The misdiagnosis of Andrew Speaker’s tuberculosis underscores the pitfalls and limits of tests to identify the disease, federal health officials said.
Speaker made headlines this past spring when he traveled to Europe after being diagnosed with an extensively drug-resistant strain of TB.
Doctors at Denver’s National Jewish Medical and Research Center – where the 31-year-old Atlanta lawyer is being treated – said Tuesday the first diagnosis was wrong and that Speaker’s disease can be treated.
The problem was in the TB test, in which bacteria from the patient are grown in petri dishes and exposed to different drugs to see what medicines work.
The test is “antiquated, crude … and time-consuming,” said Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases.
“It takes weeks, and you’ve got people walking around not knowing what they’ve got, getting the wrong medicine,” Fauci said.
At a news conference Tuesday in Atlanta, Rear Adm. Mitchell Cohen, an official with the Centers for Disease Control and Prevention, said: “We have a very significant problem in not having the type of diagnostic test that we truly need.”
Speaker’s diagnosis changed from extensively drug-resistant TB to multidrug-resistant, and he is being treated with six medications.
Doctors are waiting to see how he responds and whether he needs surgery.
“I am incredibly relieved,” Speaker said in a statement.
Speaker lashed out at the CDC, which issued its first isolation order in 43 years to prevent him from traveling.
“It is true that at times the government must act to protect the public’s welfare,” Speaker said in the statement.
“I hope they realize the terribly chilling effect they can have when they come after someone and their family,” Speaker said. “They can, in a few days, destroy an entire family’s reputation, ability to make a living and good name.”
Dr. Charles Daley, head of the infectious-disease division at National Jewish and Speaker’s physician, said: “This is a weakness in the diagnostic.”
“Even in reference labs, the state of the art is such that there is variance of results,” he said.
In Speaker’s case, the CDC’s laboratory initially tested a culture and determined portions in the specimen were extensively drug-resistant.
National Jewish’s laboratory later tested organisms from Speaker obtained in April, May and June and found each time that the cultures were “susceptible” to tuberculosis drugs.
Further tests at the CDC lab had the same results.
“This is an important finding,” Daley said. “We now have a regimen that is more potent. We believe his prognosis is better.”
Daley said he does not know why the first cultures showed extensive drug resistance.
“I don’t think we can ever figure this out,” he said.
Speaker is still under a city public-health order to stay isolated, Daley said.
Cohen, director of the CDC’s Coordinating Center for Infectious Diseases, said multidrug-resistant tuberculosis is still a dangerous illness and that Speaker would still be banned from travel on commercial airlines. The case would not be handled any differently, he said.
“It was better to err on the side of caution to reduce exposure to other individuals,” Cohen said.
National Jewish has treated about five other cases of multidrug-resistant TB in the past year. There are about 125 diagnosed cases in the United States every year.
Chances of curing a standard case of TB are between 95 percent and 97 percent, Cohen said. Cure rates for a multidrug-resistant strain are about 70 percent, Cohen said.
A new diagnostic test based on molecular and genetic analysis that can be completed in hours is needed, NIAID’s Fauci said.
“We’re really not going to get anywhere until we get a good state-of-the-art diagnostic,” he said.
Staff writer Jeremy P. Meyer can be reached at 303-954-1367 or jpmeyer@denverpost.com.
