Tuberculosis: Should You Be Concerned?

By Linda Good, R.N., Scripps Memorial Hospital La Jolla

Tuberculosis is a strange disease. In some people, it leads to serious health problems and may even be fatal; in fact, it was a leading cause of death in the United States during the early 1900s. In others, the tuberculosis bacteria (Mycobacterium tuberculosis) can live in the body for years without any negative effects.

Whether or not tuberculosis (or TB, as it is commonly known) makes you sick depends on whether the bacteria are active or latent. If you have an active TB infection, the bacteria in your lungs multiplies and may travel through your blood to other parts of your body, such as the kidneys, brain and spine. Active TB can be highly contagious; if you have TB in your lungs or chest and you cough or sneeze, the bacteria can spread through the air and infect others around you who breathe it in.

However, just because you become infected with TB doesn’t necessarily mean you will get sick. In most cases, your immune system successfully fights the bacteria and keeps them from multiplying, but the germs continue to live in the body. This is known as latent TB infection— you don’t feel sick, have no symptoms, and can’t spread the bacteria to others. Some people with latent TB may eventually develop active TB, especially if they have weakened immune systems. Others may have the latent form forever.

Although new medications brought TB under control in the 1940s, there recently has been an upswing in new cases – including several in San Diego. That’s why it’s important to understand how TB is spread and what you can do to protect yourself and your family.

*How do you know if you have it?
*Active TB infection has a number of symptoms. Many of these are similar to the flu, such as chills, fever, loss of appetite, and fatigue; in addition, TB symptoms may include a severe cough that lasts for several weeks, chest pain, and coughing up blood or phlegm. If you have these symptoms, see your doctor right away. He or she will run tests to confirm the diagnosis, such as a blood test, chest X-ray or skin test. Should you be diagnosed with active TB, you’ll need to stay home from work or school to avoid spreading the infection to others.

Even if you don’t have active TB symptoms, it’s a good idea to be tested if you think you may have been exposed to someone with active TB. A quick, simple skin test can determine whether you have TB infection: your doctor will inject a small amount of testing fluid called tuberculin or PPD just beneath the skin on the inside of your forearm. After two or three days, you’ll return to the doctor to have the test “read” and determine whether your reaction is positive or negative.

A positive reaction may indicate a latent TB infection. Your doctor may order additional tests a blood test or phlegm test to confirm the diagnosis (chest X-rays usually do not show latent infections).

A positive reaction may indicate a latent TB infection. Your doctor may order additional tests a blood test or phlegm test to confirm the diagnosis (chest X-rays usually do not show latent infections).

It can take several weeks after infection for the skin test to show a positive reaction, such as significant swelling. If you have been exposed to someone with active TB and your test comes back negative, your doctor may recommend you return in eight to ten weeks for a second test.

How is TB treated?
With proper medical care, TB can be treated and cured. Active TB disease typically requires several medications used simultaneously. Taking a combination of medications increases the likelihood of killing all of the bacteria and ensuring that they do not develop a resistance to the drugs. The most common TB medications include isoniazid (INH), rifampin (RIF), ethambutol and pyrazinamide.

If you have been diagnosed with latent TB, your doctor may recommend treatment to prevent the bacteria from becoming active. This is especially likely if you have a weakened immune system.

Linda Good, R.N., is an employee health nurse at Scripps Memorial Hospital La Jolla. For more information on staying healthy or for physician referral, please call 1-800-SCRIPPS (1-800-727-4777).