BETHESDA -- The top federal AIDS scientist, Dr. Anthony S. Fauci, raised the possibility yesterday that the spread of drug-resistant tuberculosis might become as serious a public health threat as AIDS unless a major new research effort was begun against tuberculosis.
Although the immediate tuberculosis threat is chiefly to people infected with the human immunodeficiency virus, which causes AIDS, participants at a meeting here expressed alarm that the spread of tuberculosis from such patients also threatened the health workers who care for them and ultimately healthy people who are not infected with HIV.
Dr. Fauci said he did not want to start a panic but wanted to warn about the seriousness of tuberculosis as a public health problem.
Tuberculosis is one of the so-called opportunistic infections that can be deadly to people with AIDS. HIV is spread through sexual intercourse and blood.
But tuberculosis seems to be the only opportunistic infection that can be spread from people infected with HIV to those who are not infected with the virus, Dr. Fauci and other participants said.
The meeting was the latest in a series that federal health officials have called in recent weeks to deal with deadly outbreaks of drug-resistant tuberculosis that have struck in New York and several other states.
Although many of the outbreaks have involved the inner city populations of New York and Miami, the experts said there was evidence that scattered cases were occurring elsewhere.
The states in which dangerous strains of TB have struck are Alabama, Arizona, California, Florida, Georgia, Hawaii, Illinois, Michigan, Mississippi, Missouri, New Jersey, New York State, Pennsylvania, Texas, Utah, Virginia and Washington.
"This is the way things start off, with a few scattered cases, but one case can lead to an outbreak," said Dr. Samuel W. Dooley, a tuberculosis epidemiologist at the national Centers for Disease Control in Atlanta.
Yesterday's meeting was sponsored by the National Institute of NTC Allergy and Infectious Diseases, which Dr. Fauci directs.
Experts summoned to advise the institute urged major efforts be directed at developing new drugs, diagnostic tests, vaccines, and understanding at a genetic level how tuberculosis bacilli have developed resistance to standard drugs.
The advisers said that federal health officials had to move immediately to develop a new cadre of tuberculosis researchers because very few younger scientists have been trained in recent years to replace the experts who have retired or died.
Tuberculosis was the leading killer of Americans earlier in the century, but the number of cases declined dramatically with improvements in housing, sanitation and the introduction of antibiotics around World War II.
As the number of tuberculosis cases fell to record lows, many people, including government officials and doctors, said it no longer was an important health problem.
But in the last decade, tuberculosis has made a strong comeback and explosive outbreaks due to drug resistant strains of the bacilli have been documented in recent months in New York.