In May 2007, the U.S. Centers for Disease Control and Prevention (CDC)
issued an order to quarantine a man who flew on two transatlantic flights with a rare, dangerous form of tuberculosis
and potentially exposed passengers and
crew to the infection.
The Atlanta man was believed to be infected with the form of the tuberculosis bacteria known
as "extensively drug-resistant" TB, abbreviated XDR TB. Tuberculosis is a
bacterial infection that primarily affects the lungs, and the infection is
spread via air droplets released during coughing, spitting, sneezing, or
talking. XDR TB causes the same symptoms that a person would develop with TB. If TB disease is present, cough and fever would be the predominant symptoms. XDR TB is a rare form of the disease that is resistant to the drugs
routinely used to treat tuberculosis infections and is extremely difficult to
treat. The few treatment options available for XDR TB are less effective and
associated with worse outcomes than traditional antibiotic therapies for TB. In
2006, there were two documented cases of XDR TB in the U.S.
Health authorities were aware of the man's condition and had warned the man
against traveling, but he stated that compelling personal reasons led him to fly
from Atlanta to Paris on May 13. On May 24, he returned to North America on a
flight from Prague to Montreal and entered the U.S. by car. While it is not
certain that passengers and crew on board the flights were infected, the CDC
recommended that passengers and crew on those flights be tested for TB
infection. Particularly those seated within two rows of the infected man are at
greatest risk for infection.
After his return to the U.S., the man cooperated with authorities and
voluntarily entered a hospital in Atlanta and was placed in respiratory
isolation to prevent spread of the infection. This event marked the first time
since 1963, when a patient with smallpox was quarantined, that the CDC
issued this type of isolation order.
Extensively drug-resistant tuberculosis (XDR TB) is a relatively rare
type of multidrug-resistant tuberculosis (MDR TB). It is resistant to almost all
drugs used to treat TB, including the two best first-line drugs: isoniazid and
rifampin. XDR TB is also resistant to the best second-line medications:
fluoroquinolones and at least one of three injectable drugs (i.e., amikacin,
kanamycin, or capreomycin).
How is XDR TB spread?
Drug-susceptible (regular) TB and XDR TB are spread the
same way. TB germs are put into the air when a person with TB disease of the
lungs or throat coughs, sneezes, speaks, or sings. These germs can float in the
air for several hours, depending on the environment. Persons who breathe in the
air containing these TB germs can become infected.
TB is not spread by
shaking someone's hand
sharing food or drink touching bed linens or toilet
seats
sharing toothbrushes
kissing smoking or sharing cigarettes
Why is XDR TB
so serious?
Because XDR TB is resistant to the most powerful first-line and
second-line drugs, patients are left with treatment options that are much less
effective and often have worse treatment outcomes. XDR TB is of special concern
for persons with HIV infection or other conditions that can weaken the immune
system. These persons are more likely to develop TB disease once they are
infected, and also have a higher risk of death once they develop TB disease.
Who is at risk for getting XDR TB?
Drug-resistant TB (MDR or XDR) is more
common in people who:
Do not take their TB medicine regularly
Do not take all of their TB medicines
as told by their doctor or nurse
Develop active TB disease again, after having
taken TB medicine in the past
Come from areas of the world where drug-resistant
TB is common
Have spent time with someone known to have drug-resistant TB
disease
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria. Symptoms include weakness, fever, weight loss, night sweats and in worse cases, chest pain, shortness of breath, and coughing up blood. A person with an active infection (a positive TB skin test, abnormal chest x-ray and TB bacteria in their sputum) requires treatment with izoniazid, rifampin, ethambutol and pyrazinaide.
ICU psychosis is a disorder (also a form of delirium or acute brain failure) in which patients in an intensive care unit or a similar setting experience a cluster of serious psychiatric symptoms. These symptoms include anxiety, reastlessness, hearing voices, hallucinations, nightmares, paranoia and more. Causes of ICU psychosis are generally from a combination of environmental and medical conditions.
Bioterrorism is a form of terrorism where there is the intentional release of biological agents such as viruses, germs, or bacteria. Diseases caused by bioterrorism agents include anthrax, botulism, plague, smallpox, tularemia, brucellosis, food poisoning, Q fever, ricin toxin poisoning, cholera, epidemic typhus, viral encephalitis, XDR TB, and MDR TB.
Lymph nodes are an important component of the body's immune system and help
in fighting infections.
They are small, soft, round or oval structures that are found throughout the
body and are connected to each other in chain-like (lymphatic chains) fashion by
channels similar to blood vessels. Each individual lymph node is covered
by a capsule made up of connective tissue.
Within the capsule, lymph nodes contain certain kinds of
immune cells. These
cells are mainly lymphocytes, which produce proteins that capture and fight
viruses and other microbes, and macrophages, which destroy and remove the
captured material.
Where are the lymph nodes located in the body?
Lymph nodes are located throughout the body. Some are directly under the skin
while others are deep inside the body. Even the most superficial (close to the
skin) lymph nodes are usually not visible or palpable (felt by touchi...
In May 2007, the U.S. 
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