Monday 26 February 2018

Tuberculosis (TB) Disease: TB Risk Factors Symptoms and Risk Factors

Tuberculosis (TB) is a disease caused by bacteria that are spread through the air from person to person. If not treated properly, TB disease can be fatal. People infected with TB bacteria who are not sick may still need treatment to prevent TB disease from developing in the future. Learn to recognize the symptoms of TB disease and find out if you are at risk.

Anyone Can Get TB

At first, it felt like a bad cold. Then came a constant cough and night sweats. After going to the hospital for what she thought was severe pneumonia, Nicole was soon diagnosed with TB. “I didn’t really understand very much about TB at all, and I didn’t realize at that time that anyone can get it,”

A cough lasting 3 weeks or longer is a symptom of TB disease.

People with latent TB infection do not have symptoms, but may still need treatment.
Thomas had a similar experience. When he started feeling sick his doctors diagnosed him with pneumonia. A couple of months later he was still having night sweats, didn’t have an appetite, and felt extremely tired all the time. At his next hospital visit he had a chest x-ray and was told he had TB.
“Most people think that, okay, it’s out here but it will never happen to me. I know people are still testing for it but I didn’t think it was big enough to reach me,” says Thomas.
Anyone can get TB. People with TB disease can be found in every state; in rural areas and cities; in schools, workplaces, homes; and in many other places where people are in close contact. Learn to recognize the symptoms of TB disease and find out if you are at risk.

Latent TB Infection and TB Disease

The bacteria that cause TB are spread through the air from person to person when a person with TB disease coughs, speaks, or sings. People nearby may breathe in these bacteria and become infected. There are two types of TB conditions: latent TB infection and TB disease.
TB bacteria can live in the body without making you sick. This is called latent TB infection . In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. People with latent TB infection do not feel sick, do not have any symptoms, and cannot spread TB bacteria to others.
If TB bacteria become active in the body and multiply, the person will go from having latent TB infection to being sick with TB disease. For this reason, people with latent TB infection are often prescribed treatment to prevent them from developing TB disease.
People with TB disease usually have symptoms and may spread TB bacteria to others.
TB bacteria most commonly grow in the lungs, and can cause symptoms such as:
  • A bad cough that lasts 3 weeks or longer
  • Pain in the chest
  • Coughing up blood or sputum (mucus from deep inside the lungs)
Other symptoms of TB disease may include:
  • Weakness or fatigue
  • Weight loss
  • No appetite
  • Chills
  • Fever
  • Sweating at night
TB disease can be treated by taking medicine. It is very important that people who have TB disease are treated, finish the medicine, and take the drugs exactly as prescribed. If they stop taking the drugs too soon, they can become sick again; if they do not take the drugs correctly, the TB bacteria that are still alive may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to treat.

Eliminating TB in the United States

Millions of people in the United States have latent TB infection. Without treatment, they are at risk for developing TB disease. Treatment of latent TB infection is essential to controlling and eliminating TB in the United States. If you think you may have latent TB infection, TB disease, or were exposed to someone with TB disease, contact your health care provider or your TB control office. You and your health-care provider can discuss your options for testing and treatment.

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Basic TB Facts
Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection (LTBI) and TB disease. If not treated properly, TB disease can be fatal.




How TB Spreads
TB bacteria are spread through the air from one person to another. 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.

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TB is NOT spread by

    shaking someone’s hand
    sharing food or drink
    touching bed linens or toilet seats
    sharing toothbrushes
    kissing

When a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow. From there, they can move through the blood to other parts of the body, such as the kidney, spine, and brain.

TB disease in the lungs or throat can be infectious. This means that the bacteria can be spread to other people. TB in other parts of the body, such as the kidney or spine, is usually not infectious.

People with TB disease are most likely to spread it to people they spend time with every day. This includes family members, friends, and coworkers or schoolmates.

TB Risk Factors

Some people develop TB disease soon after becoming infected (within weeks) before their immune system can fight the TB bacteria. Other people may get sick years later, when their immune system becomes weak for another reason.

Overall, about 5 to 10% of infected persons who do not receive treatment for latent TB infection will develop TB disease at some time in their lives. For persons whose immune systems are weak, especially those with HIV infection, the risk of developing TB disease is much higher than for persons with normal immune systems.

Generally, persons at high risk for developing TB disease fall into two categories:

    Persons who have been recently infected with TB bacteria
    Persons with medical conditions that weaken the immune system

Persons who have been Recently Infected with TB Bacteria

This includes:

    Close contacts of a person with infectious TB disease
    Persons who have immigrated from areas of the world with high rates of TB
    Children less than 5 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
    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

Persons with Medical Conditions that Weaken the Immune System

Babies and young children often have weak immune systems. Other people can have weak immune systems, too, especially people with any of these 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 transplant
    Specialized treatment for rheumatoid arthritis or Crohn’s disease

Vaccines


TB Vaccine (BCG)

Bacille Calmette-Guérin (BCG) is a vaccine for tuberculosis (TB) disease. This vaccine is not widely used in the United States, but it is often given to infants and small children in other countries where TB is common. BCG does not always protect people from getting TB.

BCG Recommendations

In the United States, BCG should be considered for only very select people who meet specific criteria and in consultation with a TB expert. Health care providers who are considering BCG vaccination for their patients are encouraged to discuss this intervention with the TB control program in their area.

Children

BCG vaccination should only be considered for children who have a negative TB test and who are continually exposed, and cannot be separated from adults who

    Are untreated or ineffectively treated for TB disease, and the child cannot be given long-term primary preventive treatment for TB infection; or
    Have TB disease caused by strains resistant to isoniazid and rifampin.

Health Care Workers

BCG vaccination of health care workers should be considered on an individual basis in settings in which

    A high percentage of TB patients are infected with TB strains resistant to both isoniazid and rifampin;
    There is ongoing transmission of drug-resistant TB strains to health care workers and subsequent infection is likely; or
    Comprehensive TB infection-control precautions have been implemented, but have not been successful.

Health care workers considered for BCG vaccination should be counseled regarding the risks and benefits associated with both BCG vaccination and treatment of latent TB infection.

Testing for TB in BCG-Vaccinated People

Many people born outside of the United States have been BCG-vaccinated.

People who were previously vaccinated with BCG may receive a TB skin test to test for TB infection. Vaccination with BCG may cause a positive reaction to a TB skin test. A positive reaction to a TB skin test may be due to the BCG vaccine itself or due to infection with TB bacteria.

TB blood tests (IGRAs), unlike the TB skin test, are not affected by prior BCG vaccination and are not expected to give a false-positive result in people who have received BCG.

For children under the age of five, the TB skin test is preferred over TB blood tests.

A positive TB skin test or TB blood test only tells that a person has been infected with TB bacteria. It does not tell whether the person has latent TB infection or has progressed to TB disease. Other tests, such as a chest x-ray and a sample of sputum, are needed to see whether the person has TB disease

 

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