotics, but that's assuming the bacteria in your body aren't drug resistant. Epidemics of drug resistant TB are raging in some parts of Central America and in the Russian prison system. Paul Farmer is the man for treating it, and quite a good man in general. On the plus side, possibly having TB puts me in good company: Orwell, Kafka, Chekhov, Chopin, and the 70s favorite mummy, King Tut all had it. Every one of the Brontes did too, and they were all geniuses. Of course they all died of it. On a more sober note, if I do have to get treatment, but I refuse, I might be ordered to take medications by a judge.
posted by OmieWise (11 comments total)
Paul was also the subject of a recent biography by Tracy Kidder called "Mountains Beyond Mountains". A very good read.

MDRTB is a fantastically dangerous bug and it is absolutely cheaper, from a public health perspective, to treat it now in Siberia and Lima than to wait for it to spread.
posted by sohcahtoa at 7:12 AM on December 2, 2004

don't forget keats.
posted by scrim at 7:23 AM on December 2, 2004

Excellent first post.
posted by driveler at 7:26 AM on December 2, 2004

That sucks you have to deal with this, but at least the common drug doesn't commonly cause side effects according the NIH. A friend if mine in college had it assymptomaticly when he moved here from China as a 13 year old and he didn't have any horror stories about the drugs. Do you know who you caught it from? Here's a cheer up link if you'd like =)
posted by RemusLupin at 7:54 AM on December 2, 2004

There appears to be good news on the TB vaccine front.

Almost all regimens now use more than one drug--usally a combo of INH (isoniazid, which does have serious side effects, even if they're asymptomatic) and Rifampin, which makes your pee, tears, and other body fluids orange. PZA is also commonly included in the regimen. TB is a tough bug to get rid of, so you *have* to stay on the meds for the entire time. DOT (Directly-observed therapy) is the common standard now, to make sure people take their meds daily. It's cost-effective and easy to do.
posted by gramcracker at 8:58 AM on December 2, 2004

You could ask to be part of a trial of various fungus on TB.
posted by rough ashlar at 9:29 AM on December 2, 2004

posted by TwelveTwo at 9:35 AM on December 2, 2004

Sorry about the positive test, but it does not necessarily mean you have TB, and there are treatments today. Most people can tough out most treatment regimens if a cure is in sight, speaking from experience (though not with TB). It would be good to try to figure out who might have exposed you so that they could get treated.

In the 1930's, they worried that my mother (child of struggling immigrants during the depression) might have TB. She was thin, coughing, "shadows" on the lung x-rays, etc.. So, they prescribed the only available "treatment" at that time. They sent her to the country to a sanitorium at state expense. There she was given lots of food, fresh milk, and made to sleep on a screened porch even in winter (she remembers waking up with frost on her blanket and with the water jug frozen), since fresh air was thought to be good for TB. She gained 20+ pounds and went home healthy (turned out she never did have TB, we found out later). Others at that place were not as lucky as her.
posted by gudrun at 9:39 AM on December 2, 2004

You lucky b*gger, Omiewise! I've had 2 shots of BCG vaccine and still barely produce any reaction in a TB skin test (I do get an initial allergic flare to the stuff, but after 24 hours you can scarcely see where the test was done). I must have a weird immune system, I suppose.* It seems odd from a UK viewpoint that any doctor would consider treating someone for TB just on the strength of a skin test - we usually wait for a positive film or culture, although we do have some pretty neat fast PCR tests which can even detect the genes responisible for rifampicin resistance in the TB.

*I have a worse track record for smallpox vaccination - had three of the things without producing the required scarring. Obviously my immune system doesn't recognise smallpox as a pathogen!
posted by tabbycat at 1:29 PM on December 2, 2004

I also get false positives due to the BCG vaccine, and they wanted a lung x-ray before they did anything. I don't know how things are in the UK, but I would guess they're similar, so if you really don't have tuberculosis it seems unlikely you'll be subject to the barrage of medication.

And tabbycat:
...had three of the things without producing the required scarring...

posted by Tikirific at 7:00 PM on December 2, 2004

I knew a medical resident who died of fulminant liver failure from isoniazid after his PPD came up positive.

They say that's a very rare complication, but when you look at the actual numbers in terms of positive PPD actually converting to active pulmonary (or extrapulmonary) TB, you begin to wonder if your own personal concerns don't outweigh the importance of public health policy.

BCG seems to have about an 88% protect rate, but the vast majority of those who get BCG come up PPD positive. If I came up positive after BCG, I wouldn't have isoniazid on a bet. I doubt I'd have it anyway unless my chest x-ray was abnormal.

Directly Observed Therapy, the current euphemism for TB jail, is occasionally imposed in New York State, but you have to have evidence of a cavitary (necrotizing) pulmonary lesion. The folks who wind up getting it are usually pretty sick and often mentally ill as well. The TB cells in Riker's Island are not like the rest of the jail - they're comfortable, clean, well-lit, and have TV's and other amenities.
posted by ikkyu2 at 4:40 AM on December 4, 2004

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