Issue link: https://tmcpulse.uberflip.com/i/856438
t m c » p u l s e | a u g u s t 2 0 1 7 21 Cirillo and his team have worked to detect the infection when the bacteria is very low. Compared to the smear or sputum test, which has a threshold detection of 10,000 bacteria, the TB REaD test produces results by detecting as few as 10 bacteria in roughly 10 minutes, according to Cirillo. "It's almost like magic," Cirillo said. "Many people don't believe you can detect that few bacteria in that short of time, but it all comes down to the fact that the enzyme is so robust and you get reaction from the bacteria being alive." Once White's TB diagnosis was confirmed, she began the long journey toward regaining her health. Because TB is a respiratory infection that travels through the air and can be highly contagious, it is considered a matter of pub- lic health. After White was diagnosed, a public health investigator from the Houston Health Department was assigned to her case. City health officials require any individual with active TB remain in isolation until they are no longer a threat to public health. When is that? Once the individual has received three consecutive negative sputum tests. In addition to isolation, White was placed on an intense antibi- otic treatment plan. "I was so little to take all of those pills," said White, who is 5-foot-4 and weighed 99 pounds when she returned home from the hospital. "I was taking nine pills a day, seven days a week, and I couldn't handle what my body was going through." The TB treatment plan is intense and time-consuming— lasting three months to one year for most patients. Because of this, directly observed treatment has been implemented for TB patients across the country. Directly observed treatment, short course, or DOTS, is defined by the World Health Organization as a specific strategy to improve adherence to TB medication by requiring health workers, community volunteers or family members to observe and record patients taking each dose. White's community health worker, Berta Perez, senior public health investigator for the city of Houston, came to her house every day for eight months and then every three days to deliver her medication and physically watch White take it. As an added precaution, the health department also requested White's partner and her son undergo an antibiotic regimen. "In the United States, we use directly observed treatment, but that comes at a high cost," Guy said. "In other countries where there are not as many resources, people go to a central location to get their medicine and usually once they start feeling better, they stop going." 'Assume they are infected' Starke's tuberculosis clinic at Texas Children's is a microcosm of the city of Houston. Held regularly on Tuesday and Friday mornings, the clinic welcomes all children—whether they are from Sunnyside or Somalia. "We also started doing something at Texas Children's many years ago," Starke said. "If we have a kid show up who might have TB, we do immediate chest X-rays on the parents, at our expense. The idea behind it is, if the child really has TB, he or she got it from someone and it is likely somebody close to them. That person might not have been diagnosed yet, and it might even be a parent." (continued) Jeffrey Starke, M.D., examines a patient at Texas Children's Hospital. White and her primary doctor, Elizabeth Guy, M.D., embrace after White learns she has completed all her TB treatments.