TB

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.





Two Risks

31 01 2011

Courtesy of NOAA's People Collection

Ben Franklin chose not to inoculate his little boy against smallpox, fearing the inoculation more than the disease.  In 1736, Ben’s son died at the age of four — from smallpox infection.

Was Ben right to choose the “common way” of infection? Well, no, he wasn’t, although inoculation was nasty.  First, a string was drawn through a pustule of someone infected with smallpox.  The string was then left to dry, and later drawn through a cut made on an uninfected person.  The resulting infection was milder in form and about two percent of those inoculated died from infection versus 15 percent of those who became infected the common way.

Ben Franklin was a brilliant man, but in this case, he failed to look at the science.  Some years after losing his son, he said:

“In 1736 I lost one of my Sons, a fine Boy of 4 Years old, taken by the Smallpox in the common way. I long regretted that I had not given it to him by Inoculation, which I mention for the Sake of Parents, who omit that Operation on the Supposition that they should never forgive themselves if a Child died under it; my Example showing that the Regret may be the same either way, and that therefore the safer should be chosen.”

After his son’s death, Franklin became a big believer in inoculation, considering it the safer choice.  He wrote an introduction to English physician William Heberden’s pamphlet on the subject, which promoted the act and even explained how parents could inoculate their children themselves.  Ben then distributed the document in America.

Nearly 300 years after Ben Franklin chose between two risks and lost, parents face the same choices. No vaccine is 100 percent safe, and no disease is 100 percent benign.  There’s a risk when vaccinating and a risk when choosing natural infection.

The fact is, our kids don’t live in bubbles, and we can’t keep them safe from exposure to germs.  Although the vaccines today are not perfectly risk-free, they are much safer than the infections they prevent.

All we can do as parents is look at the science, talk to our pediatricians, and make the safest choices for our kids.





Teaching 911 Basics

30 10 2009

Teaching our kids to call 911 can be as important to their health and the health of others as teaching them the importance of good nutrition and how to stop-drop-and-roll. And just like stop-drop-and-roll, we must teach them not just the ‘when’, but the ‘how’ of it, until it becomes second nature.

Consider teaching a 911 mini-class to your kids at least once a day for three days, then quizzing every other day, then quizzing about once a week.  By that time, the routine should be stuck in their heads.

Here’s some suggested text for your lesson plan:

If there is an emergency, dial 9-1-1 from a telephone. An emergency is when a person is badly hurt or in danger ‘right now.’ An emergency is if you see a crime happening, like a person hurting another person or someone breaking into someone’s house, or a fire somewhere a fire shouldn’t be. An emergency is if someone is suddenly very sick, having a hard time speaking or breathing.

An emergency isn’t something like forgetting your homework or arguing with a brother or sister.

Go to a safe place to call. If there’s a fire, leave the building first. Get away from the person hurting you or someone else, then call 911.

It’s normal to feel afraid or nervous about it, grownups often feel the same way. Call anyway. The people answering the phone will understand.

It’s OK to make a mistake. If you call 911, stay on the line and tell them why you called. It’s OK to tell them you think it might not be an emergency after all. If you start the call, but hang up before someone has a chance to answer, the 911 operators might think you are still in danger.

*****

Help them prepare. Teach them their address and phone number and explain what to expect when the operator picks up the phone, and that they should stay on the phone until the operator tells them it’s time to hang up.

Role-play the scenario with them so that the first time they call 911 won’t necessarily feel like the first time. The 911 dispatcher will ask these questions:

  • What is the emergency?
  • What happened?
  • Where are you?
  • Who needs help?
  • Are you safe where you are?

When you role-play, give your children a turn both as the caller and the 911 operator. Practicing these skills with your children will help them be more confident, feel safer and be safer.

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Antibacterial soap – yes or no?

10 09 2009

You gotta love handwashing.  Water, soap, rub, and rinse.  Too easy and gets rid of lots of germs.

The question seems to be: do we need to use antibacterial soap?

Natural soap contains fatty acids that allow oil and water to come together more easily, which in turn allows the water we’re using to carry away the germ-infested oil and grease on our hands.

In the 1990s, antibacterial soaps came on the market for home use.  It seems like using them would be a no-brainer, but experts can’t agree on this.

One concern is whether long-term and widespread use of antimicrobials is contributing to the creation of antibiotic-resistant “superbugs.”

Environmental experts are voicing concern about the long-term effects of triclosan and other chemicals used in these antibacterial products, which are building up in our waste water system, and ultimately being dumped into the environment where they disturb the natural ecosystem by killing desirable and important microbes.

In addition to questions about the environmental impact, the actual effectiveness of these ingredients in household soaps is now in doubt.  Most experts agree that antibacterial soaps are unnecessary in a healthy home setting, and may actually do more harm than good.

A 2004 report in Annals of Internal Medicine found that in a 48-week randomized double-blind study, there was no statistical difference in illness symptoms between the families that used exclusively antibacterial products, and the families that used exclusively non-antibacterial cleaning products.

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Pregnancy and H1N1 Vaccine

2 09 2009

So you’re pregnant, and you don’t want to get flu, but you also want to know that whatever goes into your body isn’t going to hurt your baby. Here’s info on H1N1 and the vaccine to help you make the best decision for you and your baby.

Is vaccination safe for pregnant women and their unborn babies?

Killed virus vaccines, such as the flu vaccines in shot form, are so safe that any risk to the unborn baby is nearly unmeasurable. FluMist, however, is live and cannot be given to pregnant women. (It can be given to other members of the family who are eligible to receive it.)

What about thimerosol?

As a pregnant woman, you can ask for a thimerosol-free vaccine, because providers are being directed to reserve thimerosol-free doses for pregnant women (and younger children) who are concerned about thimerosol. It should be noted that many studies conducted by independent bodies have shown that thimerosol does not pose any danger.

Should I get both the H1N1 and seasonal flu vaccines?

Pregnant women can get both vaccines. It’s recommended that you get each vaccine when it becomes available. The seasonal flu vaccine will be available sooner than the H1N1 vaccine, which should come out mid-October.

Should I wait until later my pregnancy to get vaccinated?

Pregnant women can receive the flu vaccines at any time during pregnancy, including the first trimester. In fact, it’s recommended that pregnant women receive the vaccine early on, since respiratory issues later in pregnancy can be more serious.

You can start the 2-dose H1N1 vaccination series during pregnancy and finish it after your baby is born. Babies ages 0-6 months cannot get the flu vaccine, so if the mother gets the vaccine during pregnancy, it can help protect her baby.

Other concerns…

The vaccine is safe for women planning on natural childbirth. Disease is a natural process, but so is building immunity.
Alternative/online education could be an option for pregnant teens enrolled in schools experiencing outbreaks (because teens are generally considered higher risk for H1N1 as it is). If you are a pregnant young adult attending college, you can continue attending even if cases of H1N1 are reported. You should definitely get vaccinated and wash your hands – a lot.

Patients receiving treatment for infertility can get the flu vaccines. There is zero evidence that flu vaccine harms development of the unborn baby’s brain.

Pregnant healthcare workers need the H1N1 vaccine. If the flu is very active around them, their job description may need to be adjusted.

What should I do if I’m pregnant and get exposed to H1N1?

If you are exposed to a KNOWN case of H1N1, tell your provider; you may need medication. If 5 kids in your child’s school have it, this is not the same as being directly exposed.

Check with your provider to see if immunization is right for you and your family.

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NVHR

9 06 2009

The National Viral Hepatitis Roundtable (NVHR) is a coalition working to eliminate viral hepatitis in the U.S.

nvhr-logo09

They have a Call to Action that, when implemented, will save lives by preventing infection.

Hepatitis B and C can cause cancer or even death in children and adults.

Join with the NVHR in asking that funds be put toward the elimination of these deadly diseases.

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Nurse Mary Beth and CMV

1 06 2009

Nurse Mary Beth explains what cytomegalovirus (CMV) is and how we can avoid infection.

Hand Washing Technique

Listen now!

Right-click here to download podcast (4mb, 8min)

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