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TB'S RESURGENCE IS A TRAGEDY, EMBARRASSMENT, UTAHN SAYS

When Americans look back on the social failure of the '80s, two problems will stick out - the savings and loan crisis and the return of tuberculosis, health-care workers predict.

"TB is alive and well in Utah. It's not just our grandparents' disease. It's back and threatening to spread if we don't start paying attention," says Lillian Tom-Orme, the nurse who directs Utah's TB program through the State Department of Health.Utah health workers joined hundreds of colleagues throughout the United States Friday afternoon in a telephone conference addressing a dangerous disease that has become epidemic in major cities, including New York, Los Angeles, Chicago, Houston and San Francisco. In "the old days" it was known as "consumption" because it locates in the lungs and begins slowly consuming the body, said Orme.

The return of TB is a social embarrassment and tragedy, created by the lack of funding to programs to keep the disease in check, she said. In 1991, there were 46 cases reported in Utah.

Compared to other cities, Salt Lake City has not reached the critical level, but if vulnerable populations are not helped, the disease will spread in the general population, she said.

Those high-risk populations include the homeless, people with AIDS or diabetes, prison populations, the elderly, nursing home residents and people from Southeast Asian and African countries.

TB causes more deaths than any other infectious disease worldwide. Because the bacteria is spread in airborne droplets - released when a TB sufferer coughs - it can be caught by anyone sharing a poorly ventilated space.

Those who work with these high-risk populations should have a skin test every three months, Tom-Orme recommends.

Symptoms include: a chronic cough, fatigue, coughing up blood, high fever, night sweats, weight loss. "But when you look at someone you can't tell if they have TB or not," she said.

Tom-Orme is gravely concerned that a Salt Lake hospital consistently treats the homeless but releases them prematurely because the homeless are without financial resources. "Those with TB are treated inappropriately, the TB is ignored. If the community continues to ignore the sick homeless, we will become another New York City," she said.

Many of the 500 refugees who locate in Utah arrive with positive TB cases under treatment. They are carefully screened, she said. "Surprisingly, the southeast Asians get adequate health care through refugee camps."

Treatment requires taking medication - every day - for six to nine months. Two main drugs are used - isoniazid and rifamtin. But the epidemic in New York is a result of people who are multi-drug resistant. Treatment of one TB patient can cost $185,000 over years.