There has been a deadly outbreak of drug-resistant tuberculosis in Australia because a Sydney doctor wrongly diagnosed a 23-year-old university student with asthma and then lung cancer before realising he had TB.
An investigation by News Corp Australia has uncovered a further 10 people were infected by the disease after the man tried to get treatment from his GP, and only after his third visit - and three months of sickness - was referred for an x-ray which uncovered a 6cm hole in his lung.
Patient Zero was told by his Chippendale-based GP that his persistent cough, shortness of breath and general malaise was likely lung cancer and sent immediately to Royal Prince Alfred Hospital on October 21 where tests confirmed he was suffering from a slightly drug resistant strain of tuberculosis.
By that stage the Sydney University graduate was highly contagious because of the misdiagnosis and he had already infected 10 people.
Tuberculosis is a slow growing bacteria and the longer a patient goes without treatment the more infectious they are.
The misdiagnosis follows several other problems in the New South Wales health system:
* The deaths of two newborn babies who were given the wrong gas at Bankstown-Lidcombe Hospital;
* A fake Indian doctor who allegedly worked under false documentation in a number of Sydney hospitals and;
* The case of a St Vincent's Hospital oncologist who gave a lower dosage of chemo drugs than recommended to patients.
Collectively they led to the resignation of former Health Minister Jillian Skinner last month.
And the federal Health Department has issued a slapdown to NSW over the handling of the case.
"TB is a nationally notifiable disease which means that there is enhanced surveillance by the Commonwealth and states and territories," a spokeswoman for the federal health department told News Corp Australia.
"Regarding the NSW case, the Federal Department of Health will be following up with NSW Health. The issue of whether there needs to be further education of health professionals about TB, will also be raised with the Communicable Diseases Network of Australia."
News Corp Australia
has chosen not to reveal the identity of Patient Zero to protect his privacy amid fears he will be stigmatised or not be able to find work as a result of his TB diagnosis.
Patient Zero was placed in isolation at RPA for three weeks and then spent a further eight weeks in isolation at home.
He is still on 16.5 antibiotics a day and has to go to hospital each weekday morning to receive his drugs which he will take for nine months.
Those who contracted the disease off him are either also on antibiotics or under monitoring by their local chest clinics for up to two years.
"I just felt like I had a really bad flu that wouldn't go away," Patient Zero told News Corp Australia.
"I was otherwise still myself and was even surfing three times a week."
Patient Zero said he likely picked up the disease while backpacking in Morocco, Vietnam, Cambodia, Bali and Thailand.
He said doctors told him he was one of the only non-refugee cases they had seen of TB in a long time.
Patient Zero was petrified to discuss his case openly for fear of persecution.
"I just don't want people to work out that it was me who was sick with this."
He said those infected included members of his family but also people he worked and studied with.
Tuberculosis is a highly infectious airborne disease caused by a bacterial infection. It can damage a person's lungs or other parts of the body and cause serious illness or death.
Around 1300 cases of TB are diagnosed in Australia each year, however, drug-resistant strains are rare.
It kills 1.8 million people a year and is the biggest single disease killer in the Asia-Pacific region.
HEALTH DEPARTMENT: TB 'NOT SPREAD BY BRIEF EXPOSURES'
Vicky Sheppeard, Director of Communicable Diseases at NSW Health denied there had been an "outbreak" of TB.
"Public announcements about people with TB disease are rarely necessary as TB is not spread by brief, casual exposures," Dr Sheppeard said.
"NSW has one of the lowest rates of TB in the world."
Dr Sheppeard said TB should be suspected in people with persistent coughs longer than three weeks.
But she said there was no current investigation into the doctor's misdiagnosis because a "complaint" had not yet been made.
Michael Gannon, president of the Australian Medical Association said doctors needed to keep TB front and mind when seeing patients with a persistent cough.
"Its incidence is on the rise around the world and it is very important it remains in the differential diagnosis," Dr Gannon said.
"We underestimate it at our peril."
Patient Zero's story comes as Australian tuberculosis experts warn a lack of funding for TB research could result in a doubling of cases in Australia in the next five years and potentially the introduction of more drug-resistant cases.
The Tuberculosis Centre for Research Excellence is due to run out of funding at the end of the year.
Gabriella Scandurra executive officer for the TBCRE said TB was a "real threat" for Australians without continued research into how best to treat the disease.
"It will only be a matter of time until the numbers shoot up because we're going to have more Australian travellers coming back with TB," Dr Scandurra said.
"This is just a ticking time bomb and it is going to be a complete economic catastrophe for Australia if we have more drug resistant strains because the cost of keeping people in isolation is astronomical."