[Hpn] TB claims life of homeless man

Graeme Bacque gbacque@colosseum.com
Fri, 26 Nov 2004 04:02:42 -0500


Nov. 26, 2004. 01:00 AM

TB claims life of homeless man
Illness undiagnosed despite checkups

Two workers from same hostel infected


A homeless man died of late-stage tuberculosis in Toronto this week, his 
illness undiagnosed despite numerous visits to doctors.

The disease went undetected despite a public-health blitz aimed at 
containing the infectious disease, which has already hit vulnerable 
residents of downtown shelters.

The man was a long-time resident of the same Salvation Army hostel, 
Maxwell Meighen Centre, where two employees recently contracted active 
TB  a discovery that led the public-health department to test 4,000 
people for the deadly disease.

"We didn't catch him. He didn't come forward" for the tests, said 
Barbara Yaffe, Toronto's associate medical officer of health.

"We are doing our best with shelter staff to get everyone, but it is a 
voluntary program," she said. "You really have to have some legal 
grounds to force people to get tested."

Cathy Crowe, a street nurse, said shelter users are afraid the disease 
will continue its spread now that the cold weather is sending more 
people into overflowing shelters, whose crowded rooms and poor 
ventilation act as incubators for disease.

"We're bracing for the worst," Crowe said.

Toronto public-health officials found another active TB case last week. 
A homeless man from Seaton House is now being treated in the hospital.

It will take several weeks before tests in both new cases will determine 
whether the TB strain carried by the men is the same as the one that 
infected the shelter workers. Both of those workers are infected with 
the strain that caused an outbreak in 2001.

As a result of the man's death, Toronto public health issued a notice on 
Wednesday to hospitals, health centres and infectious-disease experts to 
"think TB" when diagnosing patients.

Public-health officials said yesterday that the dead man, whose identity 
is not being released but is in his 50s, would have suffered from active 
tuberculosis for several months.

Symptoms of tuberculosis include coughing, night sweats and weight loss. 
Despite many visits to doctors in downtown hospitals and health centres, 
his disease went undiagnosed, Yaffe said.

On Saturday morning, shelter workers found him in a sickened state, she 
said. They sent him to the emergency ward at Mount Sinai Hospital, which 
followed infectious control measures and later diagnosed him with the 
lung disease, officials said.

By late Monday, the hospital reported the TB case to public health, but 
by early Tuesday the man was dead.

"People should not be dying of TB these days," Yaffe said. "Tuberculosis 
is preventable, treatable and curable."

This is the sixth case so far in 2004 in which TB either caused a death 
or contributed to death, said public-health spokesperson Gene Long.

It is unclear, however, whether the five other cases were contracted in 
Toronto. There are up to 400 active cases diagnosed every year in the 
city, with up to 15 of those among the homeless population.

The majority are latent cases picked up in the victim's country of 
origin that can become active years later.

Outside the Maxwell Meighen Centre on Sherbourne St. last night, several 
homeless men said they had not heard that a fellow resident had died of TB.

"It's kind of scary, but we've known it's been going around for some 
time," said one resident, who did not want to be identified.

In a report to the city last February, then medical officer of health 
Sheela Basrur asked for increased funding to counter the spread of TB 
among the homeless.

"There is a strong link between TB, poverty and homelessness," Basrur 
wrote. "In crowded shelters, where poor nutrition, stress and underlying 
health problems abound, a person with infectious TB can touch off an 
outbreak that can go on for years."

With files from Kerry Gillespie and Henry Stancu

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