Officials from the Colorado Department of Public Health and the Environment in the U.S. say a Nepalese student at Colorado State University-Pueblo who died of tuberculosis in June, probably infected 17 other people.
Following the death of 19 year old Kalpana Dangol at a Colorado Springs hospital in June this year around 150 people were tested for tuberculosis by health officials in El Paso and Pueblo counties and of those 17 were found to have a latent form of the disease.
It appears the majority of those infected were also students at Colorado State University but of 174 students who shared classes with Dangol only 133 were tested.
Juli Bettridge, contact investigation coordinator for the Colorado Department of Public Health and Environment says investigators have failed to contact the other 41 students by phone, e-mail or postal letter.
The public health department says ten of those who tested positive are in treatment, while the remaining seven others are not because they have decided to forgo it or have moved from the area.
State health officials say they cannot force anyone to undergo treatment even though those diagnosed with latent tuberculosis can rid their body of the infection by taking the drug Isoniazid for nine months.
Those who refuse treatment are not tracked by public health agencies.
According to the Centers for Disease Control and Prevention (CDC) in Atlanta, people who are infected with latent tuberculosis are not contagious and have no symptoms and as a rule the body is able to fight the bacteria and stop them from growing.
However between 5 and 10 percent of people infected do go on to develop active TB in their lifetime and people with compromised immune systems are more susceptible to the disease.
Experts suggest 3 percent to 5 percent of the population in the United States has latent TB infection.
The Colorado health officials say those who tested positive after Dangol died were more than likely infected by her, though it is difficult to determine the exact source of the infection.
In 2006, 1,538 people in Colorado were tested for tuberculosis during 64 contact investigations and of those, nine people tested positive for active tuberculosis, and 281 people were found to have latent TB infections.
At present state law do not require medical examinations for international students entering Colorado universities.
According to the World Health Organization, Nepal reported 180 cases of tuberculosis for every 100,000 people in 2005, and about 23 in every 100,000 people died from the disease.
Meanwhile a number of police officers in Pueblo are concerned they may have tuberculosis, and say they may not be the only ones who have been exposed to the disease.
The police officers have filed reports after coming into contact with 71-year-old Gilbert Ortega who has been jailed 7 times this year.
Ortega is reported to be homeless and has been diagnosed with active tuberculosis.