15 06 2013

Tuberculosis is in the air, so to speak.  After U.S. health officials carefully tracked down TB Andy in Rome and told him not, repeat not, to travel by air, young TB Andy cheerfully boarded a plane, flew to Canada and drove across the border into the United States.

He says that he didn’t want to get stuck in a hospital in Rome, as he was convinced that he would die if he didn’t get to Denver for treatment.  Apparently fear of his own death did little to prevent TB Andy from exposing hundreds of people to his particularly dangerous form of TB.

In all fairness, he is currently claiming that he was told he was not infectious.

So, what’s the brouhaha and should everyone be this excited?

It seems the critical question would be: does TB Andy have latent or active TB?

Here’s some info from the CDC on TB:

Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs. But, TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal. TB disease was once the leading cause of death in the United States.

TB is spread through the air from one person to another. The bacteria are put into the air when a person with active TB disease of the lungs or throat coughs or sneezes or, sometimes, just talks. People nearby may breathe in these bacteria and become infected. However, not everyone infected with TB bacteria becomes sick. People who are not sick have what is called latent TB infection. People who have latent TB infection do not feel sick, do not have any symptoms, and cannot spread TB to others.

But, some people with latent TB infection go on to get TB disease. People with active TB disease can be treated and cured if they seek medical help. Even better, people with latent TB infection can take medicine so that they will not develop active TB disease.

Why is TB a problem today?

Starting in the 1940s, scientists discovered the first of several medicines now used to treat TB. As a result, TB slowly began to decrease in the United States. But in the 1970s and early 1980s, the country let its guard down and TB control efforts were neglected. As a result, between 1985 and 1992, the number of TB cases increased. However, with increased funding and attention to the TB problem, we have had a steady decline in the number of persons with TB since 1992. But TB is still a problem; more than 14,000 cases were reported in 2003 in the United States.

How is TB spread?

TB is spread through the air from one person to another. The bacteria are put into the air when a person with active TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected. When a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow. From there, they can move through the blood to other parts of the body, such as the kidney, spine, and brain.

TB in the lungs or throat can be infectious. This means that the bacteria can be spread to other people. TB in other parts of the body, such as the kidney or spine, is usually not infectious.

People with active TB disease are most likely to spread it to people they spend time with every day. This includes family members, friends, and coworkers.

What is latent TB infection?

In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. The bacteria become inactive, but they remain alive in the body and can become active later. This is called latent TB infection. People with latent TB infection
• have no symptoms
• don’t feel sick
• can’t spread TB to others
• usually have a positive skin test reaction
• can develop active TB disease if they do not receive treatment for latent TB infection.

Many people who have latent TB infection never develop active TB disease. In these people, the TB bacteria remain inactive for a lifetime without causing disease. But in other people, especially people who have weak immune systems, the bacteria become active and cause TB disease.

What is active TB disease?

TB bacteria become active if the immune system can’t stop them from growing. The active bacteria begin to multiply in the body and cause active TB disease. The bacteria attack the body and destroy tissue. If this occurs in the lungs, the bacteria can actually create a hole in the lung. Some people develop active TB disease soon after becoming infected, before their immune system can fight the TB bacteria. Other people may get sick later, when their immune system becomes weak for another reason.

Babies and young children often have weak immune systems. People infected with HIV, the virus that causes AIDS, have very weak immune systems. Other people can have weak immune systems, too, especially people with any of these conditions:
• substance abuse
• diabetes mellitus
• silicosis
• cancer of the head or neck
• leukemia or Hodgkin’s disease
• severe kidney disease
• low body weight
• certain medical treatments (such as corticosteroid treatment or organ transplants)
• specialized treatment for rheumatoid arthritis or Crohn’s disease.

Symptoms of TB depend on where in the body the TB bacteria are growing. TB bacteria usually grow in the lungs. TB in the lungs may cause symptoms such as:
• a bad cough that lasts 3 weeks or longer
• pain in the chest
• coughing up blood or sputum (phlegm from deep inside the lungs).

Other symptoms of active TB disease are:
• weakness or fatigue
• weight loss
• no appetite
• chills
• fever
• sweating at night .

The Difference Between Latent TB Infection and Active TB Disease

A person with latent TB infection:
• Has no symptoms
• Does not feel sick
• Cannot spread TB to others
• Usually has a positive skin test or QuantiFERON-TB® Gold test
• Has a normal chest x-ray and sputum test

A person with active TB disease:
• Has symptoms that may include:
o a bad cough that lasts 3 weeks or longer
o pain in the chest
o coughing up blood or sputum
o weakness or fatigue
o weight loss
o no appetite
o chills
o fever
o sweating at night
• May spread TB to others
• Usually has a positive skin test or QuantiFERON-TB® Gold test
• May have an abnormal chest x-ray, or positive sputum smear or culture

What if I have a positive test for TB?

If you have a positive reaction to the TB skin test, your doctor or nurse may do other tests to see if you have active TB disease. These tests usually include a chest x-ray and a test of the phlegm you cough up. Because the TB bacteria may be found somewhere other than your lungs, your doctor or nurse may check your blood or urine, or do other tests. If you have active TB disease, you will need to take medicine to cure the disease.

What if I have been vaccinated with BCG?

BCG is a vaccine for TB. This vaccine is not widely used in the United States, but it is often given to infants and small children in other countries where TB is common. BCG vaccine does not always protect people from getting TB.

If you were vaccinated with BCG, you may have a positive reaction to a TB skin test. This reaction may be due to the BCG vaccine itself or due to infection with the TB bacteria. Your positive reaction probably means you have been infected with TB bacteria if:
• You recently spent time with a person who has active TB disease; or
• You are from an area of the world where active TB disease is very common (such as most countries in Latin America and the Caribbean, Africa, Asia, Eastern Europe, and Russia); or
• You spend time where TB disease is common (homeless shelters, migrant farm camps, drug-treatment centers, health care clinics, jails, prisons).

If I have latent TB infection, how can I keep from developing active TB disease?

Many people who have latent TB infection never develop active TB disease. But some people who have latent TB infection are more likely to develop active TB disease than others. These people are at high risk for active TB disease. They include:
• people with HIV infection
• people who became infected with TB bacteria in the last 2 years
• babies and young children
• people who inject illegal drugs
• people who are sick with other diseases that weaken the immune system
• elderly people
• people who were not treated correctly for TB in the past .

If you have latent TB infection (a positive TB skin test reaction or positive QFT) and you are in one of these high-risk groups, you need to take medicine to keep from developing active TB disease. This is called treatment for latent TB infection. There are several treatment options.You and your health care provider must decide which treatment is best for you.

The medicine usually taken for the treatment of latent TB infection is called isoniazid (INH). INH kills the TB bacteria that are in the body. If you take your medicine as instructed by your doctor or nurse, it can keep you from developing active TB disease. Children and people with HIV infection may need to take INH for a longer time.

Because there are less bacteria in a person with latent TB infection, treatment is much easier. Usually, only one drug is needed to treat latent TB infection. A person with active TB disease has a large amount of TB bacteria in the body. Several drugs are needed to treat active TB disease.

Sometimes people are given treatment for latent TB infection even if their skin test reaction is not positive. This is often done with infants, children, and HIV-infected people who have recently spent time with someone with active TB disease. This is because they are at very high risk of developing active TB disease soon after they become infected with TB bacteria.

It is important that you take all the pills as prescribed. If you start taking INH, you will need to see your doctor or nurse on a regular schedule. He or she will check on how you are doing. Some people have serious side effects from INH. If you have any of the following side effects, call your doctor or nurse right away:
• no appetite
• nausea
• vomiting
• yellowish skin or eyes
• fever for 3 or more days
• abdominal pain
• tingling in the fingers and toes.

Warning: Drinking alcoholic beverages (wine, beer, and liquor) while taking INH can be dangerous. Check with your doctor or nurse for more information.

People who have latent TB infection need to know the symptoms of active TB disease. If they develop symptoms of active TB disease, they should see a doctor right away.

How is active TB disease treated?

There is good news for people with active TB disease. It can almost always be cured with medicine. But the medicine must be taken as the doctor or nurse tells you.

If you have active TB disease, you will need to take several different medicines. This is because there are many bacteria to be killed. Taking several medicines will do a better job of killing all of the bacteria and preventing them from becoming resistant to the medicines.

If you have active TB disease of the lungs or throat, you are probably infectious. You need to stay home from work or school so that you don’t spread TB bacteria to other people. After taking your medicine for a few weeks, you will feel better and you may no longer be infectious to others. Your doctor or nurse will tell you when you can return to work or school or visit with friends.

Having active TB disease should not stop you from leading a normal life. When you are no longer infectious or feeling sick, you can do the same things you did before you had active TB disease. The medicine that you are taking should not affect your strength, sexual function, or ability to work. If you take your medicine as your doctor or nurse tells you, the medicine will kill all the TB bacteria. This will keep you from becoming sick again.

Why do I need to take TB medicine regularly?

TB bacteria die very slowly. It takes at least 6 months for the medicine to kill all the TB bacteria. You will probably start feeling well after only a few weeks of treatment. But beware! The TB bacteria are still alive in your body. You must continue to take your medicine until all the TB bacteria are dead, even though you may feel better and have no more symptoms of active TB disease.

If you don’t continue taking your medicine or you aren’t taking your medicine regularly, this can be very dangerous. The TB bacteria will grow again and you will remain sick for a longer time. The bacteria may also become resistant to the medicines you are taking. You may need new, different medicines to kill the TB bacteria if the old medicines no longer work. These new medicines must be taken for a longer time and usually have more serious side effects.

If you become infectious again, you could give TB bacteria to your family, friends, or anyone else who spends time with you. It is very important to take your medicine the way your doctor or nurse tells you.

How can I keep from spreading TB?

The most important way to keep from spreading TB is to take all your medicine, exactly as directed by your doctor or nurse.
You also need to keep all of your clinic appointments! Your doctor or nurse needs to see how you are doing. You may need another chest x-ray or a test of the phlegm you may cough up. These tests will show whether the medicine is working. They will also show whether you can still give TB bacteria to others. Be sure to tell the doctor about anything you think is wrong.

If you are sick enough with active TB disease to go to a hospital, you may be put in a special room. These rooms use air vents that keep TB bacteria from spreading to other rooms. People who work in these special rooms must wear a special face mask to protect themselves from TB bacteria. You must stay in the room so that you will not spread TB bacteria to other people. Ask a nurse for anything you need that is not in your room.

If you are infectious while you are at home, there are certain things you can do to protect yourself and others near you. Your doctor may tell you to follow these guidelines to protect yourself and others:
• The most important thing is to take your medicine.
• Always cover your mouth with a tissue when you cough, sneeze, or laugh. Put the tissue in a closed bag and throw it away.
• Do not go to work or school. Separate yourself from others and avoid close contact with anyone. Sleep in a bedroom away from other family members.
• Air out your room often to the outside of the building (if it is not too cold outside). TB spreads in small closed spaces where air doesn’t move. Put a fan in your window to blow out (exhaust) air that may be filled with TB bacteria. If you open other windows in the room, the fan also will pull in fresh air. This will reduce the chances that TB bacteria will stay in the room and infect someone who breathes the air.

Remember, TB is spread through the air. People cannot get infected with TB bacteria through handshakes, sitting on toilet seats, or sharing dishes and utensils with someone who has TB.

After you take medicine for about 2 or 3 weeks, you may no longer be able to spread TB bacteria to others. If your doctor or nurse agrees, you will be able to go back to your daily routine. Remember, you will get well only if you take your medicine exactly as your doctor or nurse tells you.

Think about people who may have spent time with you, such as family members, close friends, and coworkers. The local health department may need to test them for latent TB infection. TB is especially dangerous for children and people with HIV infection. If infected with TB bacteria, these people need medicine right away to keep from developing active TB disease.

What is multidrug-resistant TB (MDR TB)?

If you do not take your medicine as your doctor or nurse tells you, the TB bacteria may become resistant to a certain medicine. This means that the medicine can no longer kill the bacteria.

Drug resistance is more common in people who:
• have spent time with someone with drug-resistant active TB disease
• do not take their medicine regularly
• do not take all of their medicine as told by their doctor or nurse
• develop active TB disease again, after having taken TB medicine in the past
• come from areas where drug-resistant TB is common

Sometimes the bacteria become resistant to two or more of the most important medicines: INH and RIF. This is called multidrug-resistant TB, or MDR TB. This is a very serious problem. People with MDR TB disease must be treated with special medicines. These medicines are not as good as the usual medicines for TB and they may cause more side effects. Also, most people with MDR TB disease must see a TB expert who can closely observe their treatment to make sure it is working.

People who have spent time with someone sick with MDR TB disease can become infected with these multidrug-resistant bacteria. If they have a positive skin test reaction, they may be given medicine to keep them from developing MDR TB disease. This is very important for people who are at high risk of developing MDR TB disease, such as children and HIV-infected people.

What is extensively drug-resistant tuberculosis, or XDR TB?

XDR TB is a subtype of multiple-drug resistant tuberculosis.

People with XDR TB are resistant to first- and second-line drugs; their treatment options are limited and the disease often proves fatal, although cure is possible for up to 30 percent of cases.

TB Today

22 03 2010

For many of us, the words “TB” and “tuberculosis” conjure up black-and-white images of sanatoriums and large, antiquated medical equipment. Or maybe we hear those words and think, “That can’t happen to us.”

But it does. One of our staff members recently caught up with an old friend of hers, a 30-something woman living in the U.S., and discovered she’d undergone treatment for latent TB. Being who we are, we couldn’t resist the opportunity for an interview!

Abandoned sanatorium for tuberculosis

Abandoned sanatorium for tuberculosis

When/how did you find out you had latent TB?

Two and a half years ago, I was registering to be an on-call chaplain. For that type of position, you have to have a yearly TB skin test, and mine came up positive. The test is a skin prick—if you’re positive, it reacts. I immediately felt something, and the pricked area swelled up like a bad spider bite.

What were the first thoughts you had?

I was freaking out a little, because TB has such a stigma attached to it. There’s a place in Seattle that is on the site of a former tuberculosis sanatorium—a friend of mine remembers standing outside, waving to her father in the window.

I think I might have contracted TB in the mission field. It’s fairly common for mission workers or hospital workers to have it. My sister has latent TB also, possibly from working in the inner cities.

What did you do first?

You’re required to report to your local health department if you have a positive skin test, so I did. They scheduled me for treatments.

What was the treatment process like?

I had to go to the health department twice a week to take 3 pills—they watch you take them. I only missed one treatment. It was a day that I had the stomach flu and a funeral, and the health department was calling me. They were very on top of things!

It was a 9-month course of treatment. The drugs make you feel lethargic, and they upset my stomach and gave me heartburn-like symptoms. I chose the twice weekly treatment because it was less inconvenient, and also, by the third day, I’d feel better, which was better than feeling bad every day for 9 months.

I could taste the pills for months afterward every time I drove by the health department. Pregnancy is a lot easier!

Were your friends or family concerned they might be infected?

My husband was concerned at first! Also, a relative of a friend with a son who has medical issues was very concerned about my husband being around her son, even though I’m not even symptomatic.

Another acquaintance of mine who also had latent TB began to have health problems and was concerned that my TB had activated hers, but it turned out she had other medical issues that were unrelated.

It was odd, people not understanding that people with latent TB are not contagious.

Did you have any specific concerns about TB and pregnancy?

You’re not supposed to get pregnant while on the drugs. But other than that, it hasn’t been a concern for me.

Do you ever worry you’ll develop active TB?

Taking the drugs made it less likely that I’ll get it. Night sweats, coughing—they tell you to watch out for those symptoms. I’m glad I did the treatment now, when I’m more physically capable, instead of having it be an issue at some later time when I’m not as healthy. But I don’t worry about it.

Is your life today affected by having latent TB?

No. I just keep my letter on hand stating that I’ve done the treatment so I can provide it when a convalescent center or someplace requires routine testing. I’m surprised at how TB is much more common than we think it is!

When a person has latent TB, it means that the body’s immune defenses hold the TB bacilli, preventing them from multiplying. However, any number of factors – age, cancer, steroids, to name a few – can suppress the immune system, allowing the bacilli to multiply, causing active TB disease. Treating latent TB reduces the chances of this happening by over 90%.

If you or anyone you know has been exposed to active TB disease (not latent TB), you should get tested for TB. To learn more and to help prevent the spread of TB, visit the World TB Day website.