Arrest warrant issued for woman with an active case of tuberculosis
Key Takeaways
A woman in Washington state has been refusing to isolate and accept treatment for her active tuberculosis infection.
Earlier this month, an arrest warrant was issued for the woman who was not named.
It is unclear if the woman was transferred to a local jail.
A 42-year-old unnamed woman with active tuberculosis (TB) was issued an arrest warrant for not complying with health officials’ requests to isolate and seek treatment, according to a press release issued by the Tacoma-Pierce County Health Department in Washington. No reason was given as to why the patient refused treatment or quarantine.
“We have worked with family and community members for more than a year to do everything we can to persuade this woman to take her medication, [and] to protect herself and our community,” the release stated. “After 15 court hearings, we are closing in on our last option.”
That last option? An arrest warrant was issued for March 3.[] The release stated that the woman would be detained and taken to a “specially designated facility at the Pierce County Jail for isolation, testing, and treatment." In order to potentially avoid arrest, the woman was told to accept treatment and voluntarily isolate by March 3.
The release outlined the department’s struggles to find a balance between protecting the public and infringing on the woman’s civil liberties. “We are always hopeful that a patient will choose to comply voluntarily. Seeking to enforce a court order through a civil arrest warrant is always our last resort,” the release states.
Before escalating to arrest, the release said the Department’s goal was to, “Connect with family members, friends, and people in their community to help. We work to remove any barriers that may be in the way of them getting the treatment they need.” Failing that, the Department said they have an “obligation to the community and the legal authority to seek a court order to persuade patients to comply.”
MDlinx reached out to the Department for an update on the case’s status. We were told the recent press release contains the most up-to-date information.
"The update we added to our blog on March 2 is still our latest info. We will not share information about law enforcement’s implementation of the warrant," a department representative clarified.
The woman in question now is only the third person in the last 20 years to refuse to comply with the Tacoma-Pierce County Health Department’s demands. In Pierce County, there are an estimated 20 cases of active TB disease every year. Why is this so problematic? TB is the 13th leading cause of death worldwide, according to the World Health Organization. In 2021 in the United States, there were 7,882 reported cases of TB. That said, up to 13 million Americans could be living with a latent TB infection they’re not aware of.[]
TB symptoms
TB is caused by Mycobacterium tuberculosis, a slow-growing bacterium that attacks the lungs, as well as other parts of the body, like the spine or brain. People infected with TB bacteria can have two conditions: latent TB infection (LTBI) or TB disease.[]
The main symptoms of TB disease include a persistent cough (lasting three weeks or longer), bloody sputum, and chest pain. Your patients may also present with weight loss, chills, fever, weakness, or fatigue. When TB affects other parts of the body, your patients may present with bloody urine, back pain, hoarseness, or headache. Patients with LTBI will show no symptoms and aren’t contagious, but do require treatment in order to prevent active TB disease and potential spread.
Who is at risk for TB?
TB is contagious, but it’s not exactly easy to catch. “A person who is infected can spread the bacterium to other people via the airborne route (from coughing, talking, breathing, etc.),” says Erica Susky, an infection control practitioner (ICP) and instructor at Infection Prevention and Control (IPAC) Canada. That said, TB is most contagious when a patient repeatedly spends time around people who have it.[]
Certain countries and demographics have higher rates of TB. According to Susky, “TB is less common in North America than it was before the advent of antibiotics, but remains more common in some areas of the world like in India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh, and South Africa,” Susky says.
But that doesn’t mean it’s not a concern for Americans. “[It] disproportionally affects certain groups,” Susky adds. “These groups include people who emigrated from an area of the world with a higher prevalence of TB, homeless people, people who inject drugs, indigenous people, and staff or residents of healthcare facilities, shelters, and correctional facilities.” If you are working with patients in these communities, your patients should be tested for TB.
Testing for and treating TB
Many people don’t know they have LTBI or even TB—which is why it’s so important to test for and treat. According to Dr. Qaisar Usmani, a rheumatologist at SNS Rheumatology in Hamilton, New Jersey, TB “can attack your body without you even knowing it. When you finally realize it's there, it's already taken over.”
In fact, “Latent TB has a chance to emerge years later as active TB if one has not been effectively treated with antibiotics, or if one’s immune system weakensto where it can no longer maintain the bacterium within them in a latent phase,” Susky adds.
Another complication? “The bacterium [also] has [the]capacity to develop resistance to many antibiotics which make it more difficult to treat and eradicate,” Susky says.
In many cases, TB tests should be given even if patients don’t present with textbook symptoms. Physicians should test patients who[]:
Have spent time with someone with TB.
Have traveled to countries with a high rate of TB.
Have lived or worked in a facility or group setting.
Have cared for someone with TB disease.
Is part of a population of people at higher risk for TB or LTBI.
Require certain medications. For example, you’ll need to run a TB test prior to ruling out TB infection by prescribing certain treatments, like biologics.[]
What should you do if someone tests positive for TB and has symptoms of active TB?
“They should immediately put the patient under quarantine and contact the authorities to report the case,” Usmani says.
Treating TB can be a long road. Patients with active TB disease generally undergo treatment with antibacterial medications for six to 12 months and must stay quarantined for at least a few weeks.[]
“These antibiotics may have side effects, and treatment with many antibiotics over an extended period of time will require medical advice and supervision,” Susky says. “This is to minimize potential side effects, and to know the person is getting effective treatment (for the dose, time, and antibiotic choice).”
Typical treatment for TB includes isoniazid INH with rifampin, pyrazinamide, and ethambutol, although some people with TB are drug-resistant. The treatment time for drug-resistant TB is much longer, according to the American Lung Association.[]
For patients who test positive for TB without any other indicators of disease, an LBTI diagnosis may be made. According to the CDC, “The decision about treatment for latent TB infection will be based on a person’s chances of developing TB disease by considering their risk factors.”
It’s important that you educate your patients—especially the higher-risk ones—about the symptoms and risks associated with TB.