Many questions about TB, but few answers

A college student who died of tuberculosis Friday at Memorial Hospital in Colorado Springs could have had the contagious form of the disease for up to four months, but health authorities say the public health risk is low.

Officials said Monday they didn’t know how many people might have had contact with Kalpana Dangol, a 19-year-old from Nepal who was studying nursing at Colorado State University in Pueblo while living in Colorado Springs.

They also did not know how widespread their investigation will be, but it will involve the Pueblo campus, said Dr. Bernadette Albanese, medical director for the El Paso County Department of Health and Environment.

State and local health officials were tight-lipped about the case, refusing to provide Dangol’s name, information about her symptoms, and where she lived or might have worked, citing state privacy laws.

The El Paso County Coroner’s Office released the woman’s name.

Chief Medical Officer Ned Calonge of the Colorado Department of Public Health and Environment said he is confident health authorities could investigate who might have been exposed without providing that information.

“We can do what we need to do without releasing her identity,” Calonge said, adding that officials have the discretion to change their minds later.

He said they think the woman was not contagious before February based on a “clinical” finding but declined to elaborate.

Dangol came to Memorial Hospital about 12:30 a.m. Friday complaining of abdominal problems. Caregivers suspected a communicable disease and placed her in isolation in the emergency room, said Dick Eitel, chief executive officer of Memorial Health System.

He didn’t say how long she remained in the emergency room or how long it took for a diagnosis.

“I think all our staff members were protected once the diagnosis was made,” he said. He declined to tell reporters at the news conference how Dangol arrived at the ER.

Dangol died several hours after her arrival.

The coroner’s office listed Dangol’s cause of death as sepsis, a poisoning from the spread of bacteria. TB invaded other parts of her body, including her colon, which became eroded and perforated.

The perforation of her colon caused bacteria to move into her bloodstream, Coroner Robert Bux said.

Dangol might have contracted the disease in her native country, where TB is endemic, Calonge said. But she did not travel during the time period where she could have been contagious, he said.

He said she probably did not have the rare multidrugresistant or extensively drugresistant strains of TB. Those forms have a higher mortality rate, said Jim Hunger, assistant to the director for San Francisco Department of Health’s TB Control Center.

TB, which is spread by air, is usually contracted through prolonged exposures and in poorly ventilated areas. Most people exposed to it do not become infected.

“It is not easy to catch tuberculosis,” said Albanese of the county health department.

Although Memorial’s Eitel said at the news conference he couldn’t give a number for how many hospital staff members had been exposed, he told the City Council earlier in the afternoon that a dozen employees were exposed before diagnosis. They will be monitored and tested for TB, but Eitel said he thinks their chances of contracting the disease are “very, very low.” He did not explain the basis for his belief.

Officials said their efforts to contact people who may have been exposed to Dangol will begin with people who had the closest and most frequent contact with her, then work out to a broader group of people in “circles.” When there are no positive tests for latent TB, health officials know they’ve caught all possible exposures. Those methods have been used since 1948.

“The difference in this investigation is that because it involves a school, we may still do testing at the school,” Albanese said.

The investigation is made more difficult by the fact that Dangol can’t provide any information about who officials should seek out, Albanese said.

Albanese said investigations can range in scope from finding several people to testing hundreds, as officials did in October when 200 people at Falcon District 49 schools were exposed. The infection rate in that case was 2 percent, Albanese said.

Cases of TB are low in Colorado Springs compared with other areas. The state records about 120 cases of active TB a year. Officials said Monday they didn’t have immediate access to information about the last time someone died of TB in Colorado.

Across the state, a network of friends put out the word of Dangol’s death.

“All her friends and fellow classmates at CSU are saddened and shocked on the untimely and sudden demise of late Kalpana Dangol. We pray for the departed soul,” Dharma Raj Shrestha wrote in a message on the Web site for Rocky Mountain Friends of Nepal.

Staff writers Pam Zubeck and Sarah Pulliam contributed to this report.