Tuberculosis (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 a person with TB in their lungs or throat coughs, laughs, sneezes, sings, or even talks, the germs that cause TB may spread through 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 immune system is protecting them from the germs and they are not sick. This is referred to as latent TB.
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. This is referred to as active TB.
How Does Someone Become Infected with TB?
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. It is rare, but possible, for TB to be spread in an airplane.
How Does TB Disease Develop?
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 immune system protects them.
Many people who develop TB disease were infected with the TB germ in the past. Then their immune system becomes damaged and can no longer fight the germ so it develops into TB disease. The immune system may be damaged from AIDS or diabetes, drug or alcohol abuse, lack of medical care, or homelessness. 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.
How Serious is TB?
In some people, TB can cause cough, chest pain and bloody mucus. If it is not treated properly, TB can be fatal.
What is Multi-drug Resistant TB?
Multi-drug resistant tuberculosis (MDR-TB) 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. If you have TB, it is important to follow your healthcare provider's instructions for taking your TB medicine so that you will not develop MDR-TB.
What are the Symptoms of TB?
A person with TB infection will have no symptoms. A person with active TB disease may have any, all or none of the following symptoms:
- A persistent cough
- Constant fatigue
- Weight loss
- Loss of appetite
- Fever
- Coughing up blood
- Night sweats
These symptoms can also occur with other diseases so it is important to see a healthcare provider and to let them find out if you have TB. 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 test.
How is TB Detected?
TB can be detected through a skin test or a TB blood test.
The skin test is done by injecting a small amount of fluid called tuberculin into the skin in the arm. You will be told to return within 48 to 72 hours to have a healthcare worker check the arm to see if a bump has developed. The healthcare worker will measure the bump and tell you if your reaction to the test is positive or negative. If it's positive, it usually means you have been infected with the TB germ.
The TB blood test measures how your immune system reacts to the germs that cause TB.
If you have a positive test for TB infection, it only means that you have been infected with TB germs. It does not tell whether you have developed TB disease. You will be given other tests, such as a chest x-ray and a check of your sputum (coughed up mucus), to see whether you have TB disease.
How is TB Treated?
Treatment for TB depends on whether a person has active TB disease or only TB infection.
If you have become infected with TB, but do not have active TB disease, you may getpreventive therapy. This treatment kills germs that are not doing any damage right now, but could so do in the future. The most common preventive therapy is a daily dose of isoniazid (INH) for 6 to 9 months.
If you have active TB disease you will probably be treated with a combination of several drugs for 6 to 12 months. You may only have to stay a short time in the hospital, if at all, and can then continue taking medication at home. After a few weeks you can probably even return to normal activities and not have to worry about infecting others.
The most common treatment for active TB is INH plus two to three other drugs including rifampin, pyrazinamide and ethambutol. You will probably begin to feel better only a few weeks after starting to take the drugs.
It is very important that you continue to take the medicine correctly for the full length of treatment. If you take the medicine incorrectly or stop taking it, you may become sick again and will be able to infect others with TB.
If you don't take the medicine correctly and you become sick with TB a second time, the TB may be harder to treat if it has become drug resistant. This means that some drugs used to treat TB cannot fight the TB germs in the body. TB that is resistant to more than one drug, called multi-drug resistant TB (MDR-TB) is very dangerous.
If you have become infected with TB, but do not have active TB disease, you may get preventive therapy. This treatment kills germs that are not doing any damage right now, but could so do in the future. The most common preventive therapy is a daily dose of isoniazid (INH) for 6 to 9 months.
If you take your medicine as instructed by your healthcare provider, it can keep you from developing active TB disease.
Not everyone who is infected with the TB germ develops TB disease. People who are at high risk for developing TB disease from the TB germ include:
- people infected with HIV
- people who were infected with TB bacteria in the last 2 years
- babies and young children
- people who inject illegal drugs
- people who have other diseases that weaken the immune system
- elderly people
- people who were not treated correctly for TB in the past
There is a vaccine against TB called BCG, or bacille Calmette-Guerin. It is used in many foreign countries where TB is more common. However, it is not used very often in the United States because the chances of being infected with TB in the US is low, there are questions about how much protection it offers, and it can make TB skin tests less accurate
Living With Tuberculosis
You will need regular checkups to make sure your treatment is working.
You must finish your medicine and take the drugs exactly as prescribed. If you stop taking the drugs too soon you can become sick again. If you do not take the drugs correctly, the TB germs that are still alive can become resistant to the drugs.
Sometimes the drugs used to treat TB can cause side effects. If you are taking medicine for preventive therapy or for active TB disease let your doctor know if you begin having any unusual symptoms. Side effects of TB drugs can include:
- no appetite
- nausea
- vomiting
- yellowish skin or eyes
- fever for 3 or more days
- abdominal pain
- tingling fingers or toes
- skin rash
- easy bleeding
- aching joints
- dizziness
- tingling or numbness around the mouth
- easy bruising
- blurred or changed vision
- ringing in the ears
- hearing loss
A healthcare worker may make sure you are taking your medicine correctly. This is called Directly Observed Therapy (DOT).
Tips for Taking TB Medicine
If you are taking TB medicine on your own, without DOT, it's important to get into a routine. Here are some ways to help you remember to take your TB medicine:
- Take your medicine at the same time every day. For example, you can take it before breakfast, or after you brush your teeth.
- Ask someone in your family or a friend to remind you to take your medicine.
- Each day when you take your medicine mark it off on a calendar.
- Get a weekly pill dispenser that has a section for each day of the week. Put your pills in it.
Ask your healthcare provider what you should do if you forget to take your pills.
Don't Spread Your TB
If you have TB disease, it will take a few weeks of treatment before you can't spread TB bacteria to others. Until your healthcare provider tells you to go back to your daily routine, here are ways to protect yourself and others near you:
- Take your medicine exactly as the healthcare provider directed.
- When you cough, sneeze or laugh, cover your mouth with a tissue. Put the tissue in a closed bag and throw it away.
- Do not go to work or school until your healthcare provider says it's OK to go back. Avoid close contact with anyone. Sleep in a bedroom alone.
- Air out your room often so the TB germs don't stay in the room and infect someone who breathes the air.
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