On December 13th a woman who was sick with TB (tuberculosis) flew on American Airlines Flight 293 from New Delhi, India, to Chicago, USA. She then took another plane from Chicago to San Francisco.

The infected woman is from Nepal and now lives in Sunnyvale, California.

Those sitting next or near to her did not know she was infected and posed a danger to their health. The woman had been diagnosed with drug-resistant tuberculosis in India. However, there is no international law that forbids an infected woman from making that flight.

The CDC (Centers for Disease Control and Prevention, USA) told local public health authorities that one of the passengers on Flight 293 had been infected with TB. Authorities want to get in touch with about 44 people who were sitting near the infected woman. The search for those passengers extends to 17 states. These 44 people should undergo testing for tuberculosis, with a follow-up 10 weeks later. As the woman was reportedly coughing during her flight(s) the CDC is especially keen to track these people down quickly.

A week after arriving in San Francisco the woman checked into the emergency room at Stanford University Hospital, where she was hospitalized. Doctors do not yet know what her prognosis is. TB takes a long time to know whether a patient has responded to medication. Stanford's ER medical team informed the Santa Clara County Department of Public Health, which in turn notified the CDC and other government agencies.

Martin Cetron, Director, Global Migration and Quarantine, CDC, said the woman was at the extreme end of the severity of TB - she was "quite sick". Cetron added that the patient was coughing up blood when she arrived at the hospital.

What is TB?

TB, or tuberculosis, is a disease caused by the Mycobacterium tuberculosis bacterium. The bacteria can attack several parts of your body, but they generally attack the lungs. TB disease was once the number one cause of death in the United States.

In the 1940s, scientists discovered the first of several drugs now used to treat TB. As a result, TB slowly began to disappear in the developed world. But TB has come back. After 1984, the number of TB cases reported in the United States began to increase. More than 25,000 cases were reported in 1993.

How Is TB Spread?

TB is spread through the air from one person to another. The bacteria are put into the air when a person with TB disease of the lungs or throat coughs or sneezes. Laughing, singing, or playing brass or wooden instruments can also spread the germs in an enclosed area. People nearby may inhale these bacteria and become infected.

When a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow. From there, they move through the blood to other parts of the body, such as the kidney, spine, and brain.

TB in the lungs or throat can be infectious. This means that the bacteria can be spread to other people. TB in other parts of the body, such as the kidney or spine, is usually not infectious.

People with TB disease are most likely to spread it to people they spend time with every day. This includes family members, friends, and coworkers.

Signs and symptoms of TB

Although you may harbor the TB bacteria your immune system can prevent you from becoming ill. That is why doctors class TB in two ways:

TB infection or Latent TB
There are no symptoms and it is not contagious.

Active TB
The patient is ill and can spread the disease to other people. The infection could be symptomatic (no symptoms) for years even though it is active and causing damage.

About two to eight weeks after infection the human immune system starts to attack TB bacteria. Three things might happen:

1. The bacteria die and that is the end of it.
2. The bacteria stay in your body in an inactive state and cause no symptoms of TB.
3. The person develops Active TB.

TB generally affects the lungs mainly (active pulmonary TB). Coughing is frequently the only indication of infection at first.

Signs/symptoms of active pulmonary TB:

-- A cough that lasts at least three weeks, it may produce discolored or bloody sputum
-- Unintentional weight loss
-- Tiredness
-- A slight temperature
-- Night sweats
-- Chills
-- Loss of appetite
-- Pleurisy (painful breathing or coughing)



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