Tuberculosis Outbreak Shakes Wisconsin City

Looking crisp and official in his khaki-colored sheriff’s department polo shirt, Steve Steinhardt says Sheboygan, Wis., is a pretty good place to be a director of emergency services.

“Nothing bad happens here,” he says, knocking on wood. Unless, that is, you count the tuberculosis outbreak that struck the orderly Midwestern city of 50,000 this spring and summer.

“I never expected TB to be one of the bigger emergencies I’d face when I got into this field,” Steinhardt says.

Steve Steinhardt has led Sheboygan County’s emergency response to the nine tuberculosis cases recorded since April.

Jeffrey Phelps/For NPR

Sheboygan County officials have had to scramble to contain it. At the height of the crisis, the county activated its emergency operation center — a step usually reserved for major fires, floods and tornadoes.

The county has had to borrow personnel from other jurisdictions, calm parents of schoolchildren, find housing to isolate infected families and appeal to the state for millions of dollars in extra money to deal with the situation.

It’s a reminder that TB — a disease most Americans may view as a relic of the 19th century — is still an insidious threat that can pop up anywhere.

Read the full article including quotes from CFAR Director Richard Chaisson.

Experimental vaccine shows promise against TB meningitis

(Johns Hopkins Medicine) —  A team of Johns Hopkins researchers working with animals has developed a vaccine that prevents the virulent TB bacterium from invading the brain and causing the highly lethal condition TB meningitis, a disease that disproportionately occurs in TB-infected children and in adults with compromised immune system.

A report on the federally funded research is published online June 11 in the journal PLOS ONE.

TB brain infections often cause serious brain damage and death even when recognized and treated promptly, researchers say. This is so because many drugs currently used to treat resistant TB strains cannot cross the so-called brain-blood barrier, which stops pathogens from entering the brain, but also keeps most medicines woefully out of the brain’s reach.

“Once TB infects the brain, our treatment options have modest effect at best, so preventing brain infection in the first place is the only fool-proof way to avert neurologic damage and death,” said lead investigator Sanjay Jain, M.D., an infectious disease specialist at the Johns Hopkins Children’s Center. “Unfortunately, our sole preventive weapon, the traditional BCG vaccine, has a spotty track record in terms of efficacy.”

The new Johns Hopkins vaccine, tested in guinea pigs, could eventually add a much-needed weapon to a largely depleted therapeutic and preventive arsenal. TB currently affects nearly 9 million people worldwide and is growing increasingly resistant to many powerful antibiotics, according to the World Health Organization (WHO).

The experimental vaccine works against certain lethal strains of TB that are marked by the presence of a protein known as PknD, which helps the TB bacterium sneak past the blood-brain barrier. Specifically, PknD makes TB virulent by allowing it to attach to, damage and penetrate the protective cells that line the small blood vessels of the brain and prevent toxins and bugs traversing the blood from invading the organ.

Read the entire news release here.

Consumption’s Long Shadow: A Panel Discussion at The George Peabody Library, Wednesday June 12, 6-8 pm

Please join us for a panel discussion on TB and the literary arts at a special symposium that is part of the Stephen Crane exhibit at the Peabody Library.  The event will begin with a reception at 6 pm and the panel will speak beginning at 6:30 pm.

Speakers and Topics:

1)      Gabrielle Dean, PhD, the Sheridan Libraries:  “Delicate Victims and Literary Vigor: Stephen Crane and the Myth of Consumption.”  A brief overview of TB as a romantic disease, then a look at Stephen Crane, whose active life and “masculine” writing counters prevailing constructions.

2)      Juliette Wells, Goucher College: “The Tell-Tale Cough: Victorian Novelists and the Temptation of Metaphor.”  Realism alone doesn’t explain the proliferation of consumptive characters in nineteenth-century novels; authors were drawn as well towards the rich metaphorical possibilities offered by the symptoms and presumed etiology of tuberculosis.

3)      Richard Chaisson, MD, JHU Center for TB Research: “TB, Art and Poverty.”  A talk about how common TB was in the 1800s, including among artists, how it was romanticized (briefly), then a focus on TB in Baltimore in Crane’s time and the work of Osler at JHH, followed by a conclusion on how Baltimore led the way to reducing TB through innovative public health measures.

4)      Jeremy Greene, MD, PhD, History of Medicine, JHU: a brief history of TB treatments.

5)      Q & A, 7:35-8 pm.

Today! Around the TB World in 60 minutes

CFAR Director Richard Chaisson: “TB, the quiet killer”

The Baltimore Sun
By Richard E. Chaisson
8:00 a.m. EDT, March 24, 2013

This is World Tuberculosis Day, the day in 1882 when Dr. Robert Koch discovered the cause of tuberculosis (TB), an airborne infectious disease that continues to rage around the world, killing 1.4 million people each year. The disease remains a leading infectious disease killer globally. In Africa, TB is the biggest killer of people with HIV/AIDS.

Baltimore once had the highest rates of TB cases and deaths in the U.S., but a heroic effort by the Baltimore City Health Department’s TB clinic, led by the late Dr. David Glasser in the 1970s and 1980s, resulted in drastic reductions in our TB rates through the use of directly observed therapy (DOT) and aggressive use of treatment to prevent TB in those at highest risk.

However, TB has not been eliminated in Baltimore — or in any state. Maryland has had TB outbreaks in schools, social clubs, hospitals and among transplant patients in recent years. Los Angeles is currently battling a TB epidemic among a homeless population in which more than 4,600 people have potentially been exposed and 11 have died.

Read the entire article here.

Taking Down TB

(Johns Hopkins Magazine) – Carrie Tudor, Nurs ’08, ’12 (PhD), and Jason Farley, Nurs ’03 (MS), ’08 (PhD), came together over drug-resistant tuberculosis. Tudor, who had 10 years of experience in global health, had come to the School of Nursing to receive a clinical background to augment her master’s degree in public health. In the doctoral program, she studied with Farley, an assistant professor in the Department of Community-Public Health. He invited her to work on a study examining nurses’ attitudes and practices regarding infection control in 24 South African hospitals that were treating multidrug-resistant tuberculosis. TB is an enormous health problem in South Africa, where it is the leading cause of death in patients also infected with HIV, and for patients in the developing world, treatment can be prohibitively expensive and lengthy.

Tudor recently began a National Institutes of Health Fogarty Global Health Fellowship, which has taken her back to South Africa, where she’ll work on preventing TB and its transmission among health care workers infected with HIV. She will also con­tinue to collaborate with Farley, whose research focuses on the intersection of drug-resistant infections and patients with HIV.

In early September, Farley and Tudor reunited via Skype to discuss their shared dedication to eliminating this curable disease and improving the lot of health care workers. Farley spoke from his office at Johns Hopkins in Baltimore, while Tudor called from China, where she was consulting for the International Council of Nurses before heading to South Africa.

Read the full article here

Call for Submissions: Partners Infectious Disease Images

We are writing to announce the recent launch of a new Partners Infectious Disease Images web site and to ask for your help in expanding the number of HIV- and TB-related cases in this digital library.

Partners Infectious Disease Images, developed by researchers and educators at Harvard Medical School and University of Texas Austin, is a digital library of cases and images designed to facilitate learning of infectious diseases and microbiology. We are currently working on expanding the digital library to include even more HIV/AIDS and TB cases, particularly those from international sites. The site currently has more than 300 cases, of which more than 50 are HIV-related and 24 are TB-related; the site also includes more than 100 “image only” examples, of which more than 60 are HIV-related. However, to make the site more useful for health care professionals training in HIV medicine, we are looking for additional cases and images related to HIV and TB.

We invite you and your colleagues at your CFAR to submit image-based cases for possible publication on the web site. Please contact Rajesh Gandhi (rgandhi@partners.org) or Alice Cort (acort@partners.org) if you are interested in submitting a case or if you would like to learn more about the site.

Features of the Partners Infectious Disease Images:
• An extensive and easily searchable digital library of case studies and images with more than 1500 images
• Special case collections focused on topics such as HIV/AIDS, fungal infections, mycobacterial infections, and others
• Links to referenced abstracts and related articles on PubMed
• Cases with interactive annotations for medical students
• Browsing function for cases and images by organism, diagnosis, image technique, or lab technique
• Use of the site to perform self-assessment
• Ability to save favorites and to create collections of cases and images
• Free-of-charge

Sincerely,

Rajesh Gandhi, MD
HU CFAR Clinical Core Director

Alice Cort, MD
Managing Editor, Partners Infectious Disease Images

 

Research in latent tuberculosis infection (LTBI) in the setting of HIV Co-Infection (R01) PAR-13-061

The National Institute of Allergy and Infectious Diseases, at the National Institutes of Health invites grant applications which propose research to increase our understanding of the microbiologic adaptive mechanisms, host immunologic factors, and their interactions involved in the development, maintenance, and activation of latent tuberculosis infections (LTBI) with a focus on HIV co-infection.

 

Read the full FOA here.

Join us on Tuesday! TB-Proof? A South African Physician’s Personal Encounter with Nosocomial MDR Tuberculosis

6th Annual George W. Comstock Lecture – “Phthisis and Concupiscence – Tuberculosis and HIV Revisited”

 

Please join us for the first of the our World AIDS Day Events