TB patient to have surgery in July

Story Highlights

• TB patient Andrew Speaker will have surgery to remove infected lung tissue
• Infected area about the size of a tennis ball and "well contained"
• Docs: Surgery combined with antibiotics should improve recovery chances

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ATLANTA, Georgia (CNN) -- Andrew Speaker and his physicians have decided that the 31-year-old lawyer who is infected with drug-resistant tuberculosis should undergo surgery to remove infected and damaged lung tissue.

"I'm really motivated for the surgery," Speaker told CNN in a telephone interview from National Jewish Medical and Research Center in Denver.

He is confined to a room there with special ventilation to ensure he does not infect others.

"Doctors say this is the best chance to save my life."

Speaker said doctors told him their goal is to figure out -- before the surgery -- which drugs are effective "so anything they can't take out, the drugs will be able to go after."

Asked about the risks, he said, "You know, you see a Viagra commercial -- even that has risks. You can look up the risks. All I know is, my life's in the best hands."

While undergoing treatment, he is working on law cases.

"I'm getting some sleep, feeling good, basically waiting for those drug susceptibilities."

The operation is expected to take place next month, though a date has not been set, according to a hospital statement.

Optimism is high

"Andrew Speaker is an excellent candidate for surgery," said Dr. Charles Daley, who is head of the Infectious Disease Division at the Denver hospital and Speaker's physician. "The infected area of his lung is relatively small and well contained. He is also young and otherwise healthy."

The infected area, about the size of a tennis ball, is in the right upper lobe of the lungs, the statement said.

The operation is to be performed at the University of Colorado Hospital's Anschutz Medical Campus in Aurora by Dr. John D. Mitchell, chief of general thoracic surgery.

"Given the localized nature of the disease, I am optimistic about the chances for a successful surgery," Mitchell said.

The surgery is expected to last two hours, during which Mitchell plans to remove the focus of the infection, thereby reducing the amount that must be killed by drugs.

Speaker caused an international uproar last month when he disregarded doctors' advice and traveled abroad to get married, potentially exposing his fellow passengers to his strain of the disease, which is often fatal.

An odd kind of praise for Speaker case

The surgery announcement came as doctors from around the country who specialize in treating tuberculosis were meeting in Atlanta. The specialists applauded the Speaker case for focusing international attention on XDR TB as an emerging public health threat.

"Tuberculosis has been a neglected problem for such a long time and had not gotten any attention until Andrew Speaker came on the scene," said Dr. Masae Kawamura, who has directed San Francisco's TB Control Office for 11 years.

"We are actually quite grateful to him."

The Speaker case underscored the need to spread the word to all people with multiple drug-resistant TB and a positive culture test -- meaning they may be infectious -- that they should not fly commercially, said Dr. Kenneth Castro, director of the tuberculosis control division at the Centers for Disease Control and Prevention.

"I personally think we have been too mealy mouthed in communicating risk to patients," he said.

Though a person may have a "low probability" of transmitting the disease, he said, "You're not saying they're not contagious."

Speaker has said that doctors only urged him not to fly; that they never told him he would be putting others at risk.

At present, no one with multiple drug-resistant TB has been placed on a no-fly list, said Castro, who added that he has no reason to believe there is any need to take such precautions.

Still, policymakers are trying to streamline the issues of isolation and quarantine, said Dr. Marti Cetron, the CDC's quarantine chief. Tuberculosis control laws require that a potentially infectious person demonstrate noncompliance before the laws can be applied, he said.

Drug-resistant TB growing

In the case of Speaker, "The first noncompliance was the critical incident" in which he boarded a plane in Atlanta, Georgia, and flew to Paris, France, Cetron said.

The case exposed a gap that "needs to be addressed," he said.

In 1900, TB was the leading cause of death in the United States. The discovery of antibiotics caused cases to plummet. Though the incidence in the United States is now at its lowest level since record keeping began in 1953, the CDC reported in March that the average annual decline in new cases has slowed since 2000.

Worse, multiple drug-resistant TB is a threat, and XDR TB cases are growing, particularly among minorities and people born outside the United States, according to CDC data.

In 2005, the CDC tallied 14,097 TB cases in the United States, 124 of which were MDR TB.

Since 1993, there have been 48 cases of XDR TB, according to preliminary CDC data. Of the 46 patients who were alive at diagnosis, 16 have completed therapy, 15 died while on therapy, seven have moved, four are still being treated, two were removed from their medications, one was described as "other" and another was "lost."

Extreme cases

A few patients simply run out of options, and must remain isolated for the rest of their lives. Carol Pozsik, CEO of the National TB Controllers Association, a group that helps organize TB control activities, recalled a man whose tuberculosis became resistant to all known drugs and was confined to his house outside Greenville, South Carolina.

Public health authorities called him daily to make sure he answered the phone and drove by every other day to make sure he was not infecting others, Pozsik said. But even such oversight was not foolproof, Pozsik said. Once, he went on a bender and wound up in the hands of police. "We told him, 'Don't do that ever again,' " she said.

After eight years, the tuberculosis killed him.

Kawamura cited a similar case she is currently treating -- a man in his 50s with XDR TB who cannot take the most potent drugs because of their toxicity, who refuses to undergo lung surgery because it will kill his aspirations to be a professional singer and who is running out of possible drugs to take. "I'm afraid he'll have to live in isolation for the rest of his life," she said.

The cost for treating a single XDR case averages $500,000 and can exceed $2 million -- enough to wipe out the budgets of many state health departments.

The problem is worse outside U.S. borders, where budgets are often meager.

According to the World Health Organization, XDR TB has been reported in 37 countries. A study reported last year in KwaZulu-Natal province in South Africa focused on an outbreak of XDR TB that killed 52 of 53 patients -- 98 percent mortality.

"These are bad, bad outcomes," Daley told the scientists. "People who meet this definition do not do well."

He predicted that doctors will see more such outbreaks in the coming years. "It's time that we prepare for what is coming -- and that is drug-resistant tuberculosis globally," he said. "We need to think globally when it comes to tuberculosis control."

There are some good signs: A number of rapid diagnostic tests are under development, as are several new drugs, but they are in early stages.

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