Oswaldo Juarez, a 19-year-old Peruvian studying English in the US, was diagnosed and treated by Dr. David Ashkin, who heads the Southeastern National Tuberculosis Center (SNTC) and is also from A G Holley State Hospital
According to Dr Ashkin Juarez's strain of extremely drug-resistant TB has never before been seen in the United States and is so rare that only a handful of other people in the world are thought to have had it.
"He is really the future," Ashkin said. "This is the new class that people are not really talking too much about. These are the ones we really fear because I'm not sure how we treat them."Reported to have cost $500,000 Oswaldo's treatment regime were as extreme as the disease
"When he first came in we really had to throw everything and the kitchen sink at him,"
"It was definitely cutting edge and definitely somewhat risky because it's not like I can go to the textbooks or ... journal articles to find out how to do this."
Drugs were pumped into his bloodstream intravenously three times a day, and he choked down another 30 pills, including some that turned his skin a dark shade of brown. He swallowed them with spoonfuls of applesauce, yogurt, sherbet and chocolate pudding, but once they hit his stomach, waves of nausea sometimes sent him heaving. He would then have to force them all down again.It appears that Oswaldo was lucky; XXDR-TB in Europe ended in death after treatment with a host of drugs. These two cases of drug resistance, as reported in Eurosurveillance, were a consequence of human intervention
the major role played by mismanagement of TB cases and sub-optimal infection control in determining the emergence of the problem.Systems can always be improved however management was not a factor in Oswaldo's disease
In contrast, according to the AP, Juarez had never been treated for TB.The CDC are concerned
"Drug resistance is starting to be a very big problem. In the past, people stopped worrying about TB and it came roaring back. We need to make sure that doesn't happen again
"We are all connected by the air we breathe, and that is why this must be everyone's problem."
Dr. Thomas Frieden
director of the U.S. Centers for Disease Control and Prevention
Previously it was thought that modern antibiotics were the silver bullet to infectious disease
"time to close the book on infectious diseases and declare the war against pestilence won."
William H. Stewart,
US Surgeon General
Unfortunate and optimistic, since those assertions were made the emergence and spread of bacterial resistance to antibiotics has raged. We now greet 2010 with a documented case of extra drug resistance that was caught by breathing - with the promise of more to come - Lee Reichman's timebomb
