by Matt SheehanOSF Healthcare
What is Tuberculosis?
OSF Healthcare
Tuberculosis signs and symptoms
“Warning signs include, but are not limited to, unexplained fever, night sweats and unintentional weight loss,” Dr. Ahmad says. “The infection is spread through inhaling, so the lungs are the primary site for infection”
Lung symptoms include a chronic cough that doesn’t go away, along with vague chest aches and pains. You may have phlegm, which could sometimes have blood in it.
What you should know:
- Tuberculosis outbreak was reported in Kansas City, Kansas
- The disease is not common in the United States
- There is a vaccine, but its efficacy is questionable
- Symptoms can be unexplained fevers, night sweats, and weight loss
- The disease is spread airborne through respiratory droplets
“The Vampire Effect”
Dr. Ahmad says, "Before the Industrial Revolution, folklore often associated tuberculosis with vampires. When one member of a family died from the disease, the other infected members would lose their health slowly. People believed this was caused by the original person with TB draining the life from the other family members".
"It can be deadly if it's left untreated. It was colloquially referred to as 'the consumption,' way back when because it consumes the body, and the body can get overwhelmed by it."
Why do most people not get the TB vaccine?
There is a vaccine for TB, and 2021 marked 100 years it has been around. It's made from a weakened strain of bacteria, Dr. Ahmad says. It's called Bacille Calmette-Guérin (BCG). The rates of protection against tuberculosis infection vary widely.
"It offers protection from getting TB of the brain/meningitis, especially in kids. It also has some protection against TB outside the lungs," Dr. Ahmad says. "There are some factors like genetics and where the patient is, which means it is not 100% protective. Estimates of protective effect vary between 20-70% for protection against TB disease.”
The TB vaccine can also interfere with a particular skin screening test for TB if the vaccination was given recently.
“Since the disease is so rare” Dr. Ahmad adds. We've opted over the years to not mess up our ability to detect known cases," he says.
Who is most at risk?
The youngest and oldest populations are both at high-risk for TB, along with those who have been around an infected person.
"This is a disease of overcrowding and poor hygiene," Dr. Ahmad says. "It's been around in humans forever. It's transmitted from person to person via the respiratory route."
People with a weakened immune system are also at risk of developing the disease if they are exposed to it. This could include people with diabetes or HIV. Patients who take medications that suppress the immune system – including patients with autoimmune diseases, transplants, and cancer patients are also more at risk. Patients with prior history of lung disease/damage are also at risk.
Dr. Ahmad adds that homeless shelters, correctional facilities and those with substance use disorder are also at-risk for becoming infected with TB.
How TB is treated in the hospital
Dr. Ahmad says care teams use "airborne precautions," including rooms with special ventilation systems in the hospital. TB patients are kept in these "negative pressure rooms" away from others to prevent the spread of infection. The entire care team wears personal protective equipment, including gowns, gloves and N95 masks, while in the room with the patient.
The medication regimen for TB patients is intense. Traditionally, four different antibiotics will be used for the first two months. "Once we have the antibiotic susceptibility results, and everything looks good, we can drop the patient down to just two antibiotics until we reach six months’ duration of treatment for lung TB," Dr. Ahmad says. If TB spreads outside the lungs, treatment can be even longer.
While therapy can be initiated at the hospital, the patient does not have to stay in the hospital for the whole duration of treatment. Once a care plan has been formulated, it is coordinated with the local health department to ensure there are no gaps in care during the transition, the patient continues to have access to the medication, and they do not pose a public health risk to others. The aim is to limit the patient's interaction with others inside and outside the hospital until they are deemed non-infectious, meaning they cannot transmit the infection. The hospital infection control/prevention team and county health department also remain vigilant, ensuring any potential exposures are traced and screened.
