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Nurses use their eyes to fight disease

Watching patients taking treatment improves outcome

Bill Scanlon, Rocky Mountain News

Published June 1, 2007 at midnight

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The Georgia lawyer with hard- to-treat tuberculosis has become a celebrity, but keep in mind that Colorado nurses and doctors treat about 120 new active TB cases each year.

While Colorado's rate of new TB cases is about half the national pace, its rate of regular and drug-resistant TB is on the rise.

Each of those cases requires weeks or months of treatment, with nurses directly watching as each pill is swallowed and each intravenous needle is administered.

On Thursday morning, Atlanta resident Andrew Speaker got his own motorcade to National Jewish Medical and Research Center, where he'll receive treatment for his drug-resistant strain of TB for the next few months.

"This is one case. It's not even a public health issue," said Dr. Ned Calonge, Colorado's chief medical officer.

Calonge, nonetheless, welcomes the attention that Speaker's case has engendered.

"Local health agencies deal with these things every day," Calonge said. "They have to aggressively treat TB to ensure that it is halted."

Denver Health's TB program treats most cases in the metro area - bringing patients in five times a week for months so a nurse can monitor their medication.

Two or three cases a year are of the multidrug-resistant (MDR) variety that Speaker has.

"At one point we thought we really can't afford to do direct-observed therapy," said Dr. Randall Reves, medical director of the Denver Metro TB Control Program. "But then it became clear that we really can't afford not to do that.

"If we fail, these people can end up with (drug resistant) TB."

Some patients come to the Denver clinic, some prefer that a nurse come to their home, others arrange a visit at their job. Regardless, every pill that's swallowed has an eyewitness.

When patients stop showing up, an outreach team immediately goes to their home.

Day-care issues? Transportation? They'll make it work.

Most of the people who lapse come back, said Reves.

Colorado's success rate in having patients with drug-resistant TB complete their drug regimens is 95 percent, according to Reves.

Denver Health relies on doctors to be alert to bad coughs. For every active TB case, about nine close friends or relatives are tested, Reves said.

Some 1 or 2 percent of them have already developed active TB.

"Kids can go to fatal TB in just a few months," so it's extremely important to reach them, he said.

The clinic also tests immigrants and refugees and treats another 1,000 people to keep their latent TB from becoming active.

About 60 percent of those with active TB were born in other countries, Reves said. The next biggest category is the elderly. Seven percent of TB patients are HIV positive.

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