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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 occured 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:
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 the TB Disease 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 Should You 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.
Reporting
TB to the Health Department
Any confirmed or
suspected case of active TB disease is reportable to the
DCU by
a medical provider
by phone (454-4114) or fax (454-4488) within one working
day. Do not wait for laboratory results to confirm the
diagnosis prior to reporting. TB infection in recent
converters (converted from negative to positive test in the past
two years) and all children under six years of age is reportable
by phone, fax or mail within seven days.
The Santa Cruz
County Health Services Agency provides consultation, case
management and clinical services for patients with TB infection
and/or disease. A field public health nurse is assigned to each
active TB case to promote patient compliance and provide testing
and follow-up of contacts. For consultation on any aspect of TB,
our TB control program is available through the DCU at 454-4114.
Referral to the Tuberculosis
Clinic
TO REFER PATIENTS
TO OUR CLINIC SERVICES,
ALL MEDICAL
PROVIDERS MUST COMPLETE A TB REFERRAL FORM
(available at 454-4114). We
request that you do NOT send suspected or active cases
directly to the health department without prior notification and
referral. We can better serve TB clients and prevent exposures
to our patients and staff when we can prepare for their arrival.
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