Wall Street Journal (03.01.13)
In South Texas, approximately 100 miles from Mexico’s border, US authorities placed in medical isolation a man who is infected with extensively drug-resistant tuberculosis (XDR TB), one of the most severe types of drug-resistant TB. The man had been traveling from his home country of Nepal for three months through 13 countries, including South Asia, Brazil, Mexico, and lastly through Texas. According to the US government, the man’s XDR TB is resistant to at least eight of the approximately 15 standard drugs used for TB treatment, and the United States has seen his XDR strain only once before in another patient of Nepalese origin. Department of Homeland Security (DHS) officials said the US Border Patrol took the Nepalese man into custody in late November 2012, as he attempted to cross the border illegally near McAllen, Texas. Five days later, he was moved to an Immigration and Customs Enforcement (ICE) detention facility in Texas, and put into "medical isolation" with suspected TB. Officials have since moved him to a Pearsall, Texas, ICE facility; he is the first XDR TB case in ICE custody.
A Customs and Border Protection official noted that none of the 12 Border Patrol agents tested for the disease contracted it from the Nepalese patient. The extent of the man’s travels—an 8-hour flight to Brazil, his travels by car, boat, and on foot—have implications for a widespread public health impact. Officials in the 13 countries the man visited on his journey must attempt to locate thousands of people with whom he came into contact, to find out if any were infected.
Dr. Martin Castellanos, director of Mexico's national TB program, acknowledges that it will be an extremely difficult problem to reconstruct the man’s exact route through Mexico, or any county. The World Health Organization's Stop TB Department is working with CDC to notify affected countries about individuals who may have been exposed to the man, and also attempting to get more details on those countries’ potentially infected people whom local authorities have contacted. CDC and DHS have refused to discuss details of the man's case, citing patient privacy.
XDR TB is an especially dangerous form of the disease that is resistant not only to the two most potent TB drugs, but also a handful of second-line drugs. According to CDC, XDR TB is rare in the United States, but it is an increasing threat in other countries, including South Africa and India. XDR TB treatment options are limited and can themselves be toxic. It is unclear how long the man will remain in care in the United States. Treatment can take years; however, TB patients are not infectious for the entire course of treatment.