Tuberculosis still thriving in Vegas

Saturday, Sept. 16, 2000 | 5:57 a.m.

Tuberculosis, a dreaded killer in the pre-antibiotic age, is still with us.

Workers at the Clark County Health District's Tuberculosis Clinic can attest that it is not only with us, but thriving among hundreds of patients in Southern Nevada alone.

And a combination of factors -- the increased numbers of people with HIV, the virus that causes AIDS; increased numbers of people with diabetes; and immigration from places such as Mexico where the disease is still widely seen -- have set the stage for a more-or-less permanent role for tuberculosis in the U.S. population, health experts warn.

For about a decade, between 15,000 and 25,000 cases have been discovered in the United States yearly. Millions develop the disease each year worldwide.

The disease, left untreated, can kill by slowly destroying the lungs. The "active" stage has symptoms that include respiratory difficulties, fevers and night sweats and other flu-like problems. Before antibiotics came into widespread use after World War II, physicians basically had few therapies -- rest, clean air and sunshine, prescribed at thousands of sanitariums worldwide.

Today, powerful drugs can cure nearly everyone. But many people who carry the germ never develop the active form of the disease.

The disease can be found close to home. As of the end of August, there were 62 active cases identified in Southern Nevada, 10 more than this time last year, said Laurie Hickstein, senior public health nurse for the clinic.

Hickstein said the average is about 100 to 120 cases per year. Three-quarters of the cases in the state are reported in Clark County, she said.

Although the disease is often associated with people from other countries bringing the bug to the United States, Hickstein said about half of the cases she sees are from native-born residents.

In May, about 1,600 Las Vegas High School students were tested for the disease after a 15-year-old native-born student was found with an active case, she said.

About 80 students tested positive to having antibodies for tuberculosis, Hickstein said. That doesn't mean they have the active form of the disease, or even that they have the bacteria that causes it.

About one out of 10 people who test positive would eventually get the active disease without preventive treatment.

"Many carry (the bacteria) all their lives without getting the disease," said Elsa Cascos, a clinic nurse and case manager. "TB is pretty difficult to catch. A lot of times symptoms are subtle or totally absent."

The positive students probably had contact with someone with the disease at some time in the past, but not necessarily with the student, Hickstein said. None of the positive students had active cases of the disease.

Hickstein said that almost any similar-sized group would show a similar number of positives, indicating that the germ is present in the general population.

Her clinic struggles with the disease on a daily basis. Among the challenges are making sure that people diagnosed with the disease continue to take their medication, typically for six to 12 months.

Often, people begin feeling better and want to skip the daily doses of medication, which can be a dozen pills or more, Hickstein said. That can help breed a drug-resistant form of the bacteria -- one of the biggest nightmares for health professionals, and for their patients.

Hickstein said a handful of drug-resistant cases show up in Southern Nevada each year. The drug-resistant bugs can fend off some of the front-line drugs typically used to treat the disease, but there are still a few standby drugs available that can knock the bacteria out of the body.

The biggest worry is that a tuberculosis bug will show up that has a broader resistance. To make sure that doesn't happen, the Clark County clinic's biggest job is making sure that people take their medications, all of them, every day over the course of months.

Clinic's tough job

That can be a tough job, Hickstein said. The clinic must find support for undocumented immigrants and street people.

The cost of not treating them is not just the lives of the patients, Cascos said. Although it usually takes close contact to acquire the bug, an active case can infect many other people.

"We've got the alcoholics, the drug addicts, the people that live on the streets," she said. "We can't allow them to take the rest of the world with them.

"Tuberculosis is an airborne disease," Cascos said. "Homeless to professional -- anyone can be infected." Clinic nurses visit patients at their homes to deliver the daily doses of medication, making sure the patient takes them before leaving.

Close monitoring

Hickstein said that often means that patients have to be closely monitored. If the patient is a family breadwinner, it means that the clinic has to step in and be ready to help get financial support for the entire family.

Items such as coupons for low-cost or free food at area supermarkets help serve as an incentive to get people to take their medication and come into the clinic, Hickstein said.

Some patients, particularly low-income patients, are relocated to apartments near the clinic so they can come in regularly.

One of those who has moved into an apartment near the Shadow Lane clinic is Walter Sutherlin, 60.

Sutherlin knew he had lung problems before he went to the clinic in January, but chalked it up to 50 years of smoking. But when blood appeared in his cough, he realized he had a different kind of problem.

He probably was infected years ago, Cascos said, pointing out that tuberculosis germs multiply very, very slowly, and the disease usually lies dormant for years.

"He'd probably been sick for a long time before getting diagnosed," she said.

A combination of tuberculosis and emphysema means that Sutherlin cannot work, so the clinic has tried to get him as much financial support as they can. Sutherlin's roommate also has tested positive for the disease and is on a preventive regimen.

Sutherlin stays busy drawing. He showed some of his landscape sketches off at the clinic during a recent visit.

Cascos and Hickstein say that he is one of their ideal patients, never failing to show up for medical appointments or take his medication.

Sutherlin said he knows how important it is to take the medication to avoid further lung damage.

Dr. Ruben Diaz, a pulmonary physician that works with infected children at the clinic, said Sutherlin and others who have symptoms of the disease need to be tested as soon as possible. Failure to do so can lead to long term damage, he said.

In advanced cases, a patient can lose all or part of a lung.

The test to determine if a person has the disease is an inexpensive and relatively painless skin test -- a scratch. Health care workers look for a reaction to antibodies on the skin.

He said "false positives" are possible, but unlikely. Cascos said she hasn't seen one in two decades at the Clark County clinic.

Side effects

The medication can cause bad side effects, especially among those with liver problems, Diaz said. But doctors closely monitoring the disease can catch those before any problems occur, he said.

"I haven't seen anybody die from the medication in 13 years of practice," Diaz said.

The disease itself is the danger, he said.

"It is still the No. 4 killer in the world," Diaz said.

Some people, such as health professionals, get tested yearly. But Diaz thinks that more should be tested regularly.

He suggests that children, a more vulnerable group, be tested at ages 1, 5, 14 and 18.

The important message is that catching it early, before the disease scars the lungs and destroys health, is essential, health care professionals agree.

"Tuberculosis is curable," Cascos said with emphasis. "We can treat it. We can cure it.

"But without treatment, it's deadly," she said.

archive