Nicole Kidman is amazing in The Hours, the role that earned her an Academy Award. From the haunting music of Philip Glass to the fake nose on Kidman, Hours provides a powerful look into the day of a life. I find it ironic that in the movie Meryl Streep (the best actress ever–in my humble opinion) plays a character who sees a movie star outside the flower shop, because in the book, the movie star is Meryl Streep. “Meryl, Meryl, Meryl, Meryl, Life is but a dream.”

I love Nicole Kidman, and think she’s a wonderful actress. However, she should know not to smoke. In Moulin Rouge, her character died of TB. Didn’t all the hacking and coughing up blood put her in fear of lung disease?

Andrew Speaker has been in the news since May 31 because of his MDR-TB (multi-drug resistant tuberculosis). Talk about irony: Speaker is the Atlanta-based personal-injury lawyer who might have infected co-passengers on the airplane flights. Ouch! But as of early June, I still don’t have all the medical facts to understand what’s going on.

First of all, let’s define tuberculosis (TB). It’s a bacteria that has been around for centuries and has been responsible for the deaths of millions and millions of people. When TB infects a person, it doesn’t normally cause havoc right off. Instead, it’s kind of a time-bomb in the sense it can sit and sit and sit (like Ryan Seacrest announcing the results on American Idol) in the organs, and then months to years later-kaboom! Pneumonia, night sweats, weight loss, kidney damage, and so forth can occur. That is why so many people have died from TB.

It’s estimated that two to five percent of people who “catch” TB will have active TB within three months. Under the age of 35, about 10-20 percent will develop active TB sometime in their lives-usually when they’re old or the immune system isn‘t doing so well. That’s why HIV+/AIDS people are more at risk for active TB. TB was on the decline from 1953 to 1985, but it started to increase when HIV became prevalent.

Since TB infection doesn’t just jump out at you, PPD testing is done to see if the bacteria is hiding somewhere in the body. An antigen, purified protein derivative (PPD), is injected just under the skin, and 48-72 hours later it’s checked to see if there’s a reaction. So when you hear someone is PPD+ (which I assume Speaker was), it means they have been infected with TB. But it doesn’t mean they have active TB or that they are infectious.

If someone is PPD+, antimicrobial drugs can be recommended to treat the TB bacteria in hopes it won’t become active later in life-like your retirement party or your 50th wedding anniversary. The problem is, ahem, many patients don’t take their TB antimicrobial medicines correctly, and so drug-resistant strains of TB keep popping up (like Lindsay Lohan’s face on the news).

MDR-TB is when the two main drugs to treat TB fail: isoniazid and rifampin. If the TB bacteria is resistant to even more antimicrobials, it is called XDR-TB (extensively drug resistant TB). XDR-TB sounds like a model of a stereo system, but it isn’t because XDR-TB puts you in bad treble. (Sorry, but like MDR-TB, I just couldn’t resist.)

So back to the TB lawyer-what’s the deal? I don’t know how they know he has XDR-TB since he doesn’t have symptoms. Is he just PPD+, or does he have active TB?
I hate the news. They often just stir the pot but don’t serve us the… TB dinner.

© John S. Hong, MD, MS July 4, 2007

This entry was posted on Wednesday, July 4th, 2007 at 8:47 am and is filed under Pulmonary, Infections. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.