A Few Questions about the XDR-TB Story

HIS NAME is Andrew Speaker, and he’s a practicing attorney from the Atlanta, Georgia area, who — oddly enough — specializes in personal injury cases. The once anonymous 31-year-old has become the subject of countless headlines after contracting a highly drug-resistant form of tuberculosis called XDR-TB (the XDR stands for Extremely Drug Resistant — XDR fails to respond to three of the six medical options for combating Mycobacterium tuberculosis, the organism that causes tuberculosis).According to the CDC, Speaker developed a nagging cough in January of this year. His symptoms included fatigue, chest pain, weakness, and coughing up blood. X-rays indicated a ‘spot on his lung’ that remained undiagnosed for some weeks to months. Once doctors learned the causative agent was tuberculosis, the Fulton County Health Department was notified and follow-up care and testing began. (Note: The CDC has reported that no antibiotic treatment had been administered to Speaker prior to commencement in Atlanta following his return to the US in late May — odd, isn’t it?)Curiously, Speaker’s wife Sarah has never shown any signs of illness and tests negative for infection. Even more curious is the name of Sarah’s father, Robert C. Cooksey, PhD of the CDC. Yes, I said ‘of the CDC’. Bob Cooksey is a microbiologist who specializes in research on — you guessed it — tuberculosis.Now — allow me to back up a few days to the original coverage of this developing story. On May 24, Andrew Speaker and his new bride returned to the Americas aboard Czech Air flight 0104 into Montreal. He departed Montreal via a rental car, heading for the US (which meant he had to go through a border checkpoint). Even though the CDC claims Speaker’s name had been added to a ‘no fly/please detain’ list, Speaker had no trouble boarding a number of planes (reports list flights to Greece, France, Italy, the Czech Republic, and Montreal), nor was he detained at the US border when crossing in by car.

Our first suspicions

As Derek and I watched the first reports spinning around the cable stations, we suspected something amiss. First of all, why would a sick man want to take an extended vacation? If he was truly ill with TB as suspected, why wasn’t he in treatment? Considering the past SARS scare, why wouldn’t an alert airline employee note a ‘coughing man’ and report it?

What we now know is that Andrew Speaker was asymptomatic — in fact, all signs of TB ended in January or possibly February. (Note: Asymptomatic patients generally do not spread the infection. Contagion occurs during active stages of the disease via aerosolized mycobacterium particles contained within cough ‘spray’ or, in rare cases, after touching a surface contaminated by an infected person — XDR-TB can remain on surfaces for several weeks unless cleaned with a strong disinfectant)

Robert Cooksey issued a public statement today saying he gave his son ‘fatherly advice’ not to travel. He also claims it had never occurred to him that his daughter might be at risk. Cooksey also denied any connections between his son-in-law’s infection and his own job at the CDC.

California Outbreak in 2005

At this juncture, let me remind readers that a small cluster of XDR-TB emerged in California in 2005, infecting seven low-income men in San Francisco, five of whom lived in the same hotel. According to Dr. Masae Kawamura, director of TB control for the city’s Department of Public Health:

[A]fter the first case was identified as drug resistant, all of the patients who have subsequently been diagnosed with the strain have been treated with more than four antibiotics and have not developed additional resistance. That includes a hotel resident from Russia who had been sick for nearly a year before he came in for treatment and apparently carried the drug-resistant strain from Siberia.

You’ll notice in the San Francisco Chronicle article that a carrier from Siberia is mentioned. Why is no one in the press asking the big question: Who is the initial source for Andrew Speaker’s XDR-TB infection? Is there a ‘patient zero’ yet to be identified?

Andrew Speaker’s life reflects that of a healthy, athletic young man. He attended the Naval Academy as an undergraduate and joined the highly secretive Pi Kappa Alpha Fraternity (aka PIKE) at University of Georgia. (Well known ‘Pikes’ include Karl Rove, Strom Thurmond, Former WH Chief of Staff Donald Regan, Bill McCartney of Promise Keepers, Pat Robertson of CBN, Ted Koppel, Rick Dees, Fess Parker, and Congressman Pete Sessions, to name but a few).

I found a website that listed Speaker as a runner in the 2002 Gulf Coast Triathalon (his time was 5:42:47). He is heavily involved in community activities (Rotary Club, Brookhaven Boys and Girls Club, Shepherd Spinal Center, and he (and his new bride) both raise Great Danes (my internet search found both their names listed in a local Great Danes club). In other words, Speaker lived an upwardly mobile, active lifestyle. He appears to be thoughtful, well-educated, and responsible. Why would such a man take off for Europe knowing he might be spreading disease not only to fellow passengers but also to his new bride? And — if the CDC and Robert Cooksey considered his infection such a high risk, why wasn’t Speaker put into isolation prior to his wedding?

Summing it all up

For me, the more I learn, the less I know. Each new bit of information raises a dozen questions, and I’m not liking the picture that appears to be forming.

In short, this has all the hallmarks of a ‘test’, a ‘setup’, an excuse for raising public fears, passing more stringent health and travel laws, and perhaps providing healthy human test subjects for TB experiments. What, you ask? Didn’t I mention the recent completion of clinical trials on simians for a new recombinant therapy for XDR-TB? Silly me. The ‘inventor’ of the method is from UCLA — in California. Remember those cases in San Francisco?

Then again, this is all speculation, right?