Faculty Bibliography

Another goal is to increase treatment of drug-resistant cases to 110,000 from about 15,000 in 2005. Such cases occur most commonly in Africa, Eastern Europe, China and India. An even more serious form, known as extremely drug-resistant tuberculosis, does not respond to any of the fluoroquinolone class and to at least one of three second-line drugs (amikacin, capreomycin and kanamycin) that are given by injection

There are about 450 laboratories in the world now that can detect drug-resistant tuberculosis, although many are not performing to capacity, Dr. Mario Raviglione, who directs the health agency's tuberculosis department in Geneva, said by telephone. Other countries may send teams to well-run laboratories elsewhere to learn how to determine the sensitivity and susceptibility of the bacteria isolated from each case to various drugs. Under the plan, all laboratories would perform 1.8 million cultures for tuberculosis in 2007 and 2.2 million in 2008, up from the estimated 200,000 in 2006. The laboratories would perform 750,000 drug-susceptibility tests in 2007 and 900,000 in 2008, up from 75,000 in 2005

An even more serious form, known as XDR-TB for extremely drug-resistant tuberculosis, does not respond to any of the fluoroquinolone class and to at least one of three second-line drugs (amikacin, capreomycin and kanamycin) that are given by injection. There are about 450 laboratories in the world now that can detect drug-resistant tuberculosis, although many are not performing to capacity, Dr. Mario C. Raviglione, who directs the health agency's tuberculosis department in Geneva, said in a telephone interview. Under the plan, all laboratories would perform 1.8 million cultures for tuberculosis in 2007 and 2.2 million in 2008, up from the estimated 200,000 in 2006. The laboratories would perform 750,000 drug susceptibility tests in 2007 and 900,000 in 2008, up from 75,000 in 2005

Radiologists sometimes made house calls, usually for patients bedridden with a fractured hip. Dad's ''black bag'' was a portable X-ray machine the size of a large suitcase and heavy. Use of portable X-rays was limited, because the radiation exposure time was long and the quality of the films seldom matched those taken in an office. X-ray films were developed in a darkened room with the type of chemical solutions used for camera film. A technician mixed fresh solutions daily, and they stank. Radiologists would give a preliminary ''wet reading'' after looking at the X-rays before they dried. The digital age has eliminated those steps by making X-ray film obsolete. ''The more experienced eye can take in a complex pattern of shadows and images almost at a glance and become instinctively sensitive to an abnormal contour or shadow,'' said Dr. Joseph T. Ferrucci Jr., the emeritus chairman of radiology at Boston University, whose radiologist father was one of my dad's colleagues

Speaking by phone to a Senate panel, Andrew Speaker contradicted some accounts by government officials about the timing of who knew what and when about his plans to travel abroad after being told that he had extremely drug-resistant tuberculosis. Speaker, 31, who is in isolation at a Denver hospital, created an international health scare by taking commercial flights for his wedding in Greece and honeymoon in Europe last month. He spoke from his room at the National Jewish Medical and Research Center in Denver to a Senate Appropriations subcommittee that oversees the Public Health Service. After statements by Dr

After statements by Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, or CDC, about her agency's role in detecting the extremely drug-resistant form of the disease and then notifying Speaker about it, he told the committee, 'A few of things you were told are simply not accurate.' Gerberding had just told the committee that her agency learned on May 18 that Speaker had left the country. Gerberding said that her agency did not determine that Speaker had the extremely resistant form of tuberculosis until May 22 and that it then started searching for him in Europe. Speaker said CDC officials, local health officials and his doctors knew of the resistance problem before the May 10 meeting. 'They were all discussing this, because of the fact that there was resistance,' Speaker said, 'and talking about getting me out to Denver.'

After statements by Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention, about her agency's role in detecting the extremely drug-resistant form of the disease and then notifying Mr. Speaker about it, he told the committee, ''A few of things you were told are simply not accurate.'' ''They were all discussing this, because of the fact that there was resistance,'' Mr. Speaker said, ''and talking about getting me out to Denver.'' Senator Tom Harkin, Democrat of Iowa and chairman of the subcommittee, said he suspected ''some bureaucratic mismanagement'' in how several government agencies handled Mr. Speaker's case, and announced that he would hold another hearing, but did not set a time

That chilling forecast is based in part on analyses by the organization that show that, on average, a patient infected with drug-resistant tuberculosis in 2004 was resistant to more drugs than a similar patient with that diagnosis in 1994, Dr. Paul Nunn, a TB expert for the organization, said Tuesday. About 420,000, or 5 percent, of the estimated 8.8 million new cases of tuberculosis in the world are resistant to many standard anti-tuberculosis drugs, Dr. Mario Raviglione, who directs the WHO's tuberculosis department, said in an interview. 'It is possible that in some settings drug-resistant tuberculosis could completely replace standard tuberculosis,' Raviglione said

At that point, [Robert Cooksey] said on television, Andrew's smear tests showed no tuberculosis bacteria 'and so, by the guidelines, he was not considered infectious' to others. But guidelines issued by the World Health Organization say that 'patients with multiple drug resistant tuberculosis should not travel until' no tuberculosis bacteria grow on culture tests performed in a laboratory. The Fulton County health officials said they 'preferred' that Andrew Speaker not travel but did not cite a specific reason. Ted Speaker said he asked a health official whether he was 'just saying this to cover yourself' and that the official replied, 'Yes.' [Julie Gerberding] also said that several times 'he helped us facilitate communication with his son-in-law and the wife,' Sarah. Cooksey's 'assistance was actually extremely helpful' in getting the CDC in cellphone contact with Andrew Speaker in Europe, Gerberding said, 'to help us determine how to help him get into a safer health care environment.'

That chilling forecast is based in part on the organization's analyses showing that on average, a patient infected with drug-resistant tuberculosis in 2004 was resistant to more drugs than a similar patient with that diagnosis in 1994, Dr. Paul P. Nunn, a TB expert for the organization, said at a news conference. Health officials say that Mr. Speaker's was not an isolated case because the extremely resistant form has been reported in 37 countries. With the growth of international travel, health officials say that TB anywhere is TB everywhere. About 420,000, or 5 percent, of the estimated 8.8 million new cases of tuberculosis in the world are now resistant to many standard antituberculosis drugs, Dr. Mario C. Raviglione, who directs the W.H.O.'s tuberculosis department, said in an interview. About 30,000 of the 420,000 cases are extremely drug-resistant, meaning they are resistant to first-line and a number of second-line drugs. Dr. Raviglione said the organization had begun to undertake statistical modeling studies to estimate how prevalent drug-resistant tuberculosis might become. Outcomes from such studies depend on a number of variables and none have been published. ''It is possible that in some settings drug-resistant tuberculosis could completely replace standard tuberculosis,'' Dr. Raviglione said