Tuberculosis diagnosis turns patients into advocates

Karen and Scott Halstead’s 2007 honeymoon to Africa set their lives on a course they could have never imagined. It was somewhere during their travels, either on the plane or on the ground in South Africa, Zambia or Botswana, that the newlyweds were exposed to tuberculosis bacteria. After returning to their hometown of San Francisco, the tech executive developed a lingering cough, shortness of breath and overall fatigue, symptoms that Scott Halstead’s doctor misdiagnosed as a particularly stubborn flu. Around the same time, Karen Halstead, who was five months pregnant with their first child, went in for a routine prenatal visit in early 2008 and tested positive for latent TB – a milder, dormant form of the disease that does not cause immediate symptoms.

Scott had previously gotten tested with a skin test, which provided false negative results, potentially due to immune suppression from the medication he was taking for an autoimmune disease. Karen’s unexpected diagnosis triggered him to go in for another clinical evaluation, after which Scott was diagnosed with the highly contagious form of active TB.

Life after diagnosis

The diagnosis came as a major shock to the couple who led an active and healthy lifestyle. “To be honest, the only thing I really knew about TB was from movies and books based in medieval times, when you heard about people dying of consumption,” Karen admits. “I knew a little bit about TB, but thought it had been eradicated,” adds Scott.

After diagnoses, the Halsteads immediately reported to San Francisco’s public health system to start treatment. Scott Halstead was quarantined at home where he followed a regimen of four different antibiotics. “I needed to stay isolated and was pretty much confined to my house four to six weeks. The antibiotic regime lasted for around nine months in total. The side effects from the drugs were pretty serious, and it was also disruptive from a social perspective. I couldn’t see friends and family for a long period of time,” the tech executive recalls.

What made matters more worrisome was the fact that the diagnosis came as the couple was expecting their first child in just a few months. “My situation was not something common that the doctors were dealing with,” says Karen. “In the end, I took the Department of Public Health’s recommendations and I'm glad I did. I went on a course of antibiotics and I was assured that they would not affect my pregnancy or my baby,” says Karen.

Overcoming stigmas of TB

Tuberculosis still continues to cause stigma today, mostly because people don't know that it is a preventable and curable illness. Due to the many misconceptions surrounding the ill-reputed disease, the advertising executive was understandably apprehensive about sharing her condition with her colleagues, fearing she might be contagious, or somehow even shunned. “I didn’t know if they would understand, because I certainly didn’t fully understand the situation,” she recalls.

Scott, who experienced an active form of TB, not only had to contact his large family in Chicago to tell them that he had been carrying TB over Thanksgiving, he also had to inform each and every person he was working with in San Francisco that they needed to get tested. “It was a stressful time to have to explain that to people and let them know that I might have infected them with something that certainly had serious consequences,” recalls Scott. Despite the discomfort of having to share the news, the couple emphasizes that the importance of containing and preventing tuberculosis is to take precautions and find out if you’re inadvertently infecting other people that you know, whether it's work colleagues or family.

Latest blood tests give accurate results 

From the onset of Scott’s treatment, Masae Kawamura was the physician in charge of San Francisco’s TB program at General Hospital back when the couple was diagnosed. She quickly became a trusted advisor to the Halsteads as they embarked on their journey towards recovery. “Tuberculosis has been a specialty of mine for 30 years,” Masae explains. “TB is the most successful infectious disease pathogen in the world. It has been with humankind for millennia and kills about 1.5 million people every year. That’s more than any other infectious disease, including HIV. Latent TB, like in Karen’s case, is very stealthy, because it can reactivate at any time, often in the first one to two years after the infection was contracted. And we certainly didn’t want her to get TB while she was pregnant,” recalls Masae. Kawamura’s decades in the field have shown her that timely latent TB testing of people at risk, not with a simple skin test but with a more specific and accurate blood test, can make an important difference.

The doctor has taken her passion to combat TB to a new level when she joined QIAGEN in early 2012 as senior director of medical and scientific affairs. “I felt that joining an international molecular diagnostic company would give me a new platform to promote good TB control practices, focusing on testing and prevention to stop the cycle of contagion,” she says. “One of the reasons I really like working for QIAGEN is that as a diagnostic company, we're constantly looking for solutions for people that need the testing. A major benefit of blood tests like QuantiFERON, is that they replace the TB skin test, a 100-year-old method with hit-or-miss accuracy. Tuberculosis skin tests often result in false positives which can lead to people taking TB drugs unnecessarily for months on end while false negatives result in patients potentially spreading the illness.