What is Tuberculosis?

Tuberculosis (also known as TB) is a common, often lethal infectious disease that is caused by different strains of mycobacteria, most commonly by the Mycobacterium tuberculosis (M. tuberculosis) bacteria.

While a Tuberculosis infection generally attacks the lungs, TB can also attack any number of places in the body including the kidney, spine, and brain. If not properly treated, Tuberculosis can be fatal.

TB is an extremely contagious infectious disease that is transmitted through sneezing, coughing, breathing, and talking.

Those with immune disorders (such as HIV), children, and the elderly are more susceptible to tuberculosis. Talk with your practitioner immediately if you think you have been exposed to TB.

In the United States, there are approximately 3.8 cases per 100,000 people (the four states with the highest incidence of TB are Florida, California, New York, and Texas).

One person with TB can infect more than 15 people per year if untreated.

Worldwide, TB kills 1.5 million people per year.

How is Tuberculosis Spread?

TB is spread via the air from one person to another person. When a person who has Tuberculosis sneezes, coughs, speaks, sings, or laughs, the bacteria responsible for tuberculosis infection are released into the air where they can be breathed in by others around the infected individual.

Ways That Tuberculosis Is NOT Spread:

While TB is spread through the air, there are a number of ways that TB is not spread. These include:

  • Shaking hands
  • Sharing food
  • Sharing drinks
  • Kissing
  • Touching bed linens or toilet seats
  • Sharing toothbrushes

Risk Factors of Tuberculosis:

While the CDC is working tirelessly to eradicate TB, there are a number of populations that are at-risk for developing Tuberculosis. Those most commonly infected with TB include:

  • The homeless: living in tent communities or in temporary housing allows germs to spread easily.
  • Those with HIV: an already weakened immune system is easily attacked by bacteria.
  • Those who have any sort of disease that make them unable to fight off infection, such as diabetes.
  • Those who has been infected previously with TB within the last two years.
  • Those who have been treated incorrectly for TB in the past.
  • Healthcare providers: Many patients with TB come in contact with doctors, nurses, and ancillary hospital staff prior to a positive diagnosis. Health care workers are tested yearly and after any type of exposure or possible exposure.

What Are The Two Types of Tuberculosis Infections?

There are two types of Tuberculosis, Latent Tuberculosis and Tuberculosis Disease:

1) Latent Tuberculosis is what happens when the bacteria that cause TB are present in the body but do not cause infection. Most people who are exposed to the mycobacteria that cause TB, do not become sick. They are able to fight off the TB infection and do not feel sick or show any symptoms. Those who have Latent TB are also not able to spread TB to others. However, if the bacteria that cause TB become active and multiply within a person who has Latent TB, the person will go from having Latent TB to TB Disease. Many people who have Latent TB never go onto develop full-blown TB.

2) Tuberculosis Disease - when the bacteria that cause TB, mycobacteria, become active within the body because the immune system is unable to fight them off, this is called TB Disease. Those who have TB Disease are sick and can spread the TB bacteria to others.

What Are The Symptoms of Tuberculosis?

Latent TB has no symptoms. However, in full-blown TB, there are many symptoms. The symptoms of TB can include the following:

  • Severe cough lasting more than 3 weeks
  • Often coughing up blood or mucus
  • Pain in the chest
  • No appetite
  • Weight loss
  • Fatigue
  • Fever
  • Chills
  • Night sweats

These symptoms often mimic the symptoms of a respiratory cold. The cardinal differences are the length of time and the presence of blood upon coughing.

How Is Tuberculosis Diagnosed?

There are several primary ways in which TB is diagnosed:

1) A Mantoux Skin Test: the patient is injected with a bit of the tuberculin bacteria. This can be done quickly in the doctor's office or at a laboratory. The arm is wiped with alcohol and a super-fine needle is inserted just under the top layer of skin. A tiny bit of tuberculin is injected forming a bubble (called a wheal). After 72 hours, the patient returns to have the spot examined. If it reacts (meaning it swells up larger than the original bubble), the patient may have been exposed to or be ill with tuberculosis.

Important to remember when undergoing a A Mantoux Skin Test. There is a vaccine available for use (called BCG), but it is only used in countries with a very high incidence of TB; the United States does not utilize the vaccine. If you were born in a country that inoculates for TB, you may test positive on the skin testing for TB. Don’t worry, that’s expected, because a vaccine actually gives you a piece of the disease for your body to fight against. Please let your practitioners know you’ve been vaccinated; you will simply do the chest x-ray instead.

2) Chest X-Ray: this is done to look for the infection within the lungs.

3) Blood Testing: the serum (blood) will show the tuberculosis bacteria if the patient has been infected. This can be done in the laboratory or at the doctor’s office as well, and takes a few days for results to be returned.

Treatment for Tuberculosis:

As there are two types of TB: Latent TB and TB Disease, there are two treatment plans for Tuberculosis:

Treatment for Latent TB Infection:

People who have Latent TB Infection have the TB bacteria in their body, but the bacteria is inactive, so the person is not ill, does not show any symptoms, and cannot spread TB to others. However, those who have latent TB do need to be treated for TB as Latent TB can become full-blown TB should the bacteria become active.

Treatment for Latent TB includes the following medications given in long-term doses (up to nine months):

  • Isoniazid (INH)
  • Rifampin (RIF)
  • Rifapentine (RPT)

Treatment options for Tuberculosis Disease include:

  • Long-term antibiotic therapy (6-9 months). Antibiotic regiemes include the following: Isonizaid (INH), Rifampin (RIF), ethambutol (EMB), pyrazinamide (PZA).
  • The patient will be contagious for a few weeks. It is important to learn how to prevent the spread of disease. Your health care provider will give you education on how to protect yourself and your family from further illness. Many times, a mask is worn which does not allow the TB bacteria to pass through it. The mask does not need to be worn in the home, as whoever lives with the patient will have already been exposed.  Cough into a sleeve or a shoulder - coughing in to the hands will allow further spread of disease. Avoid the public until you are declared not contagious—this includes places like church, the library, the grocery store, restaurants, and work. Avoid public transportation as well.
  • DOT therapy: DOT (directly observed therapy) is a method to make sure patients take their medication properly. After a few weeks, the patient is often feeling much better. This sometimes causes them to choose to stop taking the antibiotics. DOT therapy ensures that the medications are being taken: the patient must take them while being observed by a medical professional. This can be done at home.

What Is Multidrug-Resistant Tuberculosis?

Multidrug-Resistant TB (also known as MDR TB) is a form of Tuberculosis that is resistant to at least two of the best anti-TB drugs (isoniazid and rifampicn) which are the first-line drugs are used to treat all types of TB.

MDR TB is often caused by people who do the following:

  1. Do not take their TB medication regularly
  2. Do not finish their TB medication as prescribed
  3. Develop TB after being treated for TB
  4. Live in areas of the world where TB is endemic
  5. Have spent time with someone with MDR TB.

What Is Extensively Drug-Resistant Tuberculosis?

Extensively Drug-Resistant Tuberculosis (also known as XDR TB) is a fairly rare form of Multidrug-Resistant TB in which the bacteria is resistant to to isoniazid and rifampin, plus resistant to any fluoroquinolone and at least one of three injectable second-line drugs (includes: amikacin, kanamycin, or capreomycin).

Because XDR TB is resistant to both first-line and second-line drugs to treat TB, people who have XDR TB have a very limited treatment options. XDR TB is of special concern for people who have weakened immune systems due to things like HIV or diabetes.

Can MDR TB Be Prevented?

The most important thing to do if you are diagnosed with TB is to make certain you take ALL of the medications prescribed to you EXACTLY as they're prescribed. Do not skip a dose. Do not stop treatment early. If you're having problems with side effects of the TB drugs, tell your MD.

Before traveling, talk to your doctor about making sure to have enough medication to bring with you.

Healthcare professionals can help to quickly diagnose and treat TB as well as ensuring all medications are taken as prescribed.

Related Resource Pages on Band Back Together:

Homelessness

HIV

Diabetes

Additional Tuberculosis Resources:

Center for Disease Control and Prevention (CDC) - fact sheets, treatment guidelines and a multitude of information about TB and related illnesses.

WHO: World Health Organization: Fact sheets, information as well as additional resources about TB around the world.

American Lung Association - TB fact sheets and other information.