Tuberculosis

The Florida Department of Health in Hardee County focuses efforts on case management and treatment-until-cure of active tuberculosis (TB) cases. The department also focuses on investigation of close contacts to active TB cases, in order to ensure follow-up and treatment until completion of therapy for those with latent TB infection (LTBI). Preventive medication may be prescribed to eligible persons with positive skin tests and negative chest x-rays.

What is TB?

Tuberculosis is caused by the bacteria called Mycobacterium tuberculosis. The bacterial infection can attack any part of the body, but it is found most often in the lungs. In the early 1900s, tuberculosis was the leading cause of death in the United States. In 1940, scientists began discovering drugs which could effectively treat the disease. The incidence of disease has declined over the years, but there are still approximately 16,000 cases identified in the United States each year. 

How is TB spread?

Tuberculosis is spread through droplets in the air. When an infected person coughs, sneezes, or sings, the bacteria are projected out into the air. People nearby may breathe in the droplets and become ill. After the droplets are breathed in, the bacteria begin to grow in the lungs. They may stay there, or they may move to other organs (kidney, liver, or spine). Most people who breathe in the bacteria never get sick because their immune system attacks the bacteria and destroys them. However, if a person has diabetes, HIV infection, a sexually transmitted disease, or other illnesses which cause harm to the immune system, their body may be too weak to fight the disease.

Signs and Symptoms:

• Cough (usually productive of sputum) lasting longer than 3 weeks
• Fever
• Shortness of breath
• Unexplained substantial weight loss
• Night sweats

How can I get tested for TB?

Anyone may be tested for TB, including adults, children, pregnant women, people with colds, and people who have had the bacille Calmette-Guérin (BCG) vaccine. It is only recommended in certain circumstances; however, based on a person’s risk factors, tests are free of charge to those who have had contact with an active TB case. After skin testing, a follow up visit for reading the test must be done within 48-72 hours.

TB skin testing is recommended in Florida only for:

• Persons with recent TB exposure
• Persons at risk for progression to active diseases (HIV positive patients)
• Persons who are likely to complete treatment

The decision to begin treatment after a positive test should always be a decision to complete treatment.

What if I have a positive test for TB?

If you have a positive reaction to the TB skin or blood test (QFT-G or T-Spot), your healthcare provider will order a chest x-ray or other tests to see if you have active TB disease. One of these tests is a sputum culture which is a test of the phlegm you cough up; because the TB bacteria may be found somewhere other than your lungs, your provider may check your urine or blood for signs of infection. If you have active TB disease, you will need to take medicine to treat the infection. 

What if I have been vaccinated with BCG?

BCG is a TB vaccine used in countries other than the United States where TB is common, and it is given to infants and small children to help prevent TB infection. The vaccine does not always protect people from TB however; and while a history of BCG vaccination is not a contraindication to TB skin testing, a positive result is highly indicative of TB infection in a person who has received the BCG vaccine. If you were recently (5 yrs.) vaccinated with BCG, you may have a positive reaction to a TB skin test. This reaction may be due to the BCG vaccine itself or to latent TB infection. Your positive skin test probably means that you have latent TB infection if: 

• you recently spent time with a person who has TB disease
• you are from an area of the world where TB disease is very common (most countries in Latin America and the Caribbean, Africa, Asia, Eastern Europe, and Russia)
• you spend time where TB is common (homeless shelters, drug-treatment centers, health care clinics, jails, and prisons)

If I have latent TB infection, how can I keep from developing active TB disease?

Many people who have latent TB infection never develop active TB disease.  Others may be at higher risk for active TB disease.  These people include: 

• people with HIV infection
• people who became infected with TB bacteria in the last 2 years
• babies and young children
• people who inject illegal drugs
• people who are sick with other diseases that weaken the immune system
• elderly people
• people who were not treated correctly for TB in the past

What if I have a positive test for TB?

If you have latent TB infection (a positive TB skin test reaction or positive QFT-G or T-Spot blood test) and you are in one of these high-risk groups, you should consider taking medication to help prevent you from developing active TB disease. You will need to commit to taking the medicine for 9 months in order for the medicine to be effective in killing the TB germ in your body.

What if I have HIV infection? 

HIV and TB form a lethal combination, each speeding the other’s progress. HIV weakens the immune system. Someone who is HIV-positive and infected with TB is many times more likely to become sick with TB than someone infected with TB who is HIV-negative. TB is a leading cause of death among people who are HIV-positive. It accounts for about 13% of AIDS deaths worldwide. In Africa, HIV is the single most important factor determining the increased incidence of TB in the past 10 years. 

How is active TB disease treated?

TB is treated with a number of special antibiotics given over 9-12 months. The TB germs are very strong and slow to be killed.  It is important that persons infected with TB follow the medication schedule closely. Failure to follow the medication schedule could result in a more serious "drug resistant" TB condition. 

How can I keep from spreading TB?

The most important way to keep from spreading TB is to take all your medicine, exactly as directed by your doctor or nurse. If you are sick enough with active TB disease to go to a hospital, you may be put in a special room. These rooms use air vents that keep TB bacteria from spreading to other rooms. People who work in these special rooms must wear a special face mask to protect themselves from TB bacteria. You must stay in the room so that you will not spread TB bacteria to other people. If you are infectious while you are at home, there are certain things you can do to protect yourself and others near you:

• The most important thing is to take your medicine.
• Always cover your mouth with a tissue when you cough, sneeze, or laugh. Put the tissue in a closed bag and throw it away.  
• Do not go to work or school. Separate yourself from others and avoid close contact with anyone. Sleep in a bedroom away from other family members. 
• Air out your room often to the outside of the building (if it is not too cold outside). TB spreads in small closed spaces where air doesn't move. Put a fan in your window to blow out (exhaust) air that may be filled with TB bacteria. If you open other windows in the room, the fan also will pull in fresh air. This will reduce the chances that TB bacteria will stay in the room and infect someone who breathes the air.

After you take medicine for about 2 or 3 weeks, you may no longer be able to spread TB bacteria to others. Remember, you will get well only if you take your medicine exactly as your doctor or nurse tells you, until your treatment is completed!