TB testing increased at state prisons after drug-resistant strain is detected Roxbury diagnosis raises alarm


Maryland will increase efforts to curb tuberculosis in prisons, the state corrections chief said yesterday. An inmate at Hagerstown's Roxbury Correctional Institution was diagnosed this week with a multiple drug-resistant strain of the disease.

While only one inmate was found with an active case of TB there, tests showed a third of the prisoners and 10 percent of the staff exposed to the tuberculosis bacteria.

Citing concern for the rapid spread of the TB bacteria among inmates and staff, Correction Commissioner Richard A. Lanham Sr. said the prison system will begin testing employees and inmates annually and spend $200,000 to upgrade isolation cells at five regional infirmaries.

The Hagerstown inmate, the first diagnosed with the drug-resistant strain of TB, was moved for treatment to a medical isolation unit at Eastern Correctional Institution in Somerset County, which has the most modern special ventilation equipment.

The inmate is suspected of starting the outbreak at Roxbury, where 135 inmates and 41 staff members have tested positive for the bacteria, Mr. Lanham said. That means 32.8 percent of the 411 inmates and 9.5 percent of the 430 staff members whose test results have returned are carriers of the TB bacteria. Test results of the remaining inmates are expected in the next few days, officials said.

Inmates and staff members who test positive -- which means they carry the TB bacteria, not that they have active tuberculosis -- will be given preventive drugs and chest X-rays, said Dr. Newton E. Kendig, the Division of Correction's medical director.

So far, 130 X-rays have been taken at Roxbury, and none has shown an active case of TB, Dr. Kendig said. About 10 percent of infected people will develop active TB over their lifetime and pose a threat to others, health officials said.

The Roxbury inmate was found to be resistant to three anti-tuberculosis drugs, Dr. Kendig said. When he entered the prison system in 1987, he tested negative for TB and officials now are trying to determine how he contracted the disease.

Dr. Ebenezer Israel, infectious disease director for the state health department, said the inmate's strain of TB was not "the same bug" as the resistant strain of the disease that has swept through New York prisons.

Dr. Israel said there are 10 to 15 drugs available to treat tuberculosis,but that the inmate is resistant to the three drugs that are the least toxic, least expensive and most effective.

Inmates and staff at Roxbury already have been tested, as have those at the nearby Maryland Correctional Training Center in Hagerstown, officials said. Also, tuberculosis tests have been administered at the Somerset County prison, the Central Laundry Pre-release Unit in Sykesville, Poplar Hill Pre-Release Unit in Wicomico County and the Maryland House of Correction in Jessup.

Since last May, 11 active cases of TB have been diagnosed among the 19,000 inmates in the state prison system. The Division of Correction now will increase from 10 to 34 the number of medical isolation cells for inmates at the state's five regional prison infirmaries, Mr. Lanham said.

In addition, the isolation units will be upgraded with so-called "negative-pressure" ventilation systems designed to change the air in the isolation unit six to eight times an hour and protect other inmates from being exposed to the airborne bacteria by discharging the air outside the prison, Dr. Kendig said.

The infirmaries are located at the Maryland Penitentiary in Baltimore; Maryland Correctional Institution for Women in Jessup; Maryland Correctional Institution in Hagerstown; the Maryland House of Correction; and the Somerset County prison.

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