TUBERCULOSIS (TB)

General Information

DEFINITION--An acute or chronic, contagious, bacterial infection. TB was once under control, but has resurfaced mainly due to AIDS, poverty, homelessness and abuse of alcohol and other drugs.

BODY PARTS INVOLVED--Lungs primarily, but may spread to other organs. Childhood tuberculosis is usually confined to the middle of the lungs, but it may spread to cause meningitis. Tuberculosis in adults usually affects the top of the lungs.

SEX OR AGE MOST AFFECTED--Both sexes; all ages.

SIGNS & SYMPTOMS

Early stages:

• No symptoms (often).
• Symptoms that resemble those of influenza.

Second stages:

Low fever; weight loss; chronic fatigue; heavy sweating, especially at night.

Later stages:

• Cough with sputum that becomes progressively bloody, yellow, thick or gray.
• Chest pain; shortness of breath; reddish or cloudy urine (sometimes).

CAUSES--Infection by the organism, Mycobacterium tuberculosis. It is transmitted in the air from one person to another. Cattle are also susceptible and can transmit TB through non-pasteurized milk.

RISK INCREASES WITH

• Adults over 60.
• Newborns and infants.
• Chronic illness that has lowered resistance.
• Use of cortisone or immunosuppressive drugs. These may reactivate inactive TB.
• Crowded or unsanitary living conditions.
• Alcohol and drug abuse; AIDS; homeless people; foreign born or refugees.
• Health-care workers in prolonged close contact with TB patients.

HOW TO PREVENT

Vaccination with BCG, a strain of tuberculosis bacteria. This may prevent infection, or shorten and diminish the severity of infection. Treatment for several months with isoniazid (INH) if a tuberculin skin test is positive. > Health authorities recommend vaccination and preventive treatment for the following groups:

Persons who have positive reactions to TB tests, but show no symptoms of disease, especially children under age 5. Children with negative reactions to TB tests in areas where 20% or more of classmates have positive reactions. Persons traveling to countries where TB is prevalent. Persons who must take immunosuppressive or cortisone drugs for a long time. Postgastrectomy patients whose x-rays show evidence of inactive TB. Persons with silicosis.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Tests may include tuberculin skin test, blood studies, sputum study and chest x-ray. If another disorder is suspected, tests may include a lumbar puncture, bronchoscopy and bone marrow biopsy (See Glossary for all).

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Regular follow-up x-rays.

POSSIBLE COMPLICATIONS

• Lung abscess; bronchiectasis; chronic obstructive pulmonary disease.
• Spread of infection to other organs.
• Respiratory failure.

PROBABLE OUTCOME--Usually curable with treatment. Without treatment, it can be fatal. However, recurrent strains have resistance to usual antibiotics.

How To Treat

GENERAL MEASURES--

• It may not be necessary to isolate or hospitalize a person with TB. The disease is usually spread before diagnosis (TB is difficult to catch; lengthy or repeated close contact is usually necessary). Patients are probably not infectious after 10 days to 2 weeks of treatment.
• Occasionally you will need to collect a 24-hour sputum specimen for laboratory analysis to see if TB is still active.
• See Resources for Additional Information.

MEDICATION--Antitubercular drugs, usually for 9-12 months. Several types are given at the same time to avoid bacterial resistance to the drugs. Don't discontinue medications without doctor's approval. A relapse may occur.

ACTIVITY--Rest in bed until symptoms disappear and tests show TB germs are gone. You may need to restrict activities for 6 months.

DIET--No special diet.

Call Your Doctor If

• Symptoms persist or worsen.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.