Tuberculosis

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KEY POINTS

• Tuberculosis (TB) is an infection caused by bacteria that can destroy parts of the lungs, making it hard to breathe. It can spread to the brain, kidneys, bones, and joints.
• If you have active TB, you will be treated with medicines at home or in the hospital depending on the severity of your symptoms.
• If you have latent TB, you will probably need to take medicine to kill the TB bacteria and prevent an active infection.
• Ask your healthcare provider if you need to start treatment with TB medicines. Take all of your TB medicine exactly as prescribed. Keep all follow-up appointments with your provider.

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What is tuberculosis?

Tuberculosis (TB) is an infection caused by bacteria that can destroy parts of the lungs, making it hard to breathe. The bacteria can spread to other parts of the body, causing damage to the brain, kidneys, bones, and joints. The lymph nodes, which store blood cells (lymphocytes) to fight infection, can also become infected. If TB is not treated, it can cause death.

There are 2 kinds of TB:

• Active TB, which means that you have symptoms of infection and can spread the infection to other people. If you come in contact with a large amount of TB bacteria, you may get active TB soon after you are first infected with the bacteria.
• Latent TB, which means that you are infected with the bacteria but do not get sick, and usually do not infect others. Your body’s immune system keeps the bacteria from growing. The immune system is your body’s defense against infection. If you have latent TB and get weak, ill, or have problems with your immune system, the TB bacteria may start growing and change to active TB. This is why latent TB needs to be treated.

What is the cause?

TB is very contagious. It is spread through the air by coughing, sneezing, speaking, singing, or laughing.

What are the symptoms?

The symptoms of TB can begin anytime after you are exposed, from 2 months to several years after you are exposed. Symptoms may include:

• Feeling tired all the time
• Weight loss and loss of appetite
• Fever
• Sweating at night so severe it wakes you up
• Joint pain
• A dry cough that gets worse over time so that you may cough up mucus or blood

Sometimes there are no symptoms.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. You will have tests such as:

• Tuberculin skin test: Your healthcare provider will inject a substance called tuberculin into your skin. If you have TB, a lump will form where this shot was given within 3 days. This reaction is called a positive tuberculin test. It means that you have TB bacteria in your body. It does not always mean you have active, infectious TB. If your test is positive, close family members should also have the test.

  It is very important to follow your provider’s instructions regarding follow-up after your TB test. In most cases, you will be asked to come back 48 to 72 hours after you had the test so it can be checked. A 2-step test method may be used if you are a healthcare worker or had TB a long time ago and the first test is negative. A second test is repeated in 7 to 21 days to make sure you do not have TB.

  Many people born outside of the US, in areas where TB is common, have been vaccinated against TB. This vaccine is not routinely given in the US. It may cause your TB skin test to be positive and look like you have TB even when you do not. If you have had the vaccine, be sure to tell your healthcare provider.

• If your TB skin test is positive or you have symptoms, you may have a:
  • Chest X-ray: If you have breathed in TB bacteria but have fought off the infection, your lungs may not be damaged and your chest X-ray may be normal. However, if you have an active infection and bacteria have attacked your lungs, the infection will show on a chest X-ray.
  • Sputum exam and culture: Sputum is mucus and blood coughed up from the lungs. A sample of sputum from the lungs can be checked for TB bacteria. It may take several weeks to get results from this test.

How is it treated?

If you have active TB, you will be treated with medicines at home or in the hospital depending on the severity of your symptoms. You will probably be given several medicines that you will need to take for several months. You usually have to take more than one medicine because one alone may not kill all the TB bacteria.

If you have latent TB, you will probably need to take medicine to kill the TB bacteria and prevent an active infection. This is especially important if you have other medical problems, such as diabetes, that make it harder for you to fight infections.

Tuberculosis has become a more common disease. Some forms of TB bacteria have become resistant to some medicines. TB bacteria are more likely to become resistant if people who have TB do not take their TB medicines as prescribed. To try to prevent the development of resistant strains, take your medicines exactly as your healthcare provider has directed.

Quarantine means that if you are infected you must stay away from other people. This helps keep you from infecting others. If you have just been diagnosed with active TB, you may be quarantined for a few days or a couple weeks. This is more likely if you have an active TB infection with one of the resistant types of bacteria.

How can I take care of myself?

Follow your healthcare provider’s instructions.

• Some TB treatments can affect your liver and drinking alcohol can make this worse. Talk to your healthcare provider about this.
• Start treatment with TB medicines as early as possible. Take all of your TB medicine exactly as prescribed.
• Cover your mouth and nose with a tissue when you cough, sneeze, or laugh. Put used tissues in a plastic bag and seal the bag before you throw it in the garbage. Keep disposing of used tissues in this way until your healthcare provider tells you that you are not contagious any more.

If you have latent TB, keep follow-up appointments with your provider. Repeat tests will find if TB is becoming active. The active TB can then be treated at an early stage before severe lung damage is done and before you infect many other people.

Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent tuberculosis?

• Wash your hands often and especially after using the restroom, coughing, sneezing, or blowing your nose. Also wash your hands before eating or touching your mouth, nose, or eyes.
• If you work in a prison, hospital, or long-term care facility, or if you work with groups of people who have a high rate of TB, check with your provider to find out if you should be tested for TB and how often you should be tested. You should also ask how often you should be checked for TB if you have a medical problem that weakens your immune system, such as diabetes, cancer, or HIV infection.