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Tuesday, March 26 , 2019, 2:09 am | Fair 50º

 
 
 
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Facing Alarming Rise in Tuberculosis, Santa Barbara County’s Control Efforts Shift to Latent Cases

Public health officials working with primary-care physicians as they confront a growing number of patients with active TB infections

Battling the eve-changing threat of tuberculosis is high on the priority list for Dr. Charity Dean, Santa Barbara County’s health officer, shown here with Dr. Takashi Wada, director of the County Public Health Department. “It requires a lot of detective work to diagnose tuberculosis, and it requires a lot of social history and asking questions about their life, risk factors and any possible exposure,” she says. “It requires the most critical thinking out of any infectious disease that I deal with.” Click to view larger
Battling the eve-changing threat of tuberculosis is high on the priority list for Dr. Charity Dean, Santa Barbara County’s health officer, shown here with Dr. Takashi Wada, director of the County Public Health Department. “It requires a lot of detective work to diagnose tuberculosis, and it requires a lot of social history and asking questions about their life, risk factors and any possible exposure,” she says. “It requires the most critical thinking out of any infectious disease that I deal with.” (Lara Cooper / Noozhawk file photo)

To control the number of patients with active tuberculosis, officials with the Santa Barbara County Public Health Department are focusing on latent cases to stem the disease’s spread.

“The challenge is it has to be the community physicians who do this,” Dr. Charity Dean, the county’s health officer, told Noozhawk

“Our role is to put this on primary-care physicians’ radar, educate them on how to treat latent TB infection, and then follow up to make sure they have the information to treat the patients.”

Latent TB infections are dormant but may become active in the future. Efforts to treat latent cases come as public health officials note that the county has active tuberculosis rates higher than the state average.

Especially worrisome is the fact a number of those local cases involve multidrug-resistant strains.

Approximately a third of the world’s population is infected with TB, which is spread via droplets containing the bacteria. The droplets can be transferred through coughing, sneezing, spitting or other close contact with an infected individual.

“Once you breathe it into your lungs, the bacteria go to sleep and they lie dormant in your lungs,” Dean said. “Ten percent of the time those bacteria will wake up and cause disease.

“What’s interesting is when it wakes up and causes disease, it may not necessarily be in the lungs,” she added.

Symptoms include a persistent cough, unexplained weight loss, night sweats, fatigue, fever, chills and loss of appetite, according to the Centers for Disease Control and Prevention. Risk factors include drug abuse, having a weakened immune system such as HIV or coming from a country where TB is common.

TB can be cured with medication. If left untreated, however, it can lead to death.

While tuberculosis typically is thought of as a lung disease, it can enter the bloodstream and show up in a patient’s uterus, skin, bones and other parts of the body.

The fact that it manifests in a variety of ways is one of the reasons Dean considers tuberculosis one of the most intriguing infectious diseases.

“It requires a lot of detective work to diagnose tuberculosis, and it requires a lot of social history and asking questions about their life, risk factors and any possible exposure,” she explained. “It requires the most critical thinking out of any infectious disease that I deal with.”

Dean, who serves as president of the California Tuberculosis Controllers Association, said that about 80 percent of the TB cases in California manifest in the lungs, with the remainder showing up elsewhere in the body.

It’s significantly harder to diagnose TB if it shows up elsewhere, and could require surgery or more invasive procedures to obtain tissue or other samples to identify the bacteria.

One patient presented with a chief complaint of a giant testicular abscess oozing pus. Since he had been coughing, medical staff undertook further investigation and detected TB in his lungs, with the infection showing up in the testicle sore and suspected to be in the kidneys.

Tuberculosis is evenly spread through Santa Barbara County, although the North County experiences more drug-resistant versions of the disease, Dean said.

In 2014, California reported 2,145 cases of active TB, down 1 percent from the previous year, according to the state Department of Public Health Tuberculosis Control Branch. Approximately 25 years ago, the state saw more than 5,000 cases, according to state Public Health data.

The number of latent cases is not known since those are not required to be reported. However, state public health officials estimate 2.5 million people in California have latent TB infection.

Santa Barbara County saw 26 cases of active TB in 2013 and 29 in 2014. Dean estimates the number of latent cases could range from 45,000 to 200,000.

“It’s hard to put a number on it because it really depends on a number of factors,” she said, adding that one factor is the number of local residents who were born in a foreign country.

Tuberculosis is more common in nations such as Mexico, Eastern Europe and the Philippines.

Occasionally, patients defy the Public Health Department’s quarantine rules, When that happens, Dean doesn’t hesitate to ask law-enforcement agencies to issue arrest warrants.

“I take it very seriously because if someone is coughing active tuberculosis into the air, then they are a true public health threat,” she said.

Agustin Zeferino, diagnosed with a highly contagious form of TB, was last seen in Santa Maria more than a year ago. An arrest warrant has been issued because he is considered a public health threat. (Santa Barbara County Public Health Department file photo)
Agustin Zeferino, diagnosed with a highly contagious form of TB, was last seen in Santa Maria more than a year ago. An arrest warrant has been issued because he is considered a public health threat. (Santa Barbara County Public Health Department file photo)

That step last occurred in August 2014 when authorities announced that an arrest warrant had been issued for Agustin Zeferino, a 24-year-old North County man who had been diagnosed with a highly contagious, drug-resistant TB.

More than a year later, he remains at large.

“This is a very dangerous situation because he has multidrug-resistant tuberculosis and, if he hasn’t been treated since he disappeared, then he is highly contagious with a progressive and fatal disease that’s airborne,” Dean said. “So we are still working behind the scenes to find him.”

Public Health officials are working with Santa Maria police. Investigators have received a few tips, but the contagious patient’s whereabouts are not known.

“It’s very frustrating because he infected a number of children in Santa Maria,” Dean said. “The children he infected had devastating outcomes. In my mind, this man is one of the most dangerous people in Santa Barbara County, if he’s here.”

TB in children is especially dangerous since it can move into the brain and cause meningitis, leading to permanent brain damage or death.

The infection in the bones can require years of intense treatment, including intravenously, and can result in permanent disability or disfigurement.

“It’s very, very serious,” Dean said. “Our nurses in North County have worked really hard to test and treat children.

“And that goes back to the point of latent TB infection — every single child who is diagnosed with latent TB infection must be treated. ... The good news is if you treat latent tuberculosis infection, the child’s chance of having active TB in their life decreases from 10 percent down to less than 1 percent.”

Dean said treatment is relatively easy.

“It’s fairly simple to treat,” she said. “It’s a simple antibiotic treatment.”

Noozhawk North County editor Janene Scully can be reached at .(JavaScript must be enabled to view this email address). Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.

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