In one of many cost-saving measures this year, Florida lawmakers have decided to close the state's last tuberculosis hospital, A. G. Holley in Palm Beach County. When it opened more than 60 years ago, it could care for up to 500 patients, a population that has dwindled to less than 50. Officials now are figuring out how to care for those people.
But though TB is not so common today, it remains a serious illness that's easily spread, very difficult to treat, and a critical threat to the young, the old, and people with compromised immune systems. You have to be around someone at a specific stage of the infection to catch it. Still, Florida ranks 6th in the nation for TB diagnoses. In Hillsborough County, 46 new cases were found last year; in Pinellas, 25 new cases were diagnosed.
Saturday is World TB Day, marking the anniversary of scientist Robert Koch's 1882 discovery of the tuberculosis bacterium. To find out more about TB, we spoke with Dr. John Sinnott, director of the division of infectious diseases and internal medicine at Tampa General Hospital and USF Health, and Dr. Beata Casanas, an associate professor in the division of infectious diseases at USF and director of the Tuberculosis Clinic at the Hillsborough County Health Department.
Why is TB an important disease to watch?
Casanas: It's a disease that has been with us since the beginning of time. It is airborne. You pick it up by inhalation, so you don't need to do anything special to acquire it. With TB all you need is to be around someone who has symptoms. In Hillsborough, we have 80 to 100 active cases at any given time. The majority are in foreign born individuals, but we have quite a few who acquired it locally. TB is the number one killer of HIV-infected people.
Sinnott: You can acquire it passively, in an elevator or in an airplane cabin. It's everywhere in the world including the bay area. You can become infected and not have symptoms for decades. But the illness can be triggered by stress, advancing age, treatment for other illness such as cancer. It's easily spread, easily caught and very hard to treat.
Tell me about treatment.
Sinnott: It's horrible. The pills are big and uncomfortable to take. They make you sick to your stomach and can give you headaches. You may have to take 16 to 30 pills a day, for months and months.
Casanas: Someone from the health department watches the patient swallow each pill every day (because the bacteria can become drug-resistant if the protocol is not followed precisely). We have disease intervention specialists who go to your home or your workplace, wherever you are, physically bring the pills to patients and watch them swallow the entire regimen.
What happens when drugs don't work?
Sinnott: In India and Russia there is totally resistant tuberculosis which is only curable with surgery. We remove the infected part of the lung.
Why is it so hard to treat?
Casanas: Tuberculosis is caused by a specific group of bacteria that divides once every 24 hours whereas E. coli, for example, divides about every 20 minutes, which is why 10 or 20 days of antibiotics kills it. With TB, you only get one chance to kill it every day: when it divides.
Is there a vaccine?
Casanas: Not really. We have one called BCG which is given only to infants in certain parts of the world, but it only protects against neurological TB, meningitis disease. It doesn't work against pulmonary TB.
What about people who think they could never get TB?
Sinnott: I have a message for those people. TB has not been eradicated. Probably 10 percent of people around Tampa, for example, have been exposed to TB. They don't spread it until they have active disease in the lungs, active coughing. But we mustn't let our guard down against this vicious killer.