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Gwen A. Huitt, MD, MS is from this state, and went to college at University of Northern Colorado. She got an MS and an MD at University of Colorado Health Sciences Center, where she also did residencies and a fellowship, leading to board certifications in internal medicine and infectious diseases. Dr. Huitt is interested in mycobacterial infections, diagnosis and treatment of sinopulmonary infections, and the management of bronchiectasis. She is also interested in management of adult cystic fibrosis. She directs the adult infectious disease care unit at National Jewish Medical and Research Center, where she has worked since 1993. She has been NJC's Medicine Clinician of the Year. In 2007 she took care of Andrew Speaker, the first infected person quarantined by the U.S. government since 1963, who was brought to NJC in a blaze of publicity comparable to the arrival of a head of state. Dr. Huitt had to spend almost as much time talking to reporters as taking care of her patient (that's a microphone in the picture, not a microscope.) Her team’s efforts were rewarded when they found that Mr. Speaker did not, after all, have the XDR version of the TB bacillus, though he did have the troublesome MDR (multi-drug resistant) variety. But the incident had one good outcome: to focus the media and public on what is still a very serious and intractable disease. |
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About the topic
Tuberculosis is a common and deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. Tuberculosis most commonly attacks the lungs (as pulmonary TB) but can also affect the central nervous system, the lymphatic system, the circulatory system, the genitourinary system, bones, joints and even the skin (such a condition, now rare, was called scrofula). Other mycobacteria such as Mycobacterium bovis, Mycobacterium africanum, Mycobacterium canetti, and Mycobacterium microti can also cause tuberculosis, but these species do not usually infect healthy adults.
Over one-third of the world's population has been exposed to the TB bacterium, and new infections occur at a rate of one per second. Not everyone infected develops the full-blown disease, so asymptomatic, latent TB infection is most common. However, one in ten latent infections will progress to active TB disease, which, if left untreated, kills more than half of its victims.
In 2004, mortality and morbidity statistics included 14.6 million chronic active TB cases, 8.9 million new cases, and 1.6 million deaths, mostly in developing countries. In addition, a rising number of people in the developed world are contracting or reactivating tuberculosis because their immune systems are compromised by immunosuppressive drugs, substance abuse or HIV/AIDS.
The rise in HIV infections and the neglect of TB control programs have enabled a resurgence of tuberculosis. The emergence of drug-resistant strains has also contributed to this new epidemic with, from 2000 to 2004, 20% of TB cases being resistant to standard treatments (MDR tuberculosis) and 2% resistant to second-line drugs (XDR tuberculosis). TB incidence varies widely, even in neighboring countries, apparently because of differences in health care systems. The World Health Organization declared TB a global health emergency in 1993, and the Stop TB Partnership developed a Global Plan to Stop Tuberculosis aiming to save 14 million lives between 2006 and 2015. (modified from Wikipedia)
Tuberculosis is directly responsible for Colorado’s preeminence in immunology. Even before the turn of the previous century, patients with “consumption” were sent to high altitude, where it was thought fresh air and sunlight might effect a cure. Thus in Europe, tuberculosis patients who could afford it went to sanatoria in the Alps. In the eastern US, the sans were in the Adirondacks, and in Canada, the Laurentians. In the West, it was the Rockies, and most of our older medical institutions, like National Jewish, began as sanatoria. Amazingly, may patients did well and some recovered; and nowadays we recognize the benefits of vitamin D in TB resistance; the skin makes it when exposed to sunlight (which must have been deficient in the eastern and Midwestern slums that many of our patients came from.) After the second World War, when antibiotics like streptomycin became available, TB declined and the hospitals cast about for a way to stay in business. Since TB symptoms are largely caused not by the bacillus but by the immune system struggling to overcome it, they had many experts in immunology, more so than any other state (the American Association of Immunologists was founded by Denver’s Dr. Gerald Webb.) Thus the science of immunology was more advanced here than elsewhere, and many clinicians and scientists took to the study of other immune diseases, especially asthma. So TB was moved onto the back burner, surveillance programs were unfunded, and a generally-acceptable vaccine was not pursued. As more cases of TB were inadequately treated, the probability of resistant strains emerging climbed... And as everything gets globailzed, so do infectious diseases. The pot on the back burner moves to the front, and onto the sideboard, ready to be served.
Recommended resources
The World Health Organization's A WORLD FREE OF TB. The CDC's Division of Tuberculosis Elimination.
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