Man With Rare TB Easily Eluded Safeguards

By David Brown
Washington Post Staff Writer
Thursday, May 31, 2007

The Atlanta man with extensively drug-resistant tuberculosis who sparked an international health alarm by flying to Europe and back for his wedding twice ignored requests to stay put and not travel, officials said yesterday.

He apparently also shortened his honeymoon -- which included stays in both Greece and Italy -- and returned home early in order to avoid the complicated procedure being put together to get him back to the United States in a way that would not expose other people to his dangerous microbe.

Those were among the details that emerged yesterday about a bizarre cat-and-mouse game that reveals both how seriously public health officials take the threat of transcontinental spread of infectious disease and how easily the safeguards can be eluded.

"There is some indication of deceitfulness on the part of the individual," said Russ Knocke, spokesman for the Department of Homeland Security, which was in the process of putting the patient's name on a "no-fly list" last Thursday when it learned he was already on a plane headed for Montreal.

Knocke also said last night that investigators were looking into how the man and his wife got through U.S. customs in Champlain, N.Y., when all border crossings had been given his name and told to hold him if he appeared.

The man, now back in Georgia and undergoing treatment, provided a different version of events to an Atlanta newspaper, saying he was never explicitly told he could not travel. He could not be reached yesterday. His name and identity have not been revealed; he is said to be in his 30s.

Extensively drug-resistant tuberculosis (XDR-TB) is neither more contagious nor more virulent than ordinary TB. Once acquired, however, it is very difficult to cure.

Authorities in the United States and several European countries are tracking down about 50 people who sat near the man on his Atlanta-to-Paris flight on May 12, and 30 people on his Prague-to-Montreal return May 24. They will be offered testing to see if they are infected.

This chronology emerged yesterday:

Early this year, the man fell, hurt his ribs and got an X-ray, which revealed an abnormality in the upper lobe of his right lung suggesting tuberculosis. He had no symptoms then and has reportedly felt well throughout the entire episode.

In early March he underwent a procedure to get a sample of sputum from his lungs, and by the end of the month, lab cultures revealed he had TB.

Further study of the bacterium showed on May 10 that it was "multidrug-resistant" -- it could not be killed by the two most commonly used drugs. TB patients are generally treated with at least three different antimicrobial medicines.

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