Questions and Answers about Tuberculosis
Information
Provided by the American Lung Association
What
is TB?
Who Gets It?
What are the Symptoms of TB?
How Does TB Disease Develop?
What is the TB Skin Test?
What is the Treatment for TB?
Can a TB Patient Infect Others?
What is Multi-drug Resistant TB?
TB: What You Should Do
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WHAT IS TB?
Tuberculosis
(often called TB) is an infectious disease that usually attacks the lungs, but
can attack almost any part of the body. Tuberculosis is spread from person to
person through the air.
When people
with TB in their lungs or throat cough, laugh, sneeze, sing, or even talk, the
germs that cause TB may be spread into the air. If another person breathes in
these germs there is a chance that they will become infected with tuberculosis.
It is
important to understand that there is a difference between being infected with
TB and having TB disease. Someone who is infected with TB has the TB germs, or
bacteria, in their body. The body's defenses are protecting them from the germs
and they are not sick.
Someone with
TB disease is sick and can spread the disease to other people. A person with TB
disease needs to see a doctor as soon as possible.
It is not easy
to become infected with tuberculosis. Usually a person has to be close to
someone with TB disease for a long period of time. TB is usually spread between
family members, close friends, and people who work or live together. TB is
spread most easily in closed spaces over a long period of time. However,
transmission in an airplane, although rare, has been documented.
Even if
someone becomes infected with tuberculosis, that does not mean they will get TB
disease. Most people who become infected do not develop TB disease because
their body's defenses protect them.
Experts
believe that about 10 million Americans are infected with TB germs. Only about
10 percent of these people will develop TB disease in their lifetime. The other
90 percent will never get sick from the TB germs or be able to spread them to
other people.
TB is an
increasing and major world wide problem, especially in Africa where the spread
is facilitated by AIDS. It is estimated that nearly 1 billion people will
become infected, 200 million will become sick, and 70 million will die worldwide
between now and 2020. In 1998, approximately 8 million cases and 2 million
deaths were attributed to TB; 100,000 of those 2 million deaths occurred among
children.
WHO GETS IT?
Anyone can get
TB. People of all races and nationalities. The rich and poor. And at any age.
But for many reasons, some groups of people are at higher risk to get active TB
disease. The groups that are at high risk include:
People with
HIV infection (the AIDS virus)
People in
close contact with those known to be infectious with TB
People with
medical conditions that make the body less able to protect itself from disease
(for example: diabetes, the dust disease silicosis, or people undergoing
treatment with drugs that can suppress the immune system, such as long-term use
of corticosteroids)
Foreign-born
people from countries with high TB rates
Some racial or
ethnic minorities
People who
work in or are residents of long-term care facilities (nursing homes, prisons,
some hospitals)
People who are
mal-nourished
Alcoholics and
IV drug users
WHAT ARE THE SYMPTOMS OF TB?
A person with
TB infection will have no symptoms. A person with TB disease may have any, all
or none of the following symptoms:
A cough that
will not go away
Feeling tired
all the time
Weight loss
Loss of
appetite
Fever
Coughing up
blood
Night sweats
These symptoms
can also occur with other types of lung disease so it is important to see a
doctor and to let the doctor determine if you have TB.
It is also
important to remember that a person with TB disease may feel perfectly healthy
or may only have a cough from time to time. If you think you have been exposed
to TB, get a TB skin test.
HOW DOES TB DISEASE DEVELOP?
There are two
possible ways a person can become sick with TB disease:
The first applies
to a person who may have been infected with TB for years and has been perfectly
healthy. The time may come when this person suffers a change in health. The
cause of this change in health may be another disease like AIDS or diabetes. Or
it may be drug or alcohol abuse or a lack of health care because of
homelessness.
Whatever the
cause, when the body's ability to protect itself is damaged, the TB infection
can become TB disease. In this way, a person may become sick with TB disease
months or even years after they first breathed in the TB germs.
The other way
TB disease develops happens much more quickly. Sometimes when a person first
breathes in the TB germs the body is unable to protect itself against the
disease. The germs then develop into active TB disease within weeks.
WHAT IS THE TB SKIN TEST?
The TB skin
test is a way to find out if a person has TB infection. Although there is more
than one TB skin test, the preferred method of testing is to use the Mantoux
test.
For this test,
a small amount of testing material is placed just below the top layers of skin,
usually on the arm. Two to three days later a health care worker checks the arm
to see if a bump has developed and measures the size of the bump. If the bump
is of a certain size (varying with group) the test is significant and the
person is presumed to have TB infection.
Once the
doctor knows that a person has TB infection he or she may want to determine if
the person has TB disease. This is done by using several other tests including
a chest X-ray and a test of a person's mucus (the material that is sometimes
coughed up from the lungs).
Q: Should you
get a skin test each year to check on TB?
A: Only if you
are at high risk for getting or transmitting TB.
The advice for
most people is to get a tuberculin test if you have symptoms or if you are
living in close contact or have otherwise been in close contact with someone
who recently came down with TB disease. (Some people get skin tests because of
their jobs, in a school or hospital, for example, to make sure they will not
infect others if they have TB.)
However, if
you fall into one or more of the high-risk categories for TB noted earlier, for
example, if you are HIV-positive, or if you've never had a skin test before, or
if there is no record of the last result, you should be tested.
If you're not
sure, ask your doctor. TB can be prevented, even if you are at risk.
WHAT IS THE TREATMENT FOR TB?
Treatment for
TB depends on whether a person has TB disease or only TB infection.
A person who
has become infected with TB, but does not have TB disease, may be given
preventive therapy. Preventive therapy aims to kill germs that are not doing
any damage right now, but could break out later.
If a doctor
decides a person should have preventive therapy, the usual prescription is a
daily dose of isoniazid (also called "INH"), an inexpensive TB
medicine. The person takes INH for six months (up to a year for some patients),
with periodic checkups to make sure the medicine is being taken as prescribed.
What if the
person has TB disease? Then treatment is needed.
Years ago a
patient with TB disease was placed in a special hospital for months, maybe even
years, and would often have surgery. Today, TB can be treated with very
effective drugs.
Often the
patient will only have to stay a short time in the hospital and can then
continue taking medication at home. Sometimes the patient will not have to stay
in the hospital at all. After a few weeks a person can probably even return to
normal activities and not have to worry about infecting others.
The patient
usually gets a combination of several drugs (most frequently INH plus two to
three others), usually for six to nine months. The patient will probably begin
to feel better only a few weeks after starting to take the drugs.
It is very
important, however, that the patient continue to take the medicine correctly
for the full length of treatment. If the medicine is taken incorrectly or
stopped the patient may become sick again and will be able to infect others
with TB. As a result many public health authorities recommend Directly Observed
Therapy (DOT), in which a health care worker insures that the patient takes
his/her medicine.
If the
medicine is taken incorrectly and the patient becomes sick with TB a second
time, the TB may be harder to treat because it has become drug resistant. This
means that the TB germs in the body are unaffected by some drugs used to treat
TB.
Multi-drug
resistant TB is very dangerous, so patients should be sure that they take all
of their medicine correctly.
Regular
checkups are needed to see how treatment is progressing. Sometimes the drugs
used to treat TB can cause side effects. It is important both for people
undergoing preventive therapy and people being treated for TB disease to
immediately let a doctor know if they begin having any unusual symptoms.
CAN A TB PATIENT INFECT OTHERS?
Yes, if they
have TB disease and it is not being treated. Once treatment begins, a patient
ordinarily becomes quickly noninfectious; that is, they cannot spread the
disease to others.
There is
little danger from the TB patient who is being treated, is taking his or her
medication continuously, and is responding well. The drugs usually make the
patient noninfectious within weeks.
TB is spread
by germs in the air, germs put there by coughing or sneezing. Infection is not
spread by handling a patient's bed sheets, books, furniture, or eating
utensils.
Brief exposure
to a source of TB rarely infects a person. It's day-after-day close contact
that usually does it.
WHAT IS MULTI-DRUG RESISTANT TB?
Multi-drug
resistant tuberculosis (called MDR TB for short) is a very dangerous form of
tuberculosis. Some TB germs become resistant to the effects of some TB drugs.
This happens when TB disease is not properly treated.
These
resistant germs can then cause TB disease. The TB disease they cause is much
harder to treat because the drugs do not kill the germs. MDR TB can be spread
to others, just like regular TB.
It is
important that patients with TB disease follow their doctor's instructions for
taking their TB medicine so that they will not develop MDR TB.
TB: WHAT YOU SHOULD DO
Find out if
you're infected.
Everyone
should be skin tested at least once and know whether their test result is
positive or negative. You should also be tested if there's any chance you have
been infected, recently or many years ago.
If the test is
negative:
A negative
reaction usually means that you are not infected and no treatment is needed.
Sometimes, however, when a person has only recently been infected, or when his
or her immune system isn't working properly, the test may be falsely negative.
If the test is
positive:
A positive
reaction usually means that you have been infected with the TB germ. It does
not necessarily mean that you have TB disease. Cooperate with the doctor when
he or she recommends a chest X ray and possibly other tests.
If the doctor
recommends treatment to prevent sickness, follow the recommendations. If
medicine is prescribed, be sure to take it as directed.
If you don't
need treatment, do what the doctor tells you to do about follow-up.The doctor
may simply say to return for another checkup if you get into a special risk
situation for TB sickness or develop symptoms.
If you are
sick with TB disease, follow the doctor's recommendations for treatment.
If you're a
health worker:
Your local
American Lung Association can provide you with more comprehensive information
developed for health professionals on the diagnosis, treatment and control of
TB.