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Choose a topic:

What is Tuberculosis (TB?)
What is the test for TB?
What happens if a TB test is positive?
Who is at risk from TB?
What are the symptoms of TB?
Where can I get a TB skin test?
What kind of medicines will I have to take?
What kind of side effects can I expect from the medicine?
What's the relationship between HIV and TB?
What about Multi-Drug Resistant (MDR) TB?
What about BCG Vaccine?
Where can I get more information?

What is TB?

Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis. Most often the germ attacks the lungs but TB may affect other parts of the body, especially in people who have impaired immune systems or who are malnourished.

TB has two "stages": infection or latent and active TB or TB disease.

TB infection is characterized by the following:

The TB germ is present in the body
There are no symptoms
The person is not infectious (contagious)
Sometimes, antibiotics will be used at this stage to keep the TB infection from becoming disease.

Active TB is characterized by the following:

Symptoms of TB are present, which can include:

coughing
weight loss
loss of appetite
night sweats
fever
chest pain

TB can be spread by coughing, sneezing, laughing, singing, or just talking
You must take medicines as prescribed to be cured - failure to take the medicines as prescribed can lead to drug resistant TB (MDR TB) which is far more dangerous, both to the person affected and to others, and more difficult to treat

What is the test for TB?

The test for TB is the Mantoux skin test (PPD), in which a small amount of fluid (called tuberculin) is injected into the forearm just under the skin. A health professional should read the test 48 to 72 hours after it is administered to check for a reaction. If there is a reaction (swelling), more testing is done. The Tine test (which uses a 4-pronged device) is no longer recommended because it is not as effective in delivering the proper amount of tuberculin under the skin.

What happens if a TB test is positive?

A positive test generally means that a person is infected with the TB germ, but does not necessarily mean that there is active TB disease or that active TB disease will develop. Only 10% of people who test positive for TB infection ever develop active disease (that's for HIV negative people; for HIV positive people the risk is much higher). After a positive test, an X-ray or sputum (coughed up phlegm) sample is needed to confirm active disease. If TB is suspected, seek the advice of a physician. If medication is prescribed, follow directions carefully. Even if symptoms improve after you begin taking the medications, it is important that you continue to take the full course of medicines as prescribed. Medicine may be required for a long time, up to six months or a year. Anyone who is HIV positive should be tested for TB, and anyone with active TB disease should be tested for HIV.

Who is at risk for TB?

While anyone can get TB infection or disease, the following are at particularly high risk:

people born in a country where TB is common
residents of nursing homes
intravenous drug users
people in jails/prisons (either prisoners or workers)
people with underlying conditions like diabetes or cancer or who are malnourished
people with HIV or AIDS
people who live with someone who has active TB
people who stay in homeless shelters

Where can I get a TB skin test?

Either your local health department or your doctor can administer and read a TB skin test. If you suspect that you have TB you should contact your doctor or local health department immediately to arrange for an evaluation.

What kind of medicines will I have to take?

Patients should initially be started on FOUR medications.

The standard medications for treating TB are:

Isoniazid (called INH)
Rifampin
Pyrazinamide (PZA)
Ethambutol

Other medications may be prescribed if lab tests show the TB does not respond to these standard medications.

For more detailed information consult the The Georgia TB Reference Guide

What kind of side effects can I expect from the medicine?

The following side effects may be experienced by some people:

Drug	Adverse Reactions	Comments
Isoniazid	Hepatitis, Drug Interactions, numbness/tingling/pain in extremities, Fatigue	Raises Dilantin and INH blood serum levels if taken together; this may lead to toxicity
Rifampin	Stomach upset, Symptoms of Flu, Bleeding, Rashes, Hepatitis	If you are taking other drugs (such as birth control pills) consult your doctor. Rifampin can turn body fluids orange but this is temporary.
Pyrazinamide	Joint aches, Hepatitis, Rashes, Stomach upset, Gout (rarely)	Avoid in pregnancy
Ethambutol	Visual Problems	Should not be used in young children whose vision can't be tested unless there is drug resistant TB

This table was compiled from the CORE CURRICULUM ON TUBERCULOSIS - What the clinician should know 3rd edition, 1994. Published by the U.S. Department of Health and Human Services.

DO NOT DRINK ALCOHOL WHILE TAKING THESE MEDICATIONS!!

What's the relationship between HIV and TB?

Because HIV weakens the body's immune system, HIV positive people are particularly susceptible to TB. HIV can also produce a false negative reading on the Mantoux skin test (that is, the test is negative but the person actually has TB (either latent or active)) because the body's immune system is not working properly. Someone who is HIV positive may also have to take TB medicines for a longer time than an HIV negative person. The good news is that TB can be treated and cured in HIV positive people if the medications are taken in accordance with doctor's orders!!

For more information: http://medicine.emory.edu/id/ATPC/NEWS/

What about Multi-Drug Resistant (MDR) TB?

Sometimes people stop taking their TB medication before the TB germ is eliminated. If this happens, TB may return and may no longer be susceptible to the drugs that were previously prescribed. This resistant TB may be passed to other people. It is important to take all medicines as prescribed, even if you begin to feel better.

It is also possible to get MDR TB through having the wrong medication or not enough of the right medication prescribed. Four drugs should always be prescribed until the susceptibility test results can be read.

For more detailed information on TB drugs consult the The Georgia TB Reference Guide

What about BCG vaccine?

The Bacillus Calmette-Guerin (BCG) vaccine is given to prevent TB. The vaccine is not used in the United States, but is fairly common in other countries. The vaccine's usefulness in preventing TB is still debated in the medical/scientific community; in fact, even if you have had the BCG vaccine you will still need to get the Mantoux skin test. You should tell the medical practitioner who reads your TB skin test if you have had the BCG vaccine.

Where can I get more information?

The Georgia TB Reference Guide is now available online. This booklet responds to clinicians' questions about tuberculosis infection, disease, and control. The standards and guidelines are based on the work and experience of the American Thoracic Society, the Centers for Disease Control and Prevention, the New York City Department of Health, and the Atlanta TB Prevention Coalition. This guide is helpful although technical terms are used because it is primarily geared toward medical practitioners.