Tough tuberculosis cases arrive in Snohomish County

  • Thu May 6th, 2010 8:27pm
  • News

By Sharon Salyer, Herald Writer

Two people in Snohomish County have been diagnosed with multidrug-resistant tuberculosis, a type of the disease that takes longer for people to recover from and is more expensive to treat.

The cases are thought to be the first cases of multidrug-resistant tuberculosis in Snohomish County, although two cases were reported elsewhere in Washington last year, Dr. Gary Goldbaum, health officer for the Snohomish Health District said Thursday.

“This is not unexpected; we’ve anticipated that multidrug-resistant tuberculosis would reach our county and it has,” Goldbaum said.

Despite its name, patients diagnosed with the disease can be treated and cured, he added.

Treatment of the two Snohomish County cases and investigation of whether the disease has spread to others is expected to cost $140,000 this year, he said.

Citing privacy concerns and the stigma associated with the disease, Goldbaum declined to give any other information about the patients, such as where they live, whether they are men or women, or whether they know each other.

“This is not a case where we’re concerned about the general public being placed at risk,” Goldbaum said.

The disease is not spread through casual contact, he said. “Generally it takes prolonged exposure in a very small space… If you’re in a person’s home for an hour or two, we don’t consider that a serious risk.”

It will take several more weeks before health officials know if there are any additional cases. Anyone thought to be at risk for developing the disease is given a skin or blood test.

The health district’s board will be asked to approve the $140,000 allocation at its meeting next week, Goldbaum said. The money comes from a special $250,000 reserve fund set aside this year for treatment of tuberculosis cases.

“This is difficult to treat and requires a really long treatment period,” Goldbaum said.

Treatment of patients with multi-drug resistant tuberculosis is more expensive in part because of the special types of antibiotic medications they must take. The cost of the medications for the two patients is expected to hit $20,000 a year.

Patients have to take four or more medications for 18 to 24 months, Goldbaum said.

In addition, health district staff is being dispatched twice a day to where the infected patients live to ensure they are taking their medications, Goldbaum said.

It’s critical that patients infected with multi-drug resistant tuberculosis take their medications “absolutely as prescribed,” he said. If they don’t, they could die from the disease or spread it to others.

Patients with multi-drug resistant tuberculosis are isolated or quarantined because they can spread the disease for several months.

That means they can’t work and could have problems providing for housing and food for themselves and their family.

“We’ll assure that they have housing, food and access to medical care,” Goldbaum said.

For all these reasons, “it’s very expensive for public health to manage multidrug-resistant cases,” Goldbaum said.

The antibiotics for the more typical type of tuberculosis are far less expensive and are taken for a shorter period of time, about six months, he said.

The public health agency was first alerted to the possibility of the multidrug-resistant cases about two months ago. It takes up to six weeks for tests to determine if the infection is resistant to multiple types of medications.

The health district was notified in the past several weeks that the patients had multidrug-resistant infections, he said.

Many people exposed to tuberculosis do not become infected, and only a fraction of the people who are infected have an active case of the disease, Goldbaum said.

Those who are infected have about a one-in-lifetime risk of developing active tuberculosis.

Tuberculosis is a bacterial infection of the lungs that can spread to other parts of the body. If left untreated, it destroys lung tissue, but generally it progresses slowly.

Symptoms include weight loss, night sweats and coughing.

Sharon Salyer: 425-339-3486 or

State cases

Multidrug-resistant tuberculosis cases in Washington:

Five cases diagnosed so far in this year, two from Snohomish County, two from King County and one from Whatcom County.

In 2009, two cases were reported, both were in King County

In 2008, three cases were reported, all from King County.

Source: Washington State Department of Health