Tackling TB in the exotic land of … North Carolina?

20 05 2010

Hi everyone, my name is Catherine Castillo Castro. I am a rising senior at Duke University and majoring in biology and pursuing a Global Health certificate.

This summer, I am serving as an intern in the Wake County Tuberculosis Control Program. Yes, that’s right, the same Wake County which houses the capitol of North Carolina, Raleigh, and is neighbor to Durham County, where you find Duke. And yes, you read correctly – tuberculosis.

Quick facts about tuberculosis (WHO):

  • infectious bacterial disease caused by Mycobacterium tuberculosis 
  • most commonly affects the lungs [but it can go anywhere! …so far, I’ve seen patients with TB in bones, joints, organs
  • transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease 
  • healthy people may have infection with Mycobacterium tuberculosis without symptoms [called a latent TB infection]
  • symptoms of active TB of the lung: coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats
  • treatable with a six-month [or more depending on the case, susceptibility of the strain to particular drugs, and patient] course of antibiotics
  •  preventive course of medicine exists which reduces chance that LTBI will develop into disease

When I told my friends about my summer plans, many were surprised to hear that tuberculosis still existed in the US, not to mention, right here in North Carolina. Many of us were under the impression that TB was something that had been eradicated in the US, “like polio”. While TB has become relatively uncommon in the US, especially in comparison to many countries which suffer from a high incidence (8 million new cases per year, 2 million deaths per year world-wide), in 2007 there were 13,299 cases reported in the US, which is about 4 per 100,000 population (WHO). That may not seem like a lot, but the problem is significant because it is concentrated in certain high risk populations which include: foreign-born individuals, persons with problems of substance abuse, HIV positive patients, and the homeless. 

Normal Chest X-Ray

(source: http://www.med.yale.edu/intmed/cardio/imaging/findings/normal_chest_pa2/graphics/rad1.gif)

Case of TB

(source: http://www.topnews.in/health/files/tuberculosis-cough.jpg)

As per the latest state report on TB (2008), North Carolina is ranked as the 22nd highest state for TB case rates in the nation (in 1980, it was #3).  In 2008, there were 335 total cases in the state,  40 of which were located in Wake County, and 15 in Durham County. 55% of these cases have at least one of the risk factors that I mentioned earlier, including being born in a country with higher TB incidence than the US, being homeless, excessive alcohol or drug use, and also being a resident of a long-term care or correctional facility, and being HIV co-infected. Even  in the short time that I have been looking at this issue, I have been able to see patients come in who fit these descriptions. To give you an idea of what population the program is serving today, the most recent data we have from 2009 states there were 22 total cases reported , 68% of which were foreign born (Mexico, El Salvador, Vietnam, India, Jordan, Morocco, Iran, Nigeria, Kenya, Zimbabwe), 77% of cases were male, 2 cases were HIV positive, and 1 case was homeless. 18 cases were of ages 25-64 years.

While TB is most common in these populations, there is something about TB that makes it a threat to the entire state and nation – it is very contagious, and if untreated, potentially fatal. So while 22 cases total doesn’t sound like a whole lot for an entire clinic to take care of, the reality of the situation is that if a program didn’t exist that actively screens, diagnoses, treats, and prevents the transmission of TB, the numbers would be higher, and potentially pandemic. One contagious case, if undetected, could be a threat to the entire nation in a short amount of time because anyone can get TB. In order to do this, the county TB control program must operate on many levels and serve many functions to a much larger population than just 22 people.

As I continue my time here in the program and under the mentorship of Dr. Jason Stout, the state TB Medical Director and assistant professor of medicine at Duke University Medical Center, I hope to get an insider’s perspective of just how TB is kept in control and thus generally off of most people’s radars thanks to state and national efforts. Additionally, I hope to serve the program by assisting in a couple of studies focusing on TB and HIV care quality improvement and patient’s attittudes towards preventive medicine for latent tuberculosis infections, and any other way I can contibute. I hope that through my posts, I can also contribute to other people’ understanding and awareness of communicable disease and it’s control in the US, especially regarding tuberculosis.  Stay tuned to learn more! 

– Catherine Castillo

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5 responses

20 05 2010
Michael

Great stuff!

21 05 2010
mariace matamoros

Well done Cath, I am proud of you. If I can help you in any way, just let me know….

21 05 2010
Sumi Ariely

Thanks Catherine! Also, great article in Reuters about Jason’s and team’s TB work as well (http://www.reuters.com/article/idUSTRE64F23P20100516)

21 05 2010
Homero

Those photos gave me the urge to get tested for TB in a hurry!

20 04 2011
Refugee Health « Global Health Dispatch

[…] you didn’t catch my first post, my name is Catherine Castillo Castro and I am a rising senior. This summer, I am interning at the […]

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