TB, an Atlanta lawyer and 52 South African patients

At first glance a diagnosis of tuberculosis seems to be all that unites Andrew Speaker, an Atlanta lawyer, with 52 impoverished South Africans who died of drug-resistant TB in a remote rural area in 2005. The cases “couldn’t appear more different on the surface,” said Gerald Friedland, M.D., professor of medicine and epidemiology at Yale, at internal medicine grand rounds in August.

Speaker made headlines last spring after being diagnosed with extensively drug-resistant tuberculosis (XDR-TB) and then putting fellow airline passengers at risk by traveling on seven separate commercial flights. He later received treatment at a top-rated TB hospital. Most of the rural South Africans, on the other hand, had all died by the time laboratory testing revealed the diagnosis of XDR-TB, said Friedland, who reported the cases in The Lancet in 2006.

Friedland said both Speaker and the South Africans suffered from the slowness of TB diagnostic tests and limited treatment options for drug-resistant TB. Friedland says the presence of growing numbers of cases with XDR-TB underlines the longstanding neglect of TB and the more recent rise of TB and HIV coinfection. “If there’s a silver lining,” he said, “it’s that the world attention focused on both of these cases has been a wakeup call for the need for resources to promote scientific advances and improved care for TB.”


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