The man who triggered an international alert when he travelled from the United States to Europe and back for his honeymoon despite having drug resistant tuberculosis has had surgery to remove the upper right lobe of his lung. He is also being sued by passengers who were on the same flight.
The 31 year old US lawyer Andrew Speaker had surgery last week at the University of Colorado Hospital, which collaborates with the National Jewish Medical and Research Center, in Denver, a leading tuberculosis treatment centre in the US. The surgeon, John Mitchell, chief of general thoracic surgery at the hospital, used a minimally invasive approach that required a 5 cm incision in the man's side and two 1 cm incisions for surgical instruments and a fibreoptic camera.
The main problem during surgery was finding and closing blood vessels in the area affected by tuberculosis of the right upper lobe of the lung, but it was successful, according to a CNN report from a doctor who said he witnessed the surgery (www.cnn.com/2007/HEALTH/07/17/gupta.btsc). The infected lobe was enclosed in a bag and removed through one of the small incisions.
Mr Speaker returned to the National Jewish Hospital two days after his surgery, where a spokesperson, William Allstetter, said that he was expected to stay for two or three weeks before returning to his home in Atlanta, Georgia, where he will continue treatment for tuberculosis.
Nine people are suing Mr Speaker because they fear they may develop drug resistant tuberculosis from their contact with him. Eight sat near him on a Czech Airlines flight from Prague to Montreal. The ninth is the brother and roommate of one of the passengers.
Congressional hearings have looked into the failings of the system at the time and found that health agencies had been unable to prevent him flying, could not locate him on international flights, and were slow to place him on a “no fly” list. They also found that agencies were tardy in notifying the World Health Organization, European countries, and Canada of the problem, and a border agent had disregarded instructions to stop him (BMJ 2007;334:1242, 16 Jun doi: 10.1136/bmj.39244.374757.DB).
Mr Speaker maintains that he was cautioned against but not forbidden from flying. He travelled from Atlanta to France, Greece, and Italy. Officials from the Centers for Disease Control and Prevention reached him in Rome and told him that he had extensively drug resistant tuberculosis, that he should turn himself in to the Italian health authorities, and that he should not fly on commercial flights. Instead he and his wife flew from Rome to Prague and then to Montreal, where they rented a car and drove south into the US.
Mr Speaker was originally diagnosed as having tuberculosis after a radiological examination for a rib injury in January. Tests after he returned to the US from his honeymoon showed that he had multidrug resistant tuberculosis, not extensively drug resistant tuberculosis. Multidrug resistant tuberculosis is serious but can be treated with antibiotics (BMJ 2007;335:64, 14 Jul doi: 10.1136/bmj.39272.408900.4E).