TMC PULSE

t m c » p u l s e | a u g u s t 2 0 1 7 19 S itting on the porch of her home in Houston's Sunnyside neighborhood, Lila White loves nothing more than watch- ing the cars drive up and down Scott Street and seeing what her neighbors are up to. This time last year, the porch was her only respite from the iso- lation imposed by the health department after she tested positive for tuberculosis. White, 57, landed in the emergency room at Ben Taub Hospital in July 2016. She thought she was dying. Normally a trim 115 pounds, she was down to an emaciated 99. Short of breath and unable to sleep, she had seen several doctors over several months, none of whom had diagnosed her properly. But when the ER doctors at Ben Taub examined her chest X-ray, they knew. White remained in the hospital for nine days, her bed wrapped in plastic to keep her from infecting other patients. When they sent her home, it was with strict instructions. "I had to stay in my house for about two months," White said. "I was glad to be out of the hospital and back at home. Most of the time I stayed in my room. I might come out and sit on the porch, but I had to wear a mask at all times." An ancient ailment Tuberculosis (TB) is an infectious disease that usually affects the lungs but can travel to other parts of the body. It is caused by bacteria that spread through the air when individuals with active TB cough, sneeze or spit. Although it is an ancient ailment—one study published in the journal Nature Genetics shows that TB originated in Africa some 70,000 years ago—it remains difficult to diagnose. Not everyone infected with TB becomes sick. People with latent TB infection do not feel sick, do not have symptoms and cannot pass the disease to anyone else, according to the Centers for Disease Control and Prevention. One third of the world's popu- lation carries the infection; of that group, roughly 10 percent will go on to contract the disease. If left untreated, though, TB can be deadly. Cavities can form in the lungs that bleed or fill with pus, blocking airways and making it difficult to breathe. Individuals most vulnerable to TB are those with weakened immune systems, which means people with cancer, hepatitis C, HIV/AIDS, diabetes and individuals who have received organ transplants. Also at high risk: those who live in poverty or use tobacco. TB causes permanent damage to the lungs and can spread to other parts of the body through a process known as dissemina- tion. The worst cases of disseminated TB are those that spread to the bones. Once this happens, the disease becomes extremely difficult to treat and can cause permanent disability. "I always say, tuberculosis loves human misery," said Jeffrey Starke, M.D., a professor of pediatrics at Baylor College of Medicine and a staff physician at Texas Children's Hospital, where he also runs a tuberculosis clinic. "TB goes up during war, famine. Anything that stresses the human condition tends to lead from the progression of TB infection to TB disease." In May, four cases of active TB were confirmed at George Bush High School in Fort Bend County. "These things always happen at the end of the school year— always," Starke said. "It is the rule of least convenience." Although Fort Bend health officials won't discuss details, Starke explained what typically happens in an active TB investigation. "The way they do these investigations is called concentric circles," Starke said. "We start with the patients and the charac- teristics of their disease and their relationships with other people. Usually the first circle is whether or not TB was transmitted in the home. Then we interview the patients and their families and find out what the next circle might be." Every year in the Houston area, roughly 400 people test pos- itive for TB, according to Starke. Because of this, health depart- ments must launch roughly 400 investigations every year. "Think about what that means in households, places of work, schools and how sensitive this is," Starke said. "The letter that goes out can't state the person's name because of privacy con- cerns. It just says: 'We believe you may have been exposed to TB.'" Harris County's TB rate is more than twice the national aver- age: 7 cases per 100,000 people. In the United States as a whole, the average is 3 cases per 100,000 people. "If you look at the diversity of our population, it's not surpris- ing," Starke said. Of the roughly 1 million people who immigrate to the United States legally each year, around 30 percent have TB infection, Starke said. "They are immigrants, they are vulnerable, they don't have health insurance, they don't have medical homes, so how do you find them? How do you test them? How do you get them treated? That's the problem and we have no good mechanism for doing that." (continued) Lila White, left, and above with Patricia Johnston in the kitchen of their home in Sunnyside.

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