By BETSY MCKAY

In medical isolation in South Texas, 100 miles or so from Mexico’s border, is a man who embodies one of U.S. health officials’ greatest worries: He is the first person to cross and be held in detention while infected with one of the most severe types of drug-resistant tuberculosis known today.

His three-month odyssey through 13 countries—from his homeland of Nepal through South Asia, Brazil, Mexico, and finally into Texas—shows the way in which dangerous new strains of the disease can migrate across the world unchecked.

Tuberculosis, an ancient, fatal airborne disease, has been treatable for decades with a cocktail of drugs. However, shoddy medical practices world-wide have enabled the bacteria to mutate and, in some cases, become all but untreatable. In recent months The Wall Street Journal has exposed widening TB drug resistance in hot spots like India, and shown that the U.S. is surprisingly unprepared for the growing global problem. Most U.S. cases of drug-resistant TB occur in people who were born abroad, according to the Centers for Disease Control and Prevention.

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The Nepalese man detained at the U.S. border carries a particularly deadly strain—XDR, “extensively drug-resistant” TB. His TB is resistant to at least eight of the 15 or so standard drugs, according to a U.S. government description of the case reviewed by the Journal. His XDR strain has been seen only once before in the U.S., in another patient of Nepalese origin, according to the government description.

The Nepalese patient was taken into custody by the U.S. Border Patrol in late November as he tried to cross the border illegally near McAllen, Texas, according to Department of Homeland Security officials. The government declined to name him.

He was transferred five days later to an Immigration and Customs Enforcement detention facility in Los Fresnos, Texas, and put into “medical isolation” with suspected tuberculosis, according to ICE. He has since been moved to another ICE detention facility, in Pearsall, Texas, with more medical staff, ICE said. He is the first XDR-case in ICE custody.

In-Depth: A Killer Quietly Gains Strength

The Wall Street Journal is chronicling the world’s imperfect response to the rise of drug-resistant tuberculosis, an ancient disease that modern medicine, until recently, could defeat.

A selection of reports:

• Deadly unintended consequences: The global TB-fighting strategy helped allow the spread of new, all-but-untreatable strains . (11/23/12)
• Exclusive numbers suggest more than 25% of patients at one Indian TB clinic don’t respond to the primary treatment. (11/23/12)
• One woman’s case of nearly incurable tuberculosis echoes around the world. (9/8/12)
• India’s slow reaction appears to be nurturing an all-but-untreatable strain of TB, raising the prospect of a global health hazard. (6/20/12)
• A top doctor in Mumbai reports finding 12 cases of tuberculosis that are all but untreatable by current methods. (1/19/12)

Twelve Border Patrol agents were tested for the disease, but none contracted it from the patient, a Customs and Border Protection official said. Casual contact doesn’t necessarily lead to infection, though it depends in part on how much time is spent in tight quarters with a patient, and how much the patient coughs, spreading bacteria into the air.

It remains unclear whether other people in custody with the Nepalese detainee might have been infected. By the time the Border Patrol learned of his infection, other people detained with him would have been transferred elsewhere, the CBP official said. Detainees who are suspected of being ill are placed in cells by themselves.

Given how far and wide the patient ventured—he took a flight of more than eight hours to Brazil, and also traveled by car, boat and on foot—his case was reported to the World Health Organization as having potentially widespread public-health impact. Now, officials in the 13 countries the man visited along the way must try to track down thousands of people he likely came into contact with, to see if any were infected.

That will be a challenge. “We will try to investigate where he was,” said Martin Castellanos, director of Mexico’s national TB program. But reconstructing his precise route through Mexico, or any country, will be difficult and perhaps impossible, he said.

Read the rest/ Wall Street Journal

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