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News of the Day ... In Perspective

4/12/2007

Jailing of tuberculosis patient sparks debate

A 27-year-old man in Phoenix is locked in a jail cell with negative-pressure ventilation, perhaps for life, because he failed to heed doctors’ instructions to wear a mask in public. He is infected with an extensively drug resistant strain of tuberculosis, XDR-TB, which is considered virtually untreatable.

He told the Associated Press he was treated worse than a jail inmate, kept all alone inside four walls. He said he had not even seen his own reflection in months.

Only one other person has been detained in Phoenix in the past year. Texas has placed 17 patients in the past year in an involuntary detention facility in San Antonio.

XDR-TB is apparently a new strain that is found throughout the world, including pockets in the former Soviet Union and Asia.

In the U.S., there were a total of 13,767 cases of tuberculosis reported in 2006 (Arizona Daily Star 4/3/07).

According to a report from the Pima County Health Department to the Public Health Committee of the Pima County Medical Society, the case rate in Arizona, which ranks 11th in tuberculosis morbidity nationwide, rose to 5.0 per 100,000 in 2006, a 9% increase, after declining from 7.2/100,000 in 1995 to 4.6/100,000 in 2005. Foreign-born individuals accounted for 57% of the 2006 cases, and 67% of the infected foreign-born individuals were from Mexico.

Legal immigrants are screened in their country of origin as long as 2 years before entry. The proportion of the problem attributable to illegal aliens is not known.

Arizona has the highest percentage of tuberculosis cases diagnosed in correctional facilities. Forty percent of all inmates in Arizona detention centers are Mexican nationals who entered illegally (Newsmax.com 3/15/07).

A pilot project by the Arizona Department of Health Services found the Arizona Department of Corrections to be mostly in compliance with the pertinent recently revised rules.

Additional information:

  • “Illegal Aliens and American Medicine,” by Madeleine Pelner Cosman, J Amer Phys Surg, Spring 2005.

  • Before the antibiotic age, radiation therapy was used for many infectious diseases, including “glandular tuberculosis,” with the most impressive results seen in gas gangrene. When antibiotics became available, this treatment fell completely out of favor. In a patient who otherwise faces life imprisonment and early death, cautious consideration might be given to older modes of therapy. See: Kelly JF, Dowell DA. Roentgen Treatment of Infections. Chicago, Ill.: Year Book Publishers; 1942. Also Berk LB, Hodes PJ. Roentgen therapy for infections: an historical review. Yale J Biol Med 1991;64:155-165.

 

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