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 A female patient with an extremely hard-to-treat form of tuberculosis is being treated at the National Institutes of Health outside Washington, D.C., and federal and state officials are now tracking down hundreds of people who may have been in contact with her. 
 
 The woman traveled to at least three states before she sought treatment from a U.S. doctor. While TB is not easily caught by casual contact, extensively drug resistant (XDR) TB is so dangerous that health officials will have to make a concerted effort to warn anyone who may be at risk. 
 
 “The patient was transferred to the NIH via special air and ground ambulances,” the NIH said in a statement. 
 
 “The patient was transferred to the NIH via special air and ground ambulances." 
 
 “The patient is staying in an isolation room in the NIH Clinical Center specifically designed for handling patients with respiratory infections, including XDR-TB. The National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH, is providing care and treatment for the patient in connection with an existing NIH clinical protocol for treating TB, including XDR forms. NIAID has treated other XDR-TB patients in the past under this protocol," the NIH said. 
 
 These special isolation rooms usually control air flow to prevent germs from escaping into the rest of the hospital or outside. 
 
 The patient, who isn’t being identified in any way, may face months or even years of treatment. Ordinary TB is hard to treat and requires, at a minimum, weeks of antibiotics. XDR-TB resists the effects of almost all the known TB drugs. Sometimes patients have to have pockets of infection surgically removed. 
 
 Only about a third to half of cases can even be cured. 
 
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 It’s not clear why the patient traveled so much before seeking treatment, the Centers for Disease Control and Prevention says. 
 
 “The patient traveled in April from India to the United States through Chicago O’Hare airport,” the CDC said in a statement provided to NBC News. 
 
 “The patient also spent time in Missouri and Tennessee. Seven weeks after arriving in the United States, the patient sought treatment for and was diagnosed with active TB.” 
 
 She was isolated in a suburban Chicago hospital before she was sent to NIH. 
 
 CDC and NIH are testing the patient to see what drugs may help her. 
 
 “Besides concerns about community contacts, the patient flew from India to the United States. CDC will obtain the passenger manifest for that flight from the airline and will begin a contact investigation. Although the risk of getting a contagious disease on an airplane is low, public health officers sometimes need to find and alert travelers who may have been exposed to an ill passenger,” CDC said. 
 
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 CDC takes these cases very seriously. In 2007 Andrew Speaker, an Atlanta lawyer with multi-drug-resistant tuberculosis, was arrested and forcibly isolated under federal order after he defied CDC advisories and flew out of the country to get married. 
 
 XDR-TB is very rare in the U.S. CDC says it got reports of 63 cases between 1993 and 2011. 
 
 "TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, shouts, or sings," CDC says. "These bacteria can float in the air for several hours, depending on the environment. Persons who breathe in the air containing these TB bacteria can become infected." 
 
 “The patient traveled in April from India to the United States through Chicago O’Hare airport." 
 
 People with lowered immunity, especially HIV patients, are most at risk. 
 
 “All travelers should avoid high risk settings where there are no infection control measures in place. Documented places where transmission has occurred include crowded hospitals, prisons, homeless shelters, and other settings where susceptible persons come in contact with persons with TB disease,” CDC advises. 
 
 The average cost of treating multidrug-resistant TB is $134,000, compared to $17,000 for a normal case. That can shoot up to $430,000 for an extensively resistant case. It’s not clear who will pay for this patient’s treatment. 
 
 Nine million people are infected with TB every year, including 9,000 people in the U.S. ||||| (PDFCdc-pdf – 421k) 
 
 Extensively Drug-Resistant Tuberculosis (XDR TB) 
 
 What is Extensively Drug-Resistant Tuberculosis (XDR TB)? 
 
 Extensively drug-resistant TB (XDR TB) is a rare type of multidrug-resistant tuberculosis (MDR TB) that is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin). MDR TB is caused by an organism that is resistant to at least isoniazid and rifampin, the two most potent TB drugs. 
 
 How is XDR TB spread? 
 
 Drug-susceptible TB and XDR TB are spread the same way. TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, shouts, or sings. These bacteria can float in the air for several hours, depending on the environment. Persons who breathe in the air containing these TB bacteria can become infected. 
 
 TB is not spread by 
 
 shaking someone’s hand 
 
 sharing food or drink 
 
 touching bed linens or toilet seats 
 
 sharing toothbrushes 
 
 kissing 
 
 Why is XDR TB so serious? 
 
 Because XDR TB is resistant to the most potent TB drugs, the remaining treatment options are less effective, have more side effects, and are more expensive. XDR TB is of special concern for persons with HIV infection or other conditions that can weaken the immune system. These persons are more likely to develop TB disease once they are infected, and they also have a higher risk of death if they develop TB disease. 
 
 Who is at risk for getting XDR TB? 
 
 Drug-resistant TB (MDR or XDR) is more common in people who: 
 
 Do not take their TB medicine regularly 
 
 Do not take all of their TB medicines as prescribed by their doctor 
 
 Develop TB disease again, after having taken TB medicine in the past 
 
 Come from areas of the world where drug-resistant TB is common 
 
 Have spent time with someone known to have drug-resistant TB disease 
 
 How can I prevent myself from getting TB? 
 
 Avoid close contact for a prolonged period of time with known TB patients in crowded, enclosed environments like clinics, hospitals, prisons, or homeless shelters. 
 
 Can the TB vaccine (BCG) help prevent XDR TB? 
 
 The TB vaccine is called Bacille Calmette-Guérin (BCG), and it is used in many countries to prevent severe forms of TB in children. However, BCG is not generally recommended in the United States because it has limited effectiveness for preventing the most common forms of TB and in preventing TB in adults. The effect of BCG against XDR TB would likely be similar to the effect on drug-susceptible TB. 
 
 If I have drug-susceptible TB, how can I prevent getting drug-resistant TB? 
 
 The most important thing is for you to continue taking all your TB medicines exactly as prescribed. No doses should be missed and treatment should not be stopped early. You should tell your health care provider if you are having trouble taking the medications or if you have any side effects. If you plan to travel, talk with your health care provider, and make sure you have enough medicine to last while away. 
 
 Can XDR TB be treated and cured? 
 
 Yes, in some cases. Some TB control programs have shown that cure is possible for an estimated 30% to 50% of affected people. Successful outcomes depend greatly on the extent of the drug resistance, the severity of the disease, whether the patient’s immune system is weakened, and adherence to treatment. 
 
 What are the symptoms of XDR TB? 
 
 The general symptoms of TB disease include feelings of sickness or weakness, weight loss, fever, and night sweats. The symptoms of TB disease of the lungs may also include coughing, chest pain, and coughing up blood. Symptoms of TB disease in other parts of the body depend on the area affected. If you have these symptoms, you should contact your doctor or local health department. 
 
 What should I do if I have been around someone who has XDR TB? 
 
 If you think you have been exposed to someone with XDR TB disease, you should contact your doctor or local health department about getting a TB skin test or blood test for TB infection. You should tell the doctor or nurse when you spent time with this person. You should also tell the doctor or nurse where the person with XDR TB is being treated. It will be important to know about this person’s treatment. If your test for TB infection is positive, you will need special follow up. 
 
 How long does it take to find out if you have XDR TB? 
 
 If TB bacteria are found in the sputum (phlegm), the diagnosis of TB can be made in a day or two, but this finding will not be able to distinguish between drug-susceptible TB and drug-resistant TB. To determine drug susceptibility, the bacteria need to be grown and tested in a specialized laboratory. Final diagnosis for TB, and especially for XDR TB, may take from 6 to 16 weeks. 
 
 Is XDR TB a problem in the United States? 
 
 The risk of acquiring XDR TB in the United States appears to be low because XDR TB is uncommon in the U.S. However, TB can spread easily. As long as XDR TB exists, the risk to people in the United States is not zero, and the U.S. public health system must address the threat. 
 
 How many cases of XDR TB have been reported in the United States? 
 
 In the United States, 63 cases of XDR TB have been reported between 1993 and 2011*. 
 
 *The National Tuberculosis Surveillance System (NTSS) 1993-2011. 
 
 Is it safe to travel to countries where cases of XDR TB have been reported? 
 
 Although MDR and XDR TB are occurring globally, they are still rare. HIV-infected travelers are at greatest risk if they come in contact with a person with MDR or XDR TB. 
 
 All travelers should avoid high risk settings where there are no infection control measures in place. Documented places where transmission has occurred include crowded hospitals, prisons, homeless shelters, and other settings where susceptible persons come in contact with persons with TB disease. 
 
 What can health care providers do to prevent XDR TB? 
 
 Health care providers can help prevent MDR and XDR TB by quickly diagnosing TB cases, following recommended treatment guidelines, monitoring patients’ response to treatment, and making sure therapy is completed. 
 
 Providers should also ensure proper implementation of infection control procedures to prevent exposure to TB in hospitals or health-care settings where TB patients are likely to be seen. 
 
 Why does there seem to be more cases of XDR TB now than there were in the past? 
 
 In 2006, CDC, the World Health Organization (WHO), and other global leaders in TB reported the results of a survey regarding drug-resistant TB conducted by 25 reference laboratories comprising the Global Supranational TB Reference Laboratory Network, the National TB Surveillance System in the United States, the national reference laboratory of South Korea, and the national MDR TB patient registry in Latvia. The findings indicated that 20% of M. tuberculosis isolates were MDR, and 2% also were resistant to many additional TB drugs. This highly resistant form of TB was identified in every region of the world where there was lab capacity to identify it. In a report published in 2006, the highly resistant form of TB was named extensively drug-resistant TB (XDR TB). Since then, more countries have improved their laboratory capacity to test for XDR TB and their ability to report XDR TB. These factors have contributed to an apparent increase in drug-resistant TB because of better diagnosis and better reporting. 
 
 What is CDC doing to prevent XDR TB from becoming a bigger problem? 
 
 CDC is collaborating with other federal agencies and international partners to raise awareness and enhance strategies for TB prevention worldwide by: 
 
 Strengthening TB services for people living with HIV/AIDS; 
 
 Guiding preparedness and outbreak investigation responses; 
 
 Improving access to TB drugs; 
 
 Conducting routine surveillance (including drug susceptibility) and periodic surveys; 
 
 Implementing new, rapid diagnostic tests; 
 
 Developing and promoting, national and international TB testing standards; 
 
 Conducting program evaluation (e.g., National TB Indicators Project [NTIP]); 
 
 Building capacity of health care providers to diagnose and treat TB; 
 
 Reinvigorating the Federal TB Task Force; 
 
 Providing assistance to improve TB program capacity in the U.S. and abroad; and 
 
 Developing education, risk, and media communications (Web- and print-based) to aid in preparedness and public awareness of TB prevention and control issues. 
 
 Additional Information 
 
 CDC. Extensively Drug-Resistant Tuberculosis Information 
 
 CDC. Questions and Answers About TB 
 
 CDC. Tuberculosis: General Information 
 
 CDC. Multidrug Resistant Tuberculosis 
 
 CDC. Tuberculosis Information for International Travelers 
 
 CDC. Extensively Drug-Resistant Tuberculosis – United States, 1993–2006 
 
 CDC. CDC’s Role in Preventing XDR TB ||||| Frequently asked questions - XDR-TB 
 
 1. What is XDR-TB? 
 
 XDR-TB, an abbreviation for extensively drug-resistant tuberculosis (TB), is a form of TB which is resistant to at least four of the core anti-TB drugs. XDR-TB involves resistance to the two most powerful anti-TB drugs, isoniazid and rifampicin, also known as multidrug-resistance (MDR-TB), in addition to resistance to any of the fluoroquinolones (such as ofloxacin or moxifloxacin) and to at least one of three injectable second-line drugs (amikacin, capreomycin or kanamycin). MDR-TB and XDR-TB both take substantially longer to treat than ordinary (drug-susceptible) TB, and require the use of second-line anti-TB drugs, which are more expensive and have more side-effects than the first-line drugs used for drug-susceptible TB. 
 
 2. How do people get XDR-TB? 
 
 People may get XDR-TB in one of two ways. It may develop in a patient who is receiving treatment for active TB, when anti-TB drugs are misused or mismanaged, and is usually a sign of inadequate clinical care or drug management. It can happen when patients are not properly supported to complete their full course of treatment; when health-care providers prescribe the wrong treatment, or the wrong dose, or for too short a period of time; when the supply of drugs to the clinics dispensing drugs is erratic; or when the drugs are of poor quality. 
 
 
 
 The second way that people can develop XDR-TB is by becoming infected from a patient who is already ill with the condition. Patients with TB of the lungs can spread the disease by coughing, sneezing, or simply talking. A person needs only to breathe in a small number of these germs to become infected. However only a small proportion of people infected with TB germs develop the disease. A person can be infected by XDR-TB bacteria but not develop the active disease, just as with drug-susceptible TB 
 
 3. How easily is XDR-TB spread? 
 
 Studies suggest that there is probably no difference between the risk of transmission of XDR-TB and any other forms of TB. The spread of TB bacteria depends on factors such as the number and concentration of infectious people in any one place together, and the presence of people with a higher risk of being infected (such as those with HIV/AIDS). The likelihood of becoming infected increases with the time that a previously uninfected person spends in the same room as an infectious case. The risk of spread increases where there is a high concentration of TB bacteria, such as can occur in poorly-ventilated environments like overcrowded houses, hospitals or prisons. The risk of spread is reduced if infectious patients receive timely and proper treatment. 
 
 4. How can a person avoid becoming infected with XDR-TB? 
 
 While patients with XDR-TB may be as infectious as those with ordinary TB, the chances of a TB infection being XDR-TB is lower due to the rarity of the condition. The measures to be taken are the same as those for the prevention of ordinary TB. Close contact with a patient with infectious TB is to be avoided especially in poorly ventilated spaces. The risk of becoming infected with TB is very low outdoors in the open air. TB patients should be encouraged to follow good cough hygiene, for example, covering their mouths with a handkerchief when they cough, or even, in the early stages of treatment, using a surgical mask, especially when in closed environments with poor ventilation. 
 
 5. How can a person who already has ordinary TB avoid getting XDR-TB? 
 
 The most important thing is for the health care workers and community to provide all the means (information, counselling, and material support) that enable patients to continue taking all their treatment as prescribed. No doses should be missed and above all, treatment should be taken right through to the end. If a patient finds that side-effects are a problem, for example, the tablets make them feel sick, then they should inform their doctor or nurse, because often there is a simple solution. If they need to go away for any reason, patients should make sure they have enough tablets with them for the duration of the trip. 
 
 6. Can XDR-TB be cured or treated? 
 
 XDR-TB patients can be cured, but with the current drugs available, the likelihood of success is much smaller than in patients with ordinary TB or even MDR-TB. Cure depends on the extent of the drug resistance, the severity of the disease and whether the patient’s immune system is compromised. Patients infected with HIV may have a higher mortality. Early and accurate diagnosis are important so that effective treatment is provided as soon as possible. Effective treatment requires that a good selection of second-line drugs is available to clinicians who have special expertise in treating such cases. 
 
 7. How common is XDR-TB? 
 
 XDR-TB is rare, however 77 countries worldwide had reported at least one case by the end of 2011. Information from countries with reliable data suggests that about 9% of MDR-TB cases worldwide have XDR-TB. WHO estimates that there are about 650,000 MDR-TB cases in the world at any one time. Only a small proportion of these cases are detected and treated appropriately given that many low and lower middle-income countries still lack sufficient diagnostic capacity to detect MDR/XDR-TB. 
 
 8. How do countries prevent XDR-TB? 
 
 National TB control programmes working with all health services can prevent XDR-TB by ensuring that all practitioners working with people with TB adhere to the International Standards for TB Care. These emphasize providing proper diagnosis and treatment to all TB patients, including those with drug-resistant TB; assuring regular, timely supplies of all anti-TB drugs; proper management of anti-TB drugs and providing support to patients to maximize adherence to prescribed regimens; caring for MDR/XDR-TB cases in services with proper ventilation, and minimizing contact with other patients, particularly those with HIV, especially in the early stages before treatment has had a chance to reduce the infectiousness. 
 
 9. Can the TB vaccine, known as BCG, prevent XDR-TB? 
 
 The BCG vaccine prevents severe forms of TB in children, such as TB meningitis, but is less effective in preventing pulmonary TB in adults, the commonest and most infectious form of TB. It is expected that the effectiveness of BCG against XDR-TB is similar as for ordinary TB. Nevertheless, new vaccines are urgently needed, and WHO is actively advocating for the development of new vaccines. 
 
 10. What is the link between XDR-TB and HIV/AIDS? Why in some places is XDR-TB linked with HIV? 
 
 People living with HIV are at greater risk of developing TB – as well as XDR-TB - than people without HIV, because of their weakened immunity. In few places where XDR-TB strains circulate more frequently, people with HIV are therefore more likely to be infected with XDR-TB than elsewhere. To date, in most of the places with high rates of HIV infection, XDR-TB has not been widespread. For this reason, the majority of people with HIV who develop TB will have ordinary TB and can be treated with standard first-line anti-TB drugs. For those with HIV infection, treatment with antiretroviral drugs will likely reduce the risk of developing XDR-TB, just as it does with ordinary TB. Patients with both XDR-TB and HIV who do not receive antiretroviral drugs are at high risk of dying. 
 
 11. How can I tell if I might have TB or XDR-TB? 
 
 XDR-TB can only be diagnosed in a well-equipped laboratory. Symptoms of XDR-TB are no different from ordinary TB: a cough with thick, cloudy mucus (or sputum), sometimes with blood, for more than 2 weeks; fever, chills, and night sweats; fatigue and muscle weakness; weight loss; and in some cases shortness of breath and chest pain. If you have these symptoms, it does not mean you have XDR-TB. But it does mean you must go and see a doctor for a check-up. If you are already on treatment for TB, and at least some of these symptoms are not improving after a few weeks of medication, you should inform your clinician or nurse. 
 
 12. How quickly can XDR-TB be diagnosed? 
 
 If TB bacteria are found in the sputum, the diagnosis of TB can be made in a day or two. To confirm XDR-TB, however, it may take from 6 to 16 weeks. 
 
 13. Is it safe to travel to places where XDR-TB has been identified? 
 
 XDR-TB is still very rare but has been documented in many countries. People who are most at risk, if they do come into contact with someone with XDR-TB, are those with reduced immunity to infectious diseases, such as those with HIV infection or other medical conditions that can weaken a person's immunity. It is also advised that such people should avoid areas where there are no infection control measures in place. Air travel carries only very minimal risks of infection with any kind of TB. Concerned travellers should seek advice before their visit from their doctor, national authorities, or trusted travel web sites such as www.who.int/topics/travel . 
 
 14. What should be done if a person has been in contact with a known or suspected case of XDR-TB? 
 
 Anyone who has been in contact with someone known, or suspected of having, XDR-TB should consult their doctor or a local TB clinic and be screened to see if they have TB. This is most important if the person has any symptoms of TB. If they have a cough, they will be asked to provide a sample of sputum, which will be tested for evidence of TB disease. If TB is found, treatment will be started with the drugs to which the person’s TB is most likely to respond. If there is any evidence of infection with TB bacteria but without TB disease, preventive treatment may be given or the person may simply be asked to attend health services periodically for a check up. 
 
 15. Should patients with XDR-TB be isolated while on treatment or after treatment options have failed? 
 
 In order to make the diagnosis, patients with suspected TB or XDR-TB are sometimes admitted to hospital. In order to protect other patients and health workers in the hospital, isolation of such patients is part of good quality care. Once the diagnosis is made and treatment begun, for patients who are willing to undergo treatment, isolation is usually neither necessary nor appropriate. Isolation has a very limited role to play in patients in whom treatment has failed. Studies have shown that treating TB patients at home with appropriate infection measures in place generally poses no substantial risk to other members of the household. By the time a diagnosis is made, the household contacts have already been exposed to the patient’s infection. However, in the absence of options for curative treatment, all infection control measures at household should be strengthened. Whenever this is not feasible then options for voluntary isolation and delivery of palliative and end of life care should be offered to the patient. 
 
 16. What risks do health-care workers face with XDR-TB, particularly those who may be HIV-positive themselves? 
 
 To protect health-care workers who may come into contact with infectious TB patients, appropriate and strict infection control measures must be implemented in health-care facilities at all times. Health-care workers are also encouraged to make sure that they are aware of their HIV status so that they can restrict putting themselves at risk of exposure. 
 
 18. What is WHO doing to combat XDR-TB? 
 
 Firstly, WHO is ensuring that the health authorities responsible for TB care and control receive accurate information about XDR-TB. Latest information on XDR-TB, and related TB issues, are published on the WHO Stop TB website. Secondly, WHO advises that good TB prevention, care and control prevents the emergence of drug resistance in the first place, and that the proper treatment of MDR-TB prevents the emergence of XDR-TB. Thirdly, WHO is regularly updating its guidance to Ministries of Health on the management of drug-resistant TB patients and diagnostic policies. 
 
 Further information 
 
 Centers for Disease Control and Prevention. Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs worldwide. MMWR Morb Mortal Wkly Rep 2006; 55: 301-305. 
 
 
 
 Guidelines for the programmatic management of drug-resistant tuberculosis: Emergency Update 2008. WHO/HTM/TB/2008.402. Geneva, World Health Organization, 2008. 
 
 
 
 The Tuberculosis Coalition for Technical Assistance. International Standards of Care. 2006. Available from: www.who.int/tb/publications/2006/istc_report_shortversion.pdf 
 
 
 
 Resolution WHA62.15. Prevention and control of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis. In: Sixty-second World Health Assembly, Geneva, 18–22 May 2009, Resolutions and decisions; annexes. Geneva, World Health Organization, 2009 (WHA62/2009/REC/1):25–29. Available from: apps.who.int/gb/ebwha/pdf_files/WHA62-REC1/WHA62_REC1-en.pdf 
 
 
 
 Towards universal access to diagnosis and treatment of multidrug-resistant and extensively drug-resistant tuberculosis by 2015. WHO progress report 2011. WHO/HTM/TB/2011.3. Geneva, World Health Organization, 2011 
 
 
 
 Multidrug and extensively drug-resistant TB (M/XDR-TB): 2010 global report on surveillance and response. WHO/HTM/TB/2010.3. Geneva, World Health Organization, 2010. 
 
 
 
 Global Tuberculosis Control 2011. WHO/HTM/TB/2011.16. Geneva, World Health Organization, 2011. 
 
 
 
 Guidance on ethics of tuberculosis prevention, care and control. WHO/HTM/TB/2010.16. Geneva, World Health Organization, 2010. 
 
 WHO Stop TB Department - 26 January 2012 
 
 
 
 For more information please contact: 
 
 Monica Dias 
 
 diash@who.int ||||| A woman with a rare, hard-to-treat form of tuberculosis visited family in McHenry County after arriving at O'Hare International Airport in April, and also traveled in Missouri and Tennessee, according to health officials who are trying to track down people who came in close contact with her. 
 
 The woman sought treatment at an undisclosed hospital in the Chicago area, where she was admitted to an isolation unit, and then was transferred to a National Institutes of Health hospital in Bethesda, Md. Her condition was reported as stable. 
 
 The woman has an extremely drug-resistant form of the disease called XDR TB, which is impervious to most TB drugs. Three to four cases are reported each year in the United States, on average. 
 
 TB is not as easily spread as diseases like the flu or measles. But it is a dangerous illness, especially for people with weakened immune systems, and health officials are taking the situation seriously, Skinner said. 
 
 Health officials in Illinois are working with the Centers for Disease Control and Prevention to find people with whom the woman may have had prolonged direct contact, in close quarters, according to CDC spokesman Tom Skinner. 
 
 Debra Quackenbush, a spokeswoman for the McHenry County Health Department, said some of the people who came into close contact with the woman have been interviewed and are being monitored. She did not believe the general public was at risk. 
 
 Tuberculosis is caused by bacteria spread from person to person through the air. It usually affects the lungs and can lead to symptoms such as chest pain and coughing up blood. 
 
 TB has been declining in the United States. But globally, each year it sickens about 9 million people and is a cause of 1.5 million deaths. 
 
 Associated Press contributed. ||||| Story highlights Woman traveled from India to the U.S. and later tested for drug-resistant TB 
 
 Contact tracing is underway for people who had prolonged close contact with patient 
 
 (CNN) Health authorities are working to identify people who may have been exposed to a patient with a drug-resistant form of tuberculosis. 
 
 The patient traveled in April from India to the United States, through Chicago, the Centers for Disease Control and Prevention said Monday. Seven weeks after arriving, the patient -- who also spent time in Missouri and Tennessee -- sought treatment and was diagnosed with active tuberculosis. 
 
 She has an extensively drug-resistant form of tuberculosis, or XDR-TB, which is a relatively rare form of the disease that is resistant to at least four of the core anti-TB drugs, according to the World Health Organization 
 
 Contact tracing is underway, and the CDC is seeking people who may have had prolonged close contact with the woman, including those who sat in the same row or near the woman on the flight. 
 
 "The likelihood that this person transmitted the illness is low, but this is a very serious illness so we can't take any chances, and need to get the close contacts in for testing," said Tom Skinner, a spokesperson at the Centers for Disease Control and Prevention. "TB is a very serious illness and the XDRTB version is difficult to treat." 
 
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– CDC officials say a woman with an extremely rare form of tuberculosis came to the US from India and traveled to three different states before being diagnosed with an active case of the disease. Now she's isolated at a National Institutes for Health clinic in Maryland, and authorities are trying to track down "hundreds of people" who may have come into contact with her, NBC News reports. If it were just a simple case of TB, there wouldn't be such a brouhaha—but the unnamed patient has extensively drug-resistant TB, or XDR TB, which doesn't respond to some of the most powerful anti-TB drugs, per the World Health Organization. Although the disease is rare—the CDC says only 63 cases of it were noted between 1993 and 2011—TB bacteria can enter the air via coughs or sneezes and remain there for several hours, the agency notes. After spending time in India—the country with the largest number of TB cases in 2013, according to WHO—the woman flew back to Chicago in April, then traveled to Missouri and Tennessee over the next seven weeks, notes NBC. CNN points out as many as 8 weeks can pass between exposure and a positive TB test. A spokeswoman for the McHenry County Health Department in Illinois tells the Chicago Tribune it's keeping an eye on some people the woman was in close contact with and that the general public is likely not at risk. An NIH statement says the patient is being treated in a room "specifically designed for handling patients with respiratory infections, including XDR-TB," per NBC; the CDC says she's in stable condition. The CDC reports only 30% to 50% of XDR TB cases can be cured, and treatment can take years, with doctors even performing surgery to remove infected areas.