Tuberculosis (TB) is a bacterial infection caused by a germ called

Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can also damage other parts of the body. TB spreads through the air when a person with TB of the lungs or throat coughs, sneezes or talks. If you have been exposed, you should go to your doctor for tests. You are more likely to get TB if you have a weak immune system. Symptoms of TB in the lungs may include
• • • • • •

A bad cough that lasts 3 weeks or longer Weight loss Coughing up blood or mucus Weakness or fatigue Fever and chills Night sweats

If not treated properly, TB can be deadly. You can usually cure active TB by taking several medicines for a long period of time. People with latent TB can take medicine so that they do not develop active TB.

What is tuberculosis?
Tuberculosis (TB) is an infectious disease caused by bacteria whose scientific name is Mycobacterium tuberculosis. It was first isolated in 1882 by a German physician named Robert Koch who received the Nobel Prize for this discovery. TB most commonly affects the lungs but also can involve almost any organ of the body. Many years ago, this disease was referred to as "consumption" because without effective treatment, these patients often would waste away. Today, of course, tuberculosis usually can be treated successfully with antibiotics. There is also a group of organisms referred to as atypical tuberculosis. These involve other types of bacteria that are in the Mycobacterium family. Often, these organisms do not cause disease and are referred to as "colonizers" because they simply live alongside other bacteria in our bodies without causing damage. At times, these bacteria can cause an infection that is sometimes clinically like typical tuberculosis. When these atypical mycobacteria cause infection, they are often very difficult to cure. Often, drug therapy for these organisms must be administered for one and a half to two years and requires multiple medications.

How does a person get TB?
A person can become infected with tuberculosis bacteria when he or she inhales minute particles of infected sputum from the air. The bacteria get into the air when someone who has a tuberculosis lung infection coughs, sneezes, shouts, or spits (which is common in some cultures). People who are nearby can then possibly breathe the bacteria into their lungs. You don't get TB by just touching the clothes or shaking the hands of someone who is infected. Tuberculosis is spread (transmitted) primarily from person to person by breathing infected air during close contact. There is a form of atypical tuberculosis, however, that is transmitted by drinking unpasteurized milk. Related bacteria, called Mycobacterium bovis, cause this form of TB. Previously, this type of bacteria was a major cause of TB in children, but it rarely causes TB now since most milk is pasteurized (undergoes a heating process that kills the bacteria).

What happens to the body when a person gets TB?
When the inhaled tuberculosis bacteria enter the lungs, they can multiply and cause a local lung infection (pneumonia). The local lymph nodes associated with the lungs may also become involved with the infection and usually become enlarged. The hilar lymph nodes (the lymph nodes adjacent to the heart in the central part of the chest) are often involved.

The body's immune (defense) system. including • • • • • • • people who live with individuals who have an active TB infection. There is no strong evidence for a genetically determined (inherited) susceptibility for TB. referred to as reactivation tuberculosis or secondary TB. foreign-born people from countries that have a high prevalence of TB. the bacteria will reproduce (become active or reactivate) in the lungs and spread elsewhere in the body. If these scars do not show any evidence of calcium on X-ray. can fight off the infection and stop the bacteria from spreading. then further symptoms can include coughing. and night sweats. or certain medications such as cortisone. and skin tests. chest pain. The body's immune system. health-care workers. Tuberculosis that occurs after initial exposure to the bacteria is often referred to as primary TB.000 new cases of TB occur each year. poor or homeless people. The scar tissue and lymph nodes may eventually harden. and HIV infection (the AIDS virus). For example. the immune system can make the lung infection inactive (dormant). including chest X-rays. coughing up of sputum (material from the lungs) and/or blood. If the infection spreads beyond the lungs. it is estimated that 10-15 million people are infected with the TB bacteria and 22. How common is TB. the symptoms will depend upon the organs involved. Anyone can get TB. Thus. can stop the bacteria from continuing to reproduce. however. TB can spread to other parts of the body. the immune system can be weakened by old age. the development of another infection or a cancer. like stone.In addition. due to the process of calcification of the scars (deposition of calcium from the bloodstream in the scar tissue). alcoholics and intravenous drug users. bone. however. TB infection usually occurs initially in the upper part (lobe) of the lungs. These scars often appear on X-rays and imaging studies like round marbles and are referred to as a granuloma. Such an individual typically has no symptoms and cannot spread TB to other people. the body's immune system becomes weakened. but certain people are at higher risk. nursing-home residents and prison inmates. analysis of sputum. The kidneys. the chest X-rays can reveal evidence of active . certain cancers. weight loss. The breakthrough of bacteria can result in a recurrence of the pneumonia and a spread of TB to other locations in the body. then the infection is contained in an inactive state. if the body's immune system cannot contain the TB bacteria. however. If the infection in the lung worsens. The immune system does so ultimately by forming scar tissue around the TB bacteria and isolating it from the rest of the body. On the other hand. Sometimes. How does a doctor diagnose tuberculosis? TB can be diagnosed in several different ways. and who gets it? Over 8 million new cases of TB occur each year worldwide. The usual symptoms that occur with an active TB infection are a generalized tiredness or weakness. and the TB bacteria break through the scar tissue and can cause active disease. fever. In the United States. they can be difficult to distinguish from cancer. It may take many months from the time the infection initially gets into the lungs until symptoms develop. or certain medications used to treat arthritis or inflammatory bowel disease. If the body is able to form scar tissue (fibrosis) around the TB bacteria. people with diabetes. and lining of the brain and spinal cord (meninges) are the most common sites affected by the spread of TB beyond the lungs. anticancer drugs. and shortness of breath. What are the symptoms of tuberculosis? As previously mentioned. Sometimes.

then no reaction will occur at the site of the injection (a negative skin test). Bacteria of the Mycobacterium family. This vaccination is believed to be important in parts of the world where TB is quite common. and no symptoms most likely has only a few TB germs in an inactive state and is not contagious. tuberculosis can still occur in an adult exposed to the tuberculosis bacteria. If the infection with tuberculosis has occurred recently. After a period of time. This test is extremely sensitive (it detects minute amounts of the bacteria) and specific (it detects only the TB bacteria). How is tuberculosis treated? A person with a positive skin test. future PPD and Tine skin tests remain positive and can cause some confusion when trying to diagnose TB. When BCG has been administered. This test involves mixing the patient's blood with substances that produce a TB-like immune response. The organism can take up to six weeks to grow in culture in the microbiology lab. stain positive with special dyes and are referred to as acid-fast bacteria (AFB). This determination requires the chest X-rays and/or sputum analysis (smear and culture) in the laboratory. When only the skin test is positive. The reason for a false-negative test with a recent infection is that it usually takes two to 10 weeks after the time of infection with tuberculosis before the skin test becomes positive. is a vaccine given throughout many parts of the world. a protein produced by the body to defend against an infection. Nevertheless. but with the proper clinical information can help distinguish a real TB infection from a positive reaction on the test due to a prior BCG vaccine. also known as BCG. such as cortisone or anticancer drugs. A special test to diagnose TB called the PCR (polymerase chain reaction) detects the genetic material of the bacteria. the immune cells. It is derived from an atypical Mycobacterium but offers some protection from developing active tuberculosis. One can usually get results from the PCR test within a few days. occurs about 48-72 hours after the injection. or evidence of prior TB is present on chest X-rays. A sample of the sputum also is usually taken and grown (cultured) in special incubators so that the tuberculosis bacteria can subsequently be identified as tuberculosis or atypical tuberculosis. the disease is referred to as "latent tuberculosis. The skin test can also be falsely negative if a person's immune system is weakened or deficient due to another illness such as AIDS or cancer. the X-rays may show scarring (fibrosis) or hardening (calcification) in the lungs. Remember. a normal chest X-ray. These so-called tuberculin skin tests include the Tine test and the Mantoux test. if infected with TB. like most. This is not the case in the United States. is not perfect. Several types of skin tests are used to screen for TB infection. Other times. treatment with an antibiotic may be recommended for this person to prevent the TB from turning into an active infection." This contrasts with active TB as described above. a small amount of purified extract from dead tuberculosis bacteria is injected under the skin. also known as the PPD (purified protein derivative) test. It is also important to realize that even with a BCG vaccine in childhood. In each of these tests. This test. suggesting that the TB is contained and inactive. The antibiotic used for this purpose is called isoniazid . Examination of the sputum on a slide (smear) under the microscope can show the presence of the tuberculosis-like bacteria. especially in infants and children. under symptoms. however. a raised and reddened area will occur around the site of the test injection. If a person is infected with tuberculosis. that the TB skin test cannot determine whether the disease is active or not. A new blood test is now available that can help distinguish between a prior BCG vaccine and a positive PPD due to TB infection. however. Is there a vaccine against tuberculosis? Bacille Calmette Guérin. or while taking medications that can suppress the immune response. a positive skin test. produce interferon-gamma. which calls into question the real utility and effectiveness of this vaccination. the skin test can be falsely negative. This reaction. including atypical mycobacteria. however. If a person is not infected with TB.tuberculosis pneumonia.

The World Health Organization (WHO) recommends improving basic TB care to prevent emergence of resistance and the development of proper laboratories for detection of resistant cases. if a person with a positive skin test does not take INH. Also. When drug-resistant cases are found. ethambutol (Myambutol). Those individuals who have been exposed to a person with TB. may be used as well. poorly formulated medications. A person with a positive skin test along with an abnormal chest X-ray and sputum evidencing TB bacteria has active TB and is contagious. the liver damage (INH hepatitis) can even be fatal. These bacteria are also resistant to three or more of the secondline treatment drugs. Four drugs are often taken for the first two months of therapy to help kill any potentially resistant strains of bacteria. This can be avoided by taking vitamin B6 (pyridoxine). and this is often prescribed along with INH. and the individual can feel tired or irritable. Rifampin (Rifadin). Streptomycin. The presence of INH-like substances in the cough syrups in that part of the world may play a role in causing the INH resistance. prompt. early diagnosis is important. or suspect that they have been.(INH). such as a cough. Treatment usually lasts for many months and sometimes for years. surgery for TB is unusual. Another side effect of INH is a decreased sensation in the extremities referred to as a peripheral neuropathy. Preventing XDR-TB from spreading is essential. Very rarely. The side effects occur infrequently. It is important therefore. If taken for six to 12 months. active TB usually is accompanied by symptoms. As already mentioned. Liver damage from isoniazid is a rare occurrence and typically reverses once the drug is stopped. and pyrazinamide are the drugs commonly used to treat active TB in conjunction with isoniazid (INH). however. Indeed. For example. Then the number is usually reduced to two drugs for the remainder of the treatment based on drug sensitivity testing that is usually available by this time in the course. weight loss. What is drug-resistant TB? Drug-resistant TB (TB that does not respond to drug treatment) has become a very serious problem in recent years in certain populations. However. Therefore. INH-resistant TB is seen among patients from Southeast Asia. and fatigue. Surgery on the lungs may be indicated to help cure TB when medication has failed. Without treatment. a drug that is given by injection. Taking isoniazid can be inadvisable (contraindicated) during pregnancy or for those suffering from alcoholism or liver disease. Drug-resistant cases are also often seen in prison populations. especially in older people. inappropriate dosing or prescribing of medication. In fact. but a rash can develop. In some locations. Treatment with appropriate antibiotics will usually cure the TB. and/or an inadequate supply of medication. INH and Rifampin. but in this day and age. This can result from poor patient compliance. particularly when the disease is extensive and/or the patients do not take their oral medications reliably (termed "poor compliance"). for the doctor to monitor a patient's liver by periodically ordering blood tests called "liver function tests" during the course of INH therapy. it will prevent the TB from becoming active in the future. Multidrug-resistant tuberculosis (MDR-TB) refers to organisms that are resistant to at least two of the first-line drugs. isoniazid can have side effects. should be examined by a doctor for signs of TB and screened with a TB skin test. the failure of a patient to take the medications as prescribed is the most important cause of failure to cure the TB infection. there is a 5%-10% lifelong risk that the TB will become active. fever. Successful treatment of TB is dependent largely on the compliance of the patient. the health department demands direct monitoring of patient compliance with therapy. This will prevent further . XDR-TB is seen throughout the world but is most frequently seen in the countries of the former Soviet Union and Asia. Active TB is treated with a combination of medications along with isoniazid. however. extensively (extremely) drug resistant tuberculosis (XDR-TB) has emerged. More recently. appropriate treatment is required. the major reason for the development of resistance is poorly managed TB care. tuberculosis can be a lethal infection.

as yet unsolved. usually successfully. Africa. With the increasing HIV epidemic in Africa. and night sweats. weight loss. TB can remain in an inactive (dormant) state for years without causing symptoms or spreading to other people. and unavailable therapy are key reasons for the development of drug-resistant TB. and PCR tests to detect the genetic material of the causative bacteria. the emergence of HIV changed the whole picture. including rifampin. The risk factors for acquiring TB include close-contact situations. Inactive tuberculosis may be treated with an antibiotic. Poor patient compliance. a tremendous increase in the frequency (incidence) of TB occurred in the '80s and throughout the '90s. and in prison populations. caused by bacteria called Mycobacterium tuberculosis. The most common symptoms of TB are fatigue. pyrazinamide. with INH in combination with one or more of several drugs. cancer. however. to prevent the TB infection from becoming active. and public-health measures by the year 2000. especially in Southeast Asia. lack of detection of resistant strains. When the immune system of a patient with dormant TB is weakened. What's in the future for TB? Conceivably. TB could have been eliminated by effective treatment. chest X-rays. diabetes. and streptomycin. health-care workers). vaccinations. both sensitive and resistant strains. and HIV) and occupations (for example. alcohol and IV drug abuse. isoniazid (INH). sputum analysis (smear and culture). control of HIV in the future will check this resurgence of tuberculosis. should substantially decrease the frequency of TB. Control of HIV in the future. coughing. public-health problem. ethambutol. serious concerns are being raised about the development of MDR-TB and XDR-TB in this population. Because of HIV. Collaboration of HIV and TB care will also help limit the spread of tuberculosis. primarily in the lungs (a pneumonia). It is spread usually from person to person by breathing infected air during close contact. Active TB is treated. Hopefully. Drug-resistant TB is a serious. the countries of the former Soviet Union. However. Tuberculosis At A Glance • • • • • • • • • • Tuberculosis (TB) is an infection. and certain diseases (for example. fever. the TB can become active (reactivate) and cause infection in the lungs or other parts of the body.transmission. The occurrence of HIV has been responsible for an increased frequency of tuberculosis. . The diagnosis of TB involves skin tests. This increase in TB happened because suppression of the body's immune (defense) system by HIV allowed TB to occur as a socalled opportunistic infection.