Wednesday, August 18, 2010

I have cavities in my lung . Im from South Africa- Can I fly?

We recently had a a lady from South Africa who came to US to visit her daughter.She is a physician in RSA in a TB clinic. She came to our ER c/o dysuria and subjective fevers. She didn't have any other symproms, and she was prescribed bactrim as urinalysis showed leucocytes & nitrites. A clever resident! did a chest Xray which showed 3-4 cavities. She is supposed to fly back to RSA the next day. This raises a few questions.

1. What is the significance of the finding of cavities in this lady ?
2. Does it need to be investigated now?
3.Can she fly back home?
4.Is there a higher chance of TB spread in a flight?

                    She is a high risk for TB ( based on work and she is from RSA). The finding of cavities in this lady is incidental. The most important point to remember is that SHE IS ASYMPTOMATIC (esp without a cough),as with regards to TB, it spreads through respiratory droplets. Cavitary TB is more infectious than other forms of TB.
As she does not have any respiratory symptoms she does not need to be investigated right now.But has to be evaluated soon ..first with a CT chest and a PPD, and then if needed, a brochoscopy.

Third....as she is asymptomatic, she is safe to fly back home. Have a look at the WHO recommendations on flying - In short.. you should not fly....if your sputum is +ve for AFB. If positive, then you should be treated for 2 weeks , and for 4 weeks in case of MDR TB before you can fly.

Forth... In 2005, CDC diagnosed 6 cases of TB in air travellrs and cabin crew, and trace down all possible contacts.This included 2900 travellers in 191 carriers.followed for a period of 3 years, only 2 of them developed TB(one was another cabin crew member, and other was a person sitting on the back row to the person with TB). So it looks like the chances of spreading TB in a flight is same as in any confined space(like in a elevator or car), and spreads only to close contacts. In both cases of TB, the flight duration was 12 hours.

So, if someone with TB has to travel, then they can do so with a little isolation, and if the flight duration is less than 8 hours.......well...provided Public Health Department is aware of this!!

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