Last Day of the TB Course

Today was the last day of the Denver TB Course (in case you couldn't tell from the title of the post). Most of the lectures today were about non-tuberculous Mycobacteria, or NTM. These are bacteria that are related to TB, but a little bit different, and so they cause a little bit different kind of disease. They're also usually more difficult to treat, sometimes requiring medication for years to a lifetime, sometimes requiring surgery. Fortunately, they are also a lot less likely to affect people who are otherwise healthy. Most people who get NTM infections have other diseases, such as HIV, cystic fibrosis, diabetes, cancer, or other diseases that require steroid medication. That isn't to say that otherwise healthy people can't get NTM infections, it's just more rare.

That being said, because TB is becoming so rare in the United States (and chronic diseases are becoming more common), most of the Mycobacteria in the US is actually NTM.

We also talked about multi-drug resistant TB (MDR) and extensively drug resistant TB (XDR), which are becoming increasingly common around the world (remember the report in the news a few years ago of the guy who flew all over the place with TB? He had MDR, and ended up at National Jewish). MDR and XDR are increasing around the world in large part because people don't completely treat their TB infections. It's a long course of a lot of medications--a typical TB infection in the lungs requires two months of taking four drugs, followed by four months of two drugs--and while the WHO calls for all of that to be directly observed therapy (DOT) to make sure that all of the doses are taken, resource-limited countries aren't all that great at always doing it. People who take the medicines for a short time and then stop, or take some medicines but stop others, increase their chances of ending up with a drug-resistant form of TB that is very difficult to treat.

In all, the TB course was pretty valuable and I feel like I learned a lot that will help me in the future. There was some stuff that isn't necessarily relevant for a preventive medicine physician (if I get a person with MDR-TB, I'm not going to be treating him or her; I'm going to be calling my friendly infectious disease physician and handing the case over), but it was still interesting. So you can rest assured that your tax dollars went to a good place (at least this once).

Not quite timely, but still appropriate: