Tuberculosis (TB)

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Tuberculosis (TB)

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What is tuberculosis?

History of tuberculosis

During the 19th century, TB claimed more lives in the United States than any other disease. But, with improvements in nutrition, housing, sanitation, and medical care during the first half of the 20th century, the number of cases and deaths dropped dramatically. In the 1940s and 1950s, with the introduction of antibiotic therapies for TB, the decline continued. By 1985, the number of cases had fallen to the lowest figure recorded in modern US history.

However, from 1985 to 1992, the nation experienced a resurgence of TB cases, and a widespread occurrence of multidrug-resistant TB - a serious public health problem in the US. Since, the Centers for Disease Control and Prevention (CDC) has developed and published the National Action Plan to Combat Multidrug-Resistant TB and allocated new resources to put the plan into effect. Among other accomplishments, these efforts have led to improved identification of TB, updated treatment protocols, continued research and education, and upgraded laboratories for early diagnosis and testing.

From 1997 to 1999, there was a 12 percent decline in TB cases, and from 1992 to 1999, there was a 34 percent reduction in TB mortality cases.

Possible Reasons for Resurgence of Tuberculosis Cases

A number of differing factors are cited as the reasons for the increase in cases of tuberculosis:

the HIV/AIDS epidemic
increased numbers of immigrants from countries with many cases of TB
increased poverty, injection-drug use, and homelessness
poor compliance with treatment regimens
increased numbers of residents in long-term care facilities

Tuberculosis (TB) is a chronic bacterial infection that usually infects the lungs, although other organs are sometimes involved. TB is primarily an airborne disease (spread by air droplets from infected people when they cough or sneeze).

There is a difference between being infected with the TB bacterium without illness and having active tuberculosis disease.

There are three important ways to describe the stages of TB. They are as follows:

1. Exposure: This occurs when a person has been in contact, or exposed to, another person who is thought to have or does have TB. The exposed person will have a negative TB skin test, a normal chest x-ray, and no symptoms of the disease.

2. TB infection: This occurs when a person has the TB bacteria in his/her body, but does not have symptoms of the disease. This person would have a positive skin test, but a normal chest x-ray and no illness.

3. TB disease: This describes the person that has symptoms of an active infection. The person would have a positive skin test, a positive chest x-ray, and might be ill.

The cause of TB is the bacterium Mycobacterium tuberculosis (M. tuberculosis). Most people infected with M. tuberculosis never develop active TB. However, in people with weakened immune systems, including those with HIV (human immunodeficiency virus), TB organisms can overcome the body's defenses, multiply, and cause an active disease.

Who is at risk for developing TB?
TB affects all ages, races, income levels, and both genders. Those at higher risk include the following:

people who live or work with others who have TB
medically underserved populations
homeless people
people from other countries where TB is prevalent
people in group settings, such as nursing homes
people who abuse alcohol
people who use intravenous drugs
people with impaired immune systems
the elderly
healthcare workers who come in contact with high-risk populations

What are the symptoms of TB?
Different symptoms of TB are present depending upon the age of the child affected. The following are the most common symptoms for TB. However, each child may experience symptoms differently. Symptoms may include:

in children:
- fever
- decrease in weight
- sweating at night
- cough
- chills
- enlarged lymph nodes
in adolescents:
- cough that lasts greater than three weeks
- productive cough
- pain in the chest
- blood in their sputum
- fatigue
- weight loss
- decrease in appetite
- fever
- night sweats

The symptoms of TB may resemble other lung conditions or medical problems. Always consult your child's physician for a diagnosis.

What causes TB?

The TB bacteria are spread through the air; however, repeated exposure to the germs is usually necessary before a child will become infected. It is not likely to be transmitted through personal items, such as clothing, bedding, or other items that a person with TB has touched. Adequate ventilation is the most important measure to prevent the transmission of TB.

How is TB infection diagnosed?

TB is diagnosed with a TB skin test. In this test, a small amount of noninfectious testing material derived from the TB bacterium is injected into the top layer of the skin. If a certain size bump develops within two or three days, the test may be positive for tuberculosis infection. Additional tests to determine if a child has TB disease include x-rays and sputum tests.

TB skin tests are suggested for those:

In high-risk categories.
Who live or work in close contact with people who are at high risk.
Who have never had a TB skin test.

Recommendations for skin testing in children, from the American Academy of Pediatrics (AAP) are as follows:

Immediate testing:

If the child is thought to have been exposed in the last five years.
If the child has an x-ray that indicates possible TB.
If the child has any symptoms of TB.
A child that is coming from countries where TB is prevalent.

Yearly skin testing:

Children with HIV.
Children that are in jail.

Testing every 2 to 3 years:

Children that are exposed to high-risk people.

Consider testing in children from ages 4 to 6 and 11 to 16 if:

A child's parent has come from a high-risk country.
A child has traveled to high-risk areas.
Children who live in densely populated areas.

Treatment for tuberculosis:

Specific treatment for tuberculosis will be determined by your child's physician based on:

Your child's age, overall health, and medical history.
Extent of the diseas.
Your child's tolerance for specific medications, procedures or therapies.
Expectations for the course of the disease.
Your opinion or preference.

Treatment may include:

Short-term hospitalization.
Medications.

Treatment may last for many months. TB infection can often be treated with a single drug, but TB disease requires several drugs given in combination. However, once the treatment begins, your child begins to feel well very soon. Your child is not usually contagious soon after treatment begins, provided that treatment is carried through to the end, as prescribed by your child's physician.

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