The Centers for Disease Control posted a Health Advisory alerting to the investigation of a travelor found to have Extensively Drug Resistant Tuberculosis (XDR TB) who may have exposed other people while traveling on commercial aircraft:
"CDC learned that a patient with XDR TB traveled to Europe via commercial airline (Air France # 385) departing Atlanta on May 12 and arriving in Paris on May 13, 2007, and returned to the United States after taking a commercial flight on May 24 from Prague, Czech Republic to Montreal, Canada (Czech Air # 0104). The patient re-entered the U.S. on May 24 via automobile."XDR TB refers to strains of Tuberculosis (caused by Mycobacterium tuberculosis) that are resistant to nearly all available antibiotics. In particular, this requires resistance to two first line agents (INH and Rifampin), to fluoroquinolones (i.e. Moxifloxacin which may soon become a preferred first line agent) as well as at least three of the second line agents. With this level of resitance, treatment usually hinges on a very lengthy duration of treatment and the use of potentially toxic drugs.
Recent reports from Africa have described a rapidly fatal course with a median survival of 16 days. This seems to be much more rapid than 'typical' tuberculosis and it is not clear at this point if there are associated changes in virulence in the XDR strains compared to routine or even MDR strains of TB. The reports from Africa were also associated with HIV infection; the current reports do not specify the HIV status of the contact from this CDC report.
According to the CDC report, there has never been an investigation of commercial airline associated contact with an XDR case. It is being recommended by the CDC to notify all persons who were associated with these flights in order to be evaluated.
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