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Tuberculosis |
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Information from CDC Table of ContentsWhat is TB? How can I get tested
for TB? How is TB disease
treated?
What is TB? In the 1940s, scientists discovered the first of several drugs now used to treat TB. As a result, TB slowly began to disappear in the United States. But TB has come back. Between 1985 and 1992, the number of TB cases increased. The country became complacent about TB and funding of TB programs was decreased. However, with increased funding and attention to the TB problem, we have had a steady decline in the number of persons with TB. But TB is still a problem; more than 16,000 cases were reported in 2000 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 TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected. People who are infected with latent TB do not feel sick, do not have any symptoms, and cannot spread TB. But they may develop TB disease at some time in the future. People with TB disease can be treated and cured if they seek medical help. Even better, people who have latent TB infection but are not yet sick can take medicine so that they will never develop TB disease. This document answers common questions about TB. Please ask your doctor or nurse if you have other questions about latent TB infection or TB disease. Return to Table of
Contents 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 TB disease are most likely to spread it to people they spend time with every day. This includes family members, friends, and coworkers. Return to Table of
Contents
Many people who have latent TB infection never develop 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. Return to Table of
Contents 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
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
Other symptoms of TB disease are
Return to Table of Contents How can I get
tested for TB?
A health care worker can give you the TB skin test. The health care worker will inject a small amount of testing fluid (called tuberculin) just under the skin on the lower part of your arm. After 2 or 3 days, the health care worker will measure your reaction to the test. You may have a small bump where the tuberculin was injected. The health care worker will measure this bump and tell you if your reaction to the test is positive or negative. A positive reaction usually means that you have latent TB infection. If you have a positive reaction to the skin test, your doctor or nurse may do other tests to see if you have 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 besides your lungs, your doctor or nurse may check your blood or urine, or do other tests. If you have TB disease, you will need to take medicine to cure the disease. If you have recently spent time with someone with infectious TB, your skin test reaction may not be positive yet. You may need a second skin test 10 to 12 weeks after the last time you spent time with the infectious person. This is because it can take several weeks after infection for your immune system to be able to react to the TB skin test. If your reaction to the second test is negative, you probably do not have latent TB infection. Return to Table of
Contents 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 to latent TB infection. But your positive reaction probably means that you have latent TB infection if:
Return to Table of
Contents
If you have latent TB infection (a positive skin test reaction) and you are in one of these high-risk groups, you need to take medicine to keep from developing TB disease. This is called treatment for latent TB infection. There are many treatment options. You and your health care provider must decide which treatment is best for you. The medicine usually used for the treatment of latent TB infection is a drug called isoniazid or INH. INH kills the TB bacteria that are in the body. If you take your medicine as prescribed, treatment for latent TB infection will keep you from ever developing TB disease. Most people must take INH for at least 6 to 9 months. Children and people with HIV infection may need to take INH for a longer time. 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 infectious TB disease. This is because they are at very high risk of developing serious TB disease soon after they become infected with TB bacteria. It is important that you take all the pills prescribed for you so that your treatment for latent TB infection is effective. 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. Very few people have serious side effects to INH. However, if you have any of the following side effects, call your doctor or nurse right away:
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 but do not receive treatment for latent TB infection need to know the symptoms of TB. If they develop symptoms of TB disease later on, they should see a doctor right away. Return to Table of
Contents Because HIV infection weakens the immune system, people with latent TB infection and HIV infection are at very high risk of developing TB disease. All HIV-infected people should be given a TB skin test to find out if they have latent TB infection. If they have latent TB infection, they need treatment for latent TB infection as soon as possible to prevent them from developing TB disease. If they have TB disease, they must take medicine to cure the disease. TB disease can be prevented and cured, even in people with HIV infection. Return to Table of Contents How is TB
disease treated? The most common drugs used to fight TB are:
If you have TB disease, you will need to take several different drugs. This is because there are many bacteria to be killed. Taking several drugs will do a better job of killing all of the bacteria and preventing them from becoming resistant to the drugs. If you have TB 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. Having TB 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 TB. 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. Return to Table of
Contents The side effects listed below are serious. If you have any of these symptoms, call your doctor or nurse immediately:
The side effects listed below are minor problems. If you have any of these side effects, you can continue taking your medicine:
Return to Table of
Contents 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 drugs you are taking. You may need new, different drugs to kill the TB bacteria if the old drugs no longer work. These new drugs 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. Return to Table of
Contents
NOTE: Remember to keep all medicine out of reach of children. If you forget to take your pills one day, skip that dose and take the next scheduled dose. Tell your doctor or nurse that you missed a dose. You may also call your doctor or nurse for instructions. The best way to remember to take your medicine is to get directly observed therapy (DOT). If you get DOT, you will meet with a health care worker every day or several times a week. You will meet at a place you both agree on. This can be the TB clinic, your home or work, or any other convenient location. You will take your medicine at this place. DOT helps in several ways. The health care worker can help you remember to take your medicine and complete your treatment. This means you will get well as soon as possible. With DOT, you may need to take medicine only 2 or 3 times each week instead of every day. The health care worker will make sure that the medicine is working as it should. This person will also watch for side effects and answer questions you have about TB. Even if you are not getting DOT, you must be checked at different times to make sure everything is going well. You should see your doctor or nurse regularly while you are taking your medicine. This will continue until you are cured. Return to Table of
Contents If you are sick enough with TB to go to a hospital, you may be put in a special room. These rooms use air vents that keep TB bacteria from spreading. People who work in these 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 if you need anything 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:
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 your 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 preventive therapy right away to keep from developing TB disease. Return to Table of
Contents Drug resistance is more common in people who:
Sometimes the bacteria become resistant to more than one drug. 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 drugs. These drugs are not as good as the usual drugs for TB and they may cause more side effects. Also, some 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 TB bacteria that are resistant to several drugs. If they have a positive skin test reaction, they may be given preventive therapy. This is very important for people who are at high risk of developing MDR TB disease, such as children and HIV-infected people. Return to Table of Contents
Glossary of Terms Related to TB BCG - a vaccine for TB named after the French scientists Calmette and GuИrin. BCG 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. Cavity - a hole in the lung where TB bacteria have eaten away the surrounding tissue. If a cavity shows up on your chest x-ray, you are more likely to cough up bacteria and be infectious. Chest x-ray - a picture of the inside of your chest. A chest x-ray is made by exposing a film to x-rays that pass through your chest. A doctor can look at this film to see whether TB bacteria have damaged your lungs. Contact - a person who has spent time with a person with infectious TB. Culture - a test to see whether there are TB bacteria in your phlegm or other body fluids. This test can take 2 to 4 weeks in most laboratories. Directly observed therapy (DOT) - a way of helping patients take their medicine for TB. If you get DOT, you will meet with a health care worker every day or several times a week. You will meet at a place you both agree on. This can be the TB clinic, your home or work, or any other convenient location. You will take your medicine at this place. Extrapulmonary TB - TB disease in any part of the body other than the lungs (for example, the kidney or lymph nodes). HIV infection - infection with the human immunodeficiency virus, the virus that causes AIDS (acquired immunodeficiency syndrome). A person with both latent TB infection and HIV infection is at very high risk for TB disease. Infectious TB - TB disease of the lungs or throat, which can be spread to other people. Infectious person - a person who can spread TB to others because he or she is coughing TB bacteria into the air. INH or isoniazid - a drug used to prevent TB disease in people who have latent TB infection. INH is also one of the five drugs often used to treat TB disease. Latent TB infection - a condition in which TB bacteria are alive but inactive in the body. People with latent TB infection have no symptoms, don't feel sick, can't spread TB to others, and usually have a positive skin test reaction. But they may develop TB disease later in life if they do not receive treatment for latent TB infection. Miliary TB - TB disease that has spread to the whole body through the bloodstream. Multidrug-resistant TB (MDR TB) - TB disease caused by bacteria resistant to more than one drug often used to treat TB. M. tuberculosis - bacteria that cause latent TB infection and TB disease. Negative - usually refers to a test result. If you have a negative TB skin test reaction, you probably do not have latent TB infection. Positive - usually refers to a test result. If you have a positive TB skin test reaction, you probably have latent TB infection. Pulmonary TB - TB disease that occurs in the lungs, usually producing a cough that lasts longer than 2 weeks. Most TB disease is pulmonary. Resistant bacteria - bacteria that can no longer be killed by a certain drug. TB skin test - a test that is often used to detect latent TB infection. A liquid called tuberculin is injected under the skin on the lower part of your arm. If you have a positive reaction to this test, you probably have latent TB infection. Treatment for latent TB infection - treatment for people with latent TB infection that prevents them from developing TB disease. Smear - a test to see whether there are TB bacteria in your phlegm. To do this test, lab workers smear the phlegm on a glass slide, stain the slide with a special stain, and look for any TB bacteria on the slide. This test usually takes 1 day. Sputum - phlegm coughed up from deep inside the lungs. Sputum is examined for TB bacteria using a smear; part of the sputum can also be used to do a culture. TB disease - an illness in which TB bacteria are multiplying and attacking different parts of the body. The symptoms of TB disease include weakness, weight loss, fever, no appetite, chills, and sweating at night. Other symptoms of TB disease depend on where in the body the bacteria are growing. If TB disease is in the lungs (pulmonary TB), the symptoms may include a bad cough, pain in the chest, and coughing up blood. Tuberculin - a liquid that is injected under the skin on the lower part of your arm during a TB skin test. If you have latent TB infection, you will probably have a positive reaction to the tuberculin. |
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