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So, what is tuberculosis? Tuberculosis, or TB for short, is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attacks the lungs, but TB bacteria can attack any part of the body, such as the kidneys, spine, and brain. It's one of the world's deadliest diseases and is contagious, but it's curable and preventable. Two TB-related conditions exist. One, latent TB infection, known as LTBI, or two, TB disease. So, what's the difference between latent TB infection and TB disease? Latent TB infection is when one has TB germs in their body, but they are not sick because the germ is not active. It also includes when they don't have symptoms of TB disease and they cannot spread the germs to others. They may develop tuberculosis disease in the future and are often prescribed treatment to prevent them from developing TB. Secondly, the TB disease is when they're sick from TB germs that are active, meaning they are multiplying and destroying tissue in their body. They usually have symptoms of tuberculosis disease and people with TB disease of the lungs or throat are capable of spreading germs to others. They are prescribed drugs that can treat tuberculosis disease. So who's at risk for tuberculosis? The categories of persons at high risk for developing TB include, one, persons who have been recently infected with tuberculosis bacteria. This can include close contact of a person with infectious TB, persons who have immigrated from areas of the world with high rates of TB, children less than five years of age who have a positive TB test, groups with high rates of TB transmission such as homeless persons, injection drug users and persons with HIV infection, and persons who work or reside with people who are at high risk for TB in facilities or institutions such as hospitals, homeless shelters, correctional facilities, nursing homes, and residential homes for those with HIV. Secondly, persons with medical conditions that weaken the immune system like babies and young children who have often weak immune systems. Other people could have weak immune systems too especially those with any of the following conditions. HIV infection, the virus that causes AIDS, substance abuse, silicosis, diabetes mellitus, severe kidney disease, low body weight, organ transplants, head and neck cancer, medical treatments such as corticosteroids or organ transplants, and specialized treatment for rheumatoid arthritis or Crohn's disease. So what is the incidence of tuberculosis in the United States? In 2016, there were a total of 9,272 TB cases that were reported just in the U.S. alone. This represents a 2.9% decrease though from 2015. The national incidence rate was 2.9 cases per 100,000 persons. That's a 3.6 decrease from 2015. How is tuberculosis transmitted? TB bacteria are spread through the air from one person to another called airborne. The TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, speaks or sings. People nearby may breathe in these bacteria and become infected. When a person breathes in TB bacteria, the bacteria can settle into the lungs and begin to grow. From there, they can move through the blood to other parts of the body such as the kidneys, spine and brain. Now, it's important to remember that TB is not spread by the following. Shaking someone's hand, sharing food or drink, touching bed linens or toilet seats, sharing toothbrushes or kissing. Now let's talk about the signs and symptoms of tuberculosis. Symptoms of TB disease depend on where in the body the TB bacteria are growing. TB bacteria usually grow in the lungs known as pulmonary TB. TB disease in the lungs may cause symptoms such as a bad cough that lasts three weeks or longer, pain in the chest, coughing up blood or sputum, phlegm from deep inside the lungs, and other symptoms of TB disease could include weakness or fatigue, weight loss, no appetite, chills, fever, or sweating at night. Symptoms of TB disease in other parts of the body depend on the area infected. So let's talk about the testing and diagnosis of tuberculosis. There are two kinds of tests that are used to detect TB bacteria in the body. A TB skin test is one of those ways. It's also called the Mantoux tuberculin skin test or TST for short. This is performed by injecting a small amount of fluid called tuberculin into the skin on the arm. A person giving the tuberculin skin test must return within 48 to 72 hours to have a trained healthcare worker look for a reaction on the arm. The result depends on the size of the raised, hard area of swelling. This is the preferred TB test for children under age five. A positive skin test means that the person's body was infected with TB bacteria. Additional tests are needed to determine if the person has latent TB infection or TB disease. A negative skin test means the person's body did not react to the test and that latent TB infection or TB disease is not likely. The second is a blood test also called the interferon-gamma release assays or IGRAs for short. A healthcare provider will draw a patient's blood and send it to the laboratory for analysis and results. If there's a positive TB blood test, which means that the person has been infected with TB bacteria, additional tests are needed to determine if the person has latent TB infection or TB disease. If it's negative, that means that the person's blood did not react to the test and that latent TB infection or TB disease is not likely. So what would the treatment and prevention include for tuberculosis? Well for treatment, there are 10 drugs currently approved by the U.S. Food and Drug Administration for treating TB. The CDC offers a guide for the basic treatment schedule. For prevention it would include the BCG vaccine. The BCG is a vaccine for tuberculosis disease and is used in many countries with a high prevalence of TB to prevent childhood tuberculosis, meningitis and miliary disease. It's recommended for children and healthcare workers. Included with the prevention of transmission of tuberculosis, educating, training and counseling of workers, customers and visitors about TB infection and TB disease, testing and evaluating workers who are at risk for exposure to TB disease, applying epidemiology-based prevention principles including the use of setting-related TB infection-control data, coordinating efforts between local or state health departments and high-risk health-care and congregate settings, ensuring proper cleaning, sterilization, disinfecting of equipment that might be contaminated, adequate, local or general ventilation of working areas, clean air by using high efficiency particulate air filtration, known as HEPA, or ultraviolet germicidal irradiation, using posters and signs to remind patients and staff of proper cough etiquette, which includes covering the mouth when coughing and respiratory hygiene. There is a period of communicability with TB. A person is able to spread TB from an assigned date of three months prior to symptom onset or a positive lab report. An individual is considered no longer communicable after effective treatment has been demonstrated for greater than two weeks causing a significant reduction in symptoms.
In this lesson, we'll be looking deeper into tuberculosis (TB). We'll examine what the disease is, the two TB-related conditions, who is most at risk, the incidence rate in the U.S., how it's transmitted, and the treatment options and preventative measures people most at risk can take.
TB is caused by a bacterium appropriately called mycobacterium tuberculosis. The bacteria usually attack the lungs, but it can also attack any part of the body including the kidneys, brain, and spine.
TB is one of the world's deadliest diseases (though not in the U.S.), and while very contagious, it's also curable and preventable.
TB-Related Conditions
There are two TB-related conditions:
1. Latent TB Infection (LTBI)
LTBI is present when an infected person has the TB germs in the body but isn't sick due to the germs not being active. There are usually no symptoms of TB disease and that person cannot spread the disease to others.
However, that same person could still develop TB disease in the future. Often, treatment is given to prevent the person from developing TB disease.
2. TB Disease
TB disease is present when the TB germs are active. In these situations, the germs multiply and destroy tissue in the body. Symptoms are usually present.
People with TB disease in the lungs and throat can spread the TB germs to others and are also prescribed treatment, usually drugs.
Who is Most at Risk?
There are two groups of people most at risk of getting TB.
1. People recently infected with TB bacteria
People who have come in close contact with a person infected with the TB bacteria, people who have immigrated from high-rate areas around the world, and children under the age of five who have tested positive for the TB bacteria are most at risk.
People with high rates of TB transmission include:
- Homeless people
- Injection drug users
- People who have HIV
- People working in or living in places where there are high-risk individuals:
• Hospitals
• Homeless shelters
• Correctional facilities
• Nursing homes
• Residential homes for people with HIV
2. People with medical conditions that weaken the immune system
Those with weakened immune systems are particularly vulnerable, and this includes babies and younger children. Others who typically have weakened immune systems include:
- People who have HIV
- Substance abusers
- People with silicosis
- People with severe kidney disease
- People with low bodyweight
- People with diabetes mellitus
- Organ transplant recipients
- People with head or neck cancer
- People on corticosteroids
- People receiving specialized treatments for rheumatoid arthritis and Crohn's disease
Incidence Rates in the U.S.
Incidence rates of TB in the U.S. are low. In 2016, there were only a total of 9272 TB cases reported, which represents a decrease of 2.9 percent from 2015. The national incidence rate is 2.9 cases per 100,000 people, which also represents a decrease from 2015 of 3.6 percent.
How is TB Transmitted?
The TB bacteria is spread by airborne transmission, meaning through the air from one person to another. The bacteria are put into the air when a person with TB in the lungs and throat cough, speak, or sing.
People in the vicinity then breathe in that bacteria and become infected. The bacteria settle in the lungs and begin to grow. They can then move through the blood to other parts of the body, namely the kidneys, brain, and spine.
Pro Tip #1: It's equally important to know how TB is NOT transmitted: by shaking hands, sharing food and drink, contact with bed linens or toilet seats, using toothbrushes, or kissing. It's passed via airborne transmission only.
Signs and Symptoms of TB
TB symptoms depend on where in the body the TB bacteria are growing. Usually, TB grows in the lungs (pulmonary TB) and this can cause:
- Bad cough lasting three or more weeks
- Pain in the chest
- Coughing up blood or phlegm
Other more general symptoms can also include:
- Weakness or fatigue
- Weight loss
- Loss of appetite
- Chills
- Fever
- Night sweats
TB Testing and Diagnosis
There are two kinds of tests to detect the TB bacteria in the body.
1. TB Skin Test
The Mantoux tuberculin skin test (TST) is performed by injecting a small amount of fluid called tuberculin into the skin on a person's arm. That person then must return 48 to 72 hours later to have a healthcare provider check for their reaction.
The diagnosis depends on the size of the raised, hard area or swelling on the arm that results from the injection. It should be noted that this is the preferred TB test for children under five years of age.
2. TB Blood Test
The TB blood test, also called Interferon-gamma release assay or IGRA, is done when a healthcare provider draws blood from a person suspected of having TB and sends it to the lab for analysis and results.
Regardless of which test is done, a positive test is a sign that the person tested is infected with the TB bacteria and additional tests must be done to see if it's a latent TB infection or TB disease
A negative test is a sign that the person's body did not react to the testing and neither latent TB infection nor TB disease are likely.
TB Treatment Options
There are 10 drugs currently approved by the FDA for treating TB. In addition, the CDC offers a guide for a basic treatment schedule.
TB Prevention Techniques
There is a TB vaccine known as the Bacille Calmette-Guerin vaccine. It's used in many countries that have high rates of infection to prevent childhood TB and also meningitis, miliary disease, and it's especially recommended for both children and healthcare workers.
Preventative measures also include education, training, and counseling about TB infection and who is most at risk. Testing and evaluating those most at risk is also vital, as is:
- Coordinating efforts between local and state health departments and high-risk healthcare and congregate settings
- Ensuring the proper cleaning, sterilization, and disinfection of equipment that may be contaminated
- Adequate local or general ventilation of working areas
- Cleaning the air using high-efficiency particulate air (HEPA) filtration or ultraviolet germicidal irradiation
- Using posters and signs to remind people to use proper cough etiquette, like covering the mouth, and respiratory hygiene
Pro Tip #2: The period of communicability for TB is from an assigned date of three months prior to symptom onset or positive testing. An individual is considered no longer communicable two weeks after the completion of effective treatment, which would cause a significant reduction in symptoms.