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12 Points of Tuberculosis (TB) Patient Education

TransmissionofTB

TBisadiseasecausedbytheTBgerm.Thediseaseismainlyinthelungs(pulmonary
TB),butthegermcantraveltootherpartsofthebody(extrapulmonaryTB)and
sometimescanbeinmultiplepartsofthebody(militaryordisseminatedTB).
TBisspreadwhensomeonewhoissickwithTBinhis/herlungscoughs,sneezes,talksor
singsandspraystheTBgermintotheair.Whensomeonespendstimewiththatperson,
he/shecanbreatheintheTBgermandbecomeinfected.Usuallyhavetobearoundan
infectiouspersonforalongtimeandsharethesameairspace
Infectiousnessdecreasesafterthepersonhasbeenontreatmentforawhile
CanNOTgetTBbysharingdrinks,toysorpersonalitems
WhenapersonisexposedtotheTBgermandbecomesinfected,thepersonsown
immunesystemwillusuallybuildawallaroundtheTBgerms,keepingthemfrom
growingandmultiplying.ThisiscalledlatentTBinfectionorLTBI.Thegermscan
remaindormantinapersonsbodythroughouthis/herlifetime.
ATBskintest(Mantoux)canbegiventoseeifsomeonehasbeeninfectedwiththeTB
germ.Iftheskintestispositive,achestXrayandsputumtestwillbedonetomake
surethepersondoesnothaveTBdisease.TheskintestonlydeterminesTBinfection.A
positiveresultdoesnotnecessarilymeanthepersonhasTBdisease.
Once TB disease is ruled out, the doctor may prescribe a preventive medicine called
Isoniazid(INH).INHcanpreventTBbykillingtheTBgerms.

DifferencesbetweenLTBI&ActiveTBdisease

Bothcanhaveapositiveskintest
LTBIhasnosymptoms&thepersonfeelsfine,butinactiveTBdisease,theperson
usuallyfeelssickandhassymptomsofTB
LTBIthechestxrayisnormal,inactiveTBdisease,itisusuallyabnormal
LTBIcanNOTtransmitthegermstoothers,inactiveTBdisease,thegermscanbe
transmittedtootherpeople
Bothcanbetreated

ProgressionofLTBItoActiveTB

ApersonwhoisexposedandbecomesinfectedwithTBhasa10%chanceofdeveloping
activeTBdisease.Themostcriticaltimeperiodisthefirst2yearsafterbecoming
infected.
Whenthebodysimmunesystemisweak,thewallaroundtheTBgermsbeginstobreak
down.TheTBgermswakeupandstartmultiplying,growingandattackingthebody,
makingthepersonfeelsickanddevelopsymptoms.
AnyonecangetTB,butsomepeopleareatgreaterriskthanothers.Theseinclude:
o PersonslivingwithsomeonewhohasactiveTBofthelungs

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o Persons who had TB disease in the past but didnt receive or complete their
treatment
o Personswhoareelderly
o Personswithweakenedimmunesystems

Signs&symptomsofdisease

TheearlysignsandsymptomsofTBdevelopslowlyandmaygounnoticedforalong
time.Theseinclude:
o Cough
o Chestpain
o Lossofappetite
o Weightloss
o Tiredness
o Fever/chills/nightsweats
Thesymptomsshouldgetbetterafterthepersonisonmedicationforacoupleof
weeks.Iftheydontoriftheycomebackaftergettingbetter,thenurseorphysician
needstobenotified.

ImportanceofHIVtesting

AllpatientsinTBclinicsshouldbetestedforHIV.ThisincludesTBsuspects,patients,
andcontacts.
PeopleinfectedwithHIV(thevirusthatcausesAIDS)aremorelikelythanuninfected
peopletogetsickwithotherinfectionsanddiseases.Tuberculosis(TB)isoneofthese
diseases.
HIVinfectionweakenstheimmunesystem.Ifapersonsimmunesystemgetsweak,TB
infectioncanactivateandbecomeTBdisease.SomeonewithTBinfectionandHIV
infectionhasaveryhighriskofdevelopingTBdisease.Withouttreatment,thesetwo
infectionscanworktogethertoshortenthelifeofthepersoninfectedwithboth.
HIVinfectionisthemostimportantknownriskfactorforprogressionfromlatentTB
infectiontoTBdisease.ProgressiontoTBdiseaseisoftenrapidamongHIVinfected
personsandcanbedeadly.Inaddition,TBoutbreakscanrapidlyexpandinHIVinfected
patientgroups.

RespiratoryIsolation&useofmasks

Itisimportantforthepatienttoremainathomeonisolation.Asmuchaspossible,
he/sheshouldstayawayfromotherpeopleinthehousebystayinginaseparateroom
orwearingasurgicalmaskwhenleavingtheroom.Separatebedroomsorbedsare
highlyrecommended,ifpossible.Thepatientcannottravel,gotowork,gotoschool,
goshoppingorparticipateinanyotheractivitywherethereiscontactwithother
people.
Thepatientneedstocoverhis/hermouthandnosewithatissuewhencoughingor
sneezing.Thesetissuesshouldbeflushed,burnedorplacedinasealedleakproofbag
beforedisposal.
Thepatientcannotleavehomeexcepttokeepmedicalappointments.He/shemust
wearasurgicalmasktotheclinicanddoctorsoffices.

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Thepatientshouldnotallowanyone,otherthanthoselivingwithhim/herorthose
individualsprovidingcaretohim/her,intothehomeandshouldstayawayfromyoung
children.
Theseisolationinstructionsremainineffectuntilthepatientistoldbythehealth
departmentthathe/shenolongerhastostayinisolation.
Theseisolationinstructionsmaybecomeeffectiveagainafterthepatienthasbeentold
thathe/sheisnolongerinfectiousshouldtheclinicalsituationchange.
Keepdoorsandwindowsopenasmuchaspossible.
DOTvisitswillbeconductedoutdoors,besideopenwindowsandasefficientlyas
possibleinordertoreduceexposuretime.
TheDOTworkerwillwearanN95maskduringthetimethepatientisconsidered
infectious.
Gooutsidetocollectsputumspecimens.TheDOTworkershouldwearanN95mask
anytimesputumisbeingcollected.

Infectiousperiod

TheinfectiousperiodisthetimewhenapatientsickwithactiveTBcanpassthegerms
tootherpeople.
Theinfectiousperiodbegins3monthspriortotheonsetofsymptomsorclinicalsignof
TB.
Theinfectiousperiodcontinuesuntilallofthefollowingcriteriaismet:
1. 3consecutivesmearnegativespecimens
2. Thepatientisonappropriatemedications
3. Thepatientisgettingbetter
Theinfectiousperiodisimportanttodetermineinordertofocusthecontact
investigation

Importanceofchemotherapyasprescribed

HavingTBshouldnotkeepsomeonefromleadinganormallife.WhenTBpatientsare
nolongerinfectiousorfeelingsick,theycandothesamethingstheydidbeforethey
hadTB.Themedicinedoesnotaffectstrength,sexualfunctionortheabilitytowork.If
theTBmedicineistakenasdirected,themedicinewillkillalltheTBgermsandprevent
thepatientfrombecomingsickwithTBagain.
It is necessary to take several different TB medications because there are many TB
germstobekilled.TakingthreetofourdifferentTBmedicationswillstoptheTBgerms
frombecomingresistanttothemedication.
ThemostcommonmedicationsareIsoniazid;Rifampin;Pyrazinamide&Ethambutol.
Thepatientwillusuallytakeseveraltabletsof4differentmedicationseveryday(MF)
forthefirst2months.Thenthepatientmaybeabletotakeseveraltabletsofjust2
medicationstwiceaweekuntiltreatmentiscompleted(another47months).
TBisalmostalwayscurableifthepatientadherestothetreatmentregimenoftaking
severalspecialmedicationsforsixtoninemonths.Themedicationmustbetaken
continuouslyanduninterruptedforthedurationoftreatment.
ThetreatmenttakesthislongbecausetheTBgermsgrowveryslowlyandareslowto
die.ThecombinationofthesemedicationsdeliveredbyDOTcancurethediseaseinless
thanayear.
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Prolongedillness,disabilityorpossibledeathareavoided
RiskofdevelopingMDRTBorXDRTBisdecreased

Sideeffectsandadversemedicationreactions

Sideeffectsofmedicationsarethosethingswhichareanticipatedtohappeninpeopletaking
certainmedications.Mostofthesideeffectsaremanageableanddonotrequirestoppingthe
medication.
Medication
SideEffect
Action
Isoniazid
Dizziness;tingling/numbness
ProactivelyB6isusuallygiven;report
aroundthemouthorinthe
anymildsignsorsymptomstothenurse
extremities
orphysician

GIdistress;nauseawhentakingthe Altertimeofdaypillsaregiven;try
pillsbutfeelsbetterlaterinthe
givingpillswithasmallsnackorfood;
day;
reporttonurseorphysician

Rifampin

Discolorationofbodilyfluids;urine,
sweatortearsmaybeorangeor
reddish

Druginteractions;caninterfere
withbirthcontrolpillsorimplants;
canaltereffectivenessof
methadone

Sunsensitivity;frequentsunburn

Easybruising;slowbloodclotting

Preparethepatienttoseethis;have
him/herswitchtohardcontactlensesor
glassesbecausestainingcanoccurofsoft
contactlenses

Counselpatienttouseanalternativeor
backupmethodofbirthcontrol(e.g.,
copperbearingIUDsuchasParaGard,
condoms,diaphragm)whenrifampinis
prescribed,itreduceseffectiveness
(degreedependingonmethod)of
combinedoralcontraceptives,progestin
onlyoralcontraceptives,levonorgestrel
implants,DepoProvera,patchandring.
Advisecondombackup. Makesure
nurse&physicianareawareofall
medicationsthepatientistaking

Counselpatienttoavoidprolonged
exposuretosun&towearadequate
sunblock

Avoidbruising;donottakeaspirinunless
orderedbyaphysician;tellhealthcare
provideraboutmedicationspriortoany
procedurethatmightcausebleeding

GIdistress;nauseawhentakingthe Altertimeofdaypillsaregiven;try
pillsbutfeelsbetterlaterintheday givingpillswithasmallsnackorfood;
reporttonurseorphysician

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Pyrazinamide

Ethambutol

GIdistress;nauseawhentakingthe Altertimeofdaypillsaregiven;try
pillsbutfeelsbetterlaterinthe
givingpillswithasmallsnackorfood;
day;
reporttonurseorphysician

Jointaches

Coldpacksorheatpacks;reporttonurse
orphysician
Monitor&testeyesmonthly

Cancauseblurredorchanges
vision;changesincolorvision

Adversemedicationreactionsaresideeffectsofmedicationsthataresevereand
warrantstoppingthemedicationstoavoidharmordamagetothepatient.
Medication
AdverseReaction
Action
Isoniazid
Dizziness;tingling/numbnessaroundthe
Stopmedicationifsevereor
mouthorintheextremities
seemstobeworsening;notify

nurseorphysician

Hepatitis:nausea;vomiting;yellowishskinor Stopmedicationandnotify
eyes;abdominalpain;dark,maplesyrupor
nurseorphysician
coffeecoloredurine;abnormalliverfunction
tests;fatigue;fever>3days;flulike
symptoms;lackofappetite
Rifampin
Easybruising;slowbloodclotting
Stopmedicationandnotify

nurseorphysician

Hepatitis:nausea;vomiting;yellowishskinor Stopmedicationandnotify
eyes;abdominalpain;dark,maplesyrupor
nurseorphysician
coffeecoloredurine;abnormalliverfunction
tests;fatigue;fever>3days;flulike
symptoms;lackofappetite
Pyrazinamide Severestomachupset;vomiting;lackof
Stopmedicationandnotify
appetite
nurseorphysician

Hepatitis:nausea;vomiting;yellowishskinor Stopmedicationandnotify
eyes;abdominalpain;dark,maplesyrupor
nurseorphysician
coffeecoloredurine;abnormalliverfunction
tests;fatigue;fever>3days;flulike
symptoms;lackofappetite
Ethambutol
Anychangesinvisionsnoted
Stopmedicationandnotify
nurseorphysician

OtherwarningstotellclientstakingTBmedications
LimitalcoholusewhentakingTBmedication.CombiningalcoholandTB
medicinecancauseliverdamage.
Tellthenurseifothermedicationsarebeingtaken.TBmedicationcan
interferewithcertainprescriptiondrugs.
Reportanycomplaintstothenurse.
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DirectlyObservedTherapy

MostTBpatientsstartfeelingwellafteronlyafewweeksoftreatmentbuttheTBgerms
arestillaliveinthebody
ItisverydangerousforaTBpatienttostoptakingmedicineearlyornottotakeit
regularly.TheTBgermsbegintogrowagainandpatientsmaybecomeinfectiousand
remainsickmuchlonger.
StoppingtreatmenttooearlyortakingtreatmentirregularlycouldcausetheTBgerms
tobecomeresistanttotheTBmedicine.Ifthishappens,newanddifferentmedicines
willbeneededtokilltheTBgerms.Thesenewmedicineshavetobetakenforalonger
timeandusuallyhavemoreserioussideeffects.
DOThelpspreventtheseproblemsbymakingsurethattreatmentiscomplete.

Importanceofregularmedicalassessments

Itisveryimportanttohaveregularcheckupsattheclinicatleastmonthly.
Bloodtestscanbedonetomakesurethemedicationsarenotharmingtheliver.
Chestxraysmaybedonetoseeifthereisimprovement.
Sputumtestswillbedonetoensuremedicationsareworking.Thesputumresultsalso
helpdecidewhenapatientisnolongerinfectiousandcanreturntohis/hernormallife.

Importanceofcontactinvestigation

WhenapatienthasTBdisease,theyaredoingtherightthingbysharingthenamesof
peopletheyspenttimewithwhentheywereabletopassTBgermstoothers(infectious
period).Byhelpingthehealthcareworkerdoacontactinvestigation,theyarehelping
theirfamilyandfriendsstaywell.Andtheyarehelpingtomakesuretheircommunity
stayshealthy.
Thehealthcareworkerwillaskforthenamesofcontacts,peoplethepatientspenttime
withbeforegettingtreatmentwhentheTBgermscouldbepassedontoothers.
Thehealthcareworkerwillcallorvisitpeopletoletthemknowtheyshouldbetested
forTB.Togetherthehealthcareworkerandpatientmakesalistofallcontacts.Contacts
arefamilymembers,friends,neighbors,coworkers,andotherswhospenttimewith
thepatientwhentheyweresick.
Givethenamesofthecontactstoyourhealthcareworker.Dontletbeingembarrassed
keepyoufromlistingpeopleyoumayhavegivenTBgerms.Thinkofhowyouare
helpingthosearoundyoustaywell.Protectyourfamilyandfriends.
Questionsthehealthcareworkermayaskthepatient:
Howlonghaveyoubeencoughing?Whendidyoufirstfeelsick?
Wheredidyouspendtimewhenyouwerefeelingsickandcoughing?Where
didyoulive?Didyougotoschool?Wheredidyouhangoutwhenyouwerenot
athomeorworking?
Whoarethefamilymembers,friends,neighbors,andcoworkersyouspent
timewithwhilecoughing?
Thehealthcareworkerwilldecidewhichpeopleneedtobecontactedbasedonthe
informationgiven.Itisimportantforthehealthcareworkertobeintouchwithpeople
whomayhavebeengivenTBgerms.Thesefriends,familymembers,coworkers,or
classmatesmayhaveTBinfection.Thismeanstheyhavedormant(sleeping)TBgermsin
theirbody,sotheymaynotfeelsick.IftheygettreatmentforTBinfection,theywont

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getsickwithTBdisease.IftheyalreadyhaveTBdisease,theywillneedtreatmentright
away.
SomepeoplewithTBdiseaseareafraidtheywilllosetheirjobifotherslearnthey
passedTBgermstopeopleatwork.Othersmaybeworriedtheirfriendsandfamilywill
rejectthem.Whatyouneedtoknowisthattheinformationyousharewiththe
healthcareworkeriskeptprivateandpersonal.
Thehealthcareworkerwillcallorvisitthepeoplenamed.He/shemaytalktoagroupof
peopleatthepatientswork,school,orplaceofworship.Thehealthcareworkerwill
suggestthecontactgetaTBskintestandwillprovideinformationonwheretoget
tested.

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