State health officials are concerned about the spread of a drug-resistant type of tuberculosis in Hawaii.

This year Hawaii officials have seen four drug-resistant tuberculosis cases, an increase from one case last year and the highest to date. Hawaii has had 104 tuberculosis cases of all types this year.

"We are seeing more drug-resistant TB cases than we’ve seen in the past," said Dr. Richard Bro­strom, state Department of Health tuberculosis branch chief, who is employed by the Centers for Disease Control and Prevention. "It’s a global phenomenon because of the rising rates of drug resistance across the world. We’re concerned the numbers we’re seeing this year may represent a new trend for Hawaii."

Those cases are a challenge to treat and also more expensive, he said.

"Thatmeans we cannot use our regular medicine on these cases to cure them," Bro­strom said. "We have to use medications that are more difficult for us to obtain,more expensive and more difficult for a patient to tolerate. Instead of treating patients for six months, we have to treat them for two years to achieve a cure."

Treating tuberculosis typically costs around $200 per patient. However, once the disease becomes drug-resistant, the cost can exceed $500,000 per case, Bro­strom said.

Tuberculosis, an infectious disease caused by bacteria spread through the air and which affects the lungs and other parts of the body, is curable in most cases, though at least two Hawaii residents died last year after contracting the disease, the Department of Health said.

Hawaii had the second-highest rate of active tuberculosis cases in the nation in 2011 and was No. 1 in 2010, with 8.9 and 8.4 cases per 100,000 people, respectively. The national average in those years was 3.4 in 2011 and 3.6 in 2010.

The state has a higher rate of the disease because of a high proportion of immigrants and travelers from Asia and the Pacific islands, where the disease is prevalent. Tuberculosis is the No. 1 killer among communicablediseases, DOH said.

Hawaii residents born in the Philippines made up 55 percent of the state’s active TBcases, followed by U.S.-born residents at 11 percent. Residents from the Federated States of Micronesia, the Marshall Islands and Vietnam each comprised 7 percent of the cases, while Chinese and Koreans each made up 4 percent.

Drug-resistant TB spreads the same way as the drug-susceptible bacteria: when a person coughs, sneezes, speaks or sings. The bacteria can float in the air for several hours, infecting people who breathe the air, the CDC says. People who do not complete treatment or improperly follow treatment contribute to drug resistance.

DOH officials are forecasting the number of drug-resistant cases to increase as the number of patients with active TB rises. The department is projecting between 125 and 130 active TB cases in 2012, compared with 123 last year.

Meanwhile, there were 4,228 people diagnosed by DOH health clinics last year with latent, or noninfectious, TB. Those cases do not include patients identified by private physicians. If not treated, between 5 percent and 10 percent of patients with latent tuberculosis develop active TB during their lifetime, the CDC said.

People with latent TB are infected but do not have symptoms. Those with weak immune systems, due to HIV infection or other chronic diseases, are at a substantially greater risk of developing active TB.

Drug manufacturers have not kept up with the changing strains of the disease. Health providers have been using the same drugs to treat the disease for the past 40 years, said Derrick Felix, the CDC’s senior public health advisor, who also works at the Health Department.

"No new drugs have reallycome on market to help us fight TB," he said. Bro­strom added that the medications have been effective against all types of TB up until recent years, when the "bug got a little bit smarter."

The state tests about50,000 people a year.

"In most places in the U.S., TBhas dropped considerably in the last five years. That has not occurred here in Hawaii," Bro­strom said. "Until TB is eliminated in Asiaand the Pacific islands, Hawaii will continue to have a rate that’s higher than the U.S. mainland."

The CDC is working with DOH to help control the spread of the disease in the Marshall Islands,Federated States of Micronesia, Guam, Saipan, American Samoa andPalau.

Tuberculosis is curable in more than 95 percent of patients, the DOH said. The World Health Organization hopes to eliminate TB worldwide by 2050.

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TUBERCULOSIS RATES

>> 9 of every 100,000 people who live in Hawaii develop active TB each year.

>> 3.4 of every 100,000 people in the U.S. develop the disease, one of the lowest rates in the world.

Source: State Department of Health