(/) NEWSLETTERS

Search Top Doctors.

Learn More
Find Trusted Care.

Advertisement

TUBERCULOSIS(/TUBERCULOSIS/GUIDE/)
If you consent, we and our
partners can store and
Latent Tuberculosis Infection vs. Active TB Disease:
access personal information
on your device to provide a

What’s the Di!erence?

more personalised browsing
experience. This is
accomplished through
After an initial
processing infection,
personal data the bacteria that causes TB often becomes dormant in the body. But if left
collected from browsing data
untreated, it can become active and infectious.
stored in cookies. Personal
information may include
health By
andRena Goldman
medical (/authors/rena-goldman/)
condition
Medically
interest. You can Reviewed by Justin Laube, MD (/authors/justin-laube/)
provide/withdraw consent at
Reviewed: March 7, 2023
any time by clicking on the
AdChoices button. Our
Privacy Policy
(https://www.everydayhealth.com/privacyterms/)
Medically Reviewed

Accept All
Advertisement close
protected by reCAPTCHA
More Options
Sign Me Up -
Privacy - Terms

The most common kind of TB is pulmonary tuberculosis, which aLects the lungs. A latent TB infection (left) can have no
symptoms, while with active TB disease (right), the bacteria multiply in the body, becoming contagious.
iStock
Tuberculosis (TB) is unlike most bacterial infections in that it usually doesn’t cause symptoms
immediately. Even when it starts to make you sick, symptoms come on very gradually and can
often be confused with other conditions.

Most commonly, tuberculosis (https://www.everydayhealth.com/tuberculosis/guide/) goes

through three stages:

Primary TB infection

Latent TB infection

Active TB disease

Millions of people carry latent TB bacteria but never develop active tuberculosis
(/tuberculosis/guide/). In fact, it’s estimated that as many as 13 million people in the United States
have a latent TB infection. (1 (https://www.cdc.gov/tb/topic/basics/default.htm),2
(https://www.cdc.gov/tb/topic/basics/tbinfectiondisease.htm),3
(https://www.cdc.gov/tb/statistics/ltbi.htm))

About 30 percent of people who get exposed to Mycobacterium tuberculosis will develop latent
TB, and if that’s left untreated, around 5 to 10 percent of those people could end up getting active
tuberculosis disease at some point in their lifetime. The number is much higher for people
infected with HIV (/hiv/guide/transmission/). (3,4
(https://jamanetwork.com/journals/jama/fullarticle/2547762))

Tuberculosis is more likely to enter the active phase in people who have acquired the infection
recently (in the past two years). It’s also more likely to be active among those whose immune
systems are weakened.
In some literature, latent tuberculosis may also be referred to as “tuberculosis infection,” while
active tuberculosis is also known as “tuberculosis disease,” as noted in a 2021 journal article
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8650795/).

Primary or Initial Tuberculosis Infection

Infection with M. tuberculosis begins when a person breathes in airborne bacteria.

This is more likely to happen if a person is in close contact with one or more people infected with
active TB who are coughing or sneezing.

In many people, any inhaled bacteria are killed immediately by the immune system. In others, the
TB bacteria are surrounded by macrophages, a type of white blood cell, and enter a dormant
state. This is called latent infection, and this stage can last for years or even for life. But in certain
populations, including infants, the elderly, those with recently acquired TB infection, and people
with weakened immune systems, symptoms of active tuberculosis may start within weeks of
primary infection. (2)

MOST HELPFUL

Everything You Need to Know About the Superbug MRSA

(https://www.everydayhealth.com/staph-infection/guide/mrsa/)

Living With Tuberculosis: How to Avoid Complications

(https://www.everydayhealth.com/tuberculosis/living-with-complications/)

What Is Staph Infection? Symptoms, Causes, Diagnosis, Treatment, and

Prevention (https://www.everydayhealth.com/staph-infection/guide/)

What It Means to Have a Latent TB Infection

While a person with latent TB has no symptoms and is not infectious, a tuberculin skin test or
blood test for TB — called the interferon-gamma release assay, or IGRA — will be positive,
showing that the person has not only been exposed to tuberculosis but has a latent (or “occult”)
infection with the bacteria that causes tuberculosis. (2,5 (https://www.mayoclinic.org/diseases-
conditions/tuberculosis/symptoms-causes/syc-20351250))
“You have a ticking bomb waiting for your immune system to get weak,” says Hayan Yacoub, MD
(https://www.austinregionalclinic.com/doctors/hayan-yacoub), internal medicine practitioner at
Austin Regional Clinic in Texas. Latent TB can also complicate treatment for potential health issues
that happen later in life, he says. That’s why it’s important to identify and treat latent TB.

If a latent infection is discovered, treatment is recommended in certain individuals at high risk to

prevent that person from developing active disease and to prevent the further spread of
tuberculosis.

People at high risk of TB (/tuberculosis/guide/risk-factors-causes-prevention/) infection (such as

those who work in hospitals) may be screened, sometimes annually, for latent infection.

Who Should Get Tested for Latent Tuberculosis?

In the United States, there isn’t a need to test everyone for latent TB because it’s unlikely most
people will come in contact with someone who has the active disease.

“The average person doesn’t get exposed to TB,” says Lee Reichman, MD, MPH
(https://globaltb.njms.rutgers.edu/educationalmaterials/newsletter/Summer%202018/limelight.php),
the founding executive director at the Rutgers Global Tuberculosis Institute in Newark, New
Jersey. “For example, if you work in publishing and just go to work and go home, we don’t test you
because [exposure] is unlikely.”

Screening for latent TB is done based on your risk factors. The following populations should
generally be screened: (6 (https://www.cdc.gov/tb/topic/treatment/decideltbi.htm),7
(https://www.cdc.gov/tb/topic/testing/whobetested.htm))

People who have recently come to the United States from a country with a high rate of
 tuberculosis

People whose work or living arrangement puts them in contact with people who have active
tuberculosis

People who struggle with injected drug use

Children under age 4 or children and adolescents exposed to adults in high-risk categories

People with other diseases that increase the risk of developing active TB once infected, such as
insulin-requiring diabetes, end-stage renal disease, prior gastrectomy, or HIV infection

People who are taking drugs that block tumor necrosis factor alpha (TNF-alpha), such as
inniximab (Remicade) (//www.everydayhealth.com/drugs/remicade), adalimumab (Humira)
(//www.everydayhealth.com/drugs/humira), or etanercept (Enbrel)
(//www.everydayhealth.com/drugs/enbrel), as well as those taking steroid medications at
higher doses or over a longer period of time

People who plan to start chemotherapy for cancer or an immunosuppressive drug — to treat an
autoimmune condition, for example — should also be screened for latent tuberculosis.

The risk of a latent TB infection becoming active is much higher in people infected with HIV than
those without HIV. (8 (https://www.ncbi.nlm.nih.gov/books/NBK513246/))

What Does Treatment for Latent TB Involve?

Treatment for latent TB involves less medication and a shorter regimen than treatment of active
TB, says Alexea M. Gakney-Adams, MD
(https://www.stonybrookmedicine.edu/LGBTQ/patientcare/our_providers/gakney-adams), an
internist with subspecialty training in infectious disease at Stony Brook Medicine in Stony Brook,
New York.
The CDC and the National Tuberculosis Controllers Association (NTCA) now recommend a short-
course of a rifamycin (Aemcolo) (https://www.everydayhealth.com/drugs/rifamycin)-based three-
or four-month latent TB infection treatment. The previous recommendation was a six- or nine-
month isoniazid (Nydrazid) (https://www.everydayhealth.com/drugs/isoniazid) single-drug
therapy. Some of the regimens your infectious disease doctor may recommend are:

EDITOR'S PICKS

(https://www.everydayhealth.com/healthy-home/clorox-recalls-37-million-pine-sol-
bottles-over-bacteria-concern/)

Clorox Recalls 37 Million Pine-Sol Bottles Over Bacteria Concern

(https://www.everydayhealth.com/healthy-home/clorox-recalls-37-
million-pine-sol-bottles-over-bacteria-concern/)

Three months of once-weekly isoniazid (/drugs/isoniazid) plus rifapentine (Priftin)

(https://www.everydayhealth.com/drugs/rifapentine), called 3HP

Four months of daily rifampin (Rifadin) (https://www.everydayhealth.com/drugs/rifampin),

called 4R

Three months of daily isoniazid plus rifampin (/drugs/rifampin), called 3HR (5,9
(https://www.cdc.gov/tb/topic/treatment/ltbi.htm))

What It Means to Have Active Tuberculosis Disease

In active tuberculosis, the bacteria multiply in the body, causing noticeable symptoms. This is also
when the disease can spread to others. The dikerence between active and latent TB is the amount
of organisms in the body, according to Dr. Reichman.

The most common kind of tuberculosis, pulmonary tuberculosis, typically causes the following
symptoms: (5,10 (https://www.lung.org/lung-health-diseases/lung-disease-
lookup/tuberculosis/symptoms-diagnosis))

Breathing dioculty (/breathing-dioculty/guide/)

Chest pain

Coughing, sometimes with phlegm (/cold-nu/everything-you-ever-wondered-about-mucus-and-

phlegm.aspx)
 Fatigue

Fever

Night sweats

Weakness

Weight loss

Wheezing

In addition to the lungs, tuberculosis can akect other parts of the body, including the lymph
nodes, other internal organs, bones and joints, or the brain. This form of the disease, called
extrapulmonary tuberculosis, also causes fatigue, fever, night sweats, weakness, and weight loss,
and it may also cause other symptoms depending on what body parts are akected.

Active TB is curable, but the disease can be deadly if left untreated. About 45 percent of people
not infected with HIV, and almost all HIV-positive people, will die from TB without proper
treatment. (11 (https://www.who.int/news-room/fact-sheets/detail/tuberculosis))

Tuberculosis is spread through the air, which means you can only get it by breathing
contaminated air. If someone who is actively sick talks, coughs, sneezes, or speaks, they can
spread TB. People with active TB can infect 10 to 15 other people they come into regular close
contact with in the course of a year. (11)

The reality is that if someone does have active TB, they’re breathing bacteria out into the air, and
anyone can pick them up, says Dr. Gakney-Adams. “You’re most likely to spread it to your
household, but it can depnitely spread elsewhere.”

MOST RECENT
Tuberculosis Vaccine Shows Promise Fighting Top Infectious Disease Killer
(https://www.everydayhealth.com/tuberculosis/tuberculosis-vaccine-shows-
promise-fighting-top-infectious-disease-killer/)

When Tuberculosis Infection Comes Back

(https://www.everydayhealth.com/tuberculosis/when-tuberculosis-infection-
comes-back.aspx)

The Right Diet to Beat Tuberculosis

(https://www.everydayhealth.com/tuberculosis/the-right-diet-to-beat-
tuberculosis.aspx)

Who Should Get Tested for Active TB Disease?

If you pnd out you’ve been exposed to someone with TB, you need to be screened, says Gakney-
Adams. If a prst screening was negative, she recommends going in for testing again, especially if
you experience any respiratory symptoms.

Screening is recommended for anyone with the following symptoms of active TB: (7)

Coughing that lasts for three weeks or longer

Weight loss that can’t be explained

Coughing up blood

Chest pain

Loss of appetite

Night sweats

Fever

Fatigue

According to Gakney-Adams, who has treated several cases of both latent and active TB, night
sweats is a very common symptom in active TB disease. It’s usually pretty dramatic, she says, like
sweating so heavily that a person needs to get up and change sheets and clothes.
What Does Treatment for Active TB Involve?

The treatment for any type of active tuberculosis is long-term administration of antibiotics.

Because there are so many drug-resistant strains of TB, people with active disease must take
more than one antibiotic (/antibiotics/guide/) to ensure that all of the bacteria are killed. In
addition, because tuberculosis bacteria grow slowly, it’s necessary to take the antibiotics for four
to nine months typically. (5,12 (https://www.cdc.gov/tb/topic/treatment/tbdisease.htm))

The two most common regimens for active TB disease, where TB is not drug resistant, are:

The four-month TB treatment regimen, which consists of a high-dose daily rifapentine

(/drugs/rifapentine) (Priftin) with moxinoxacin (Avelox)
(https://www.everydayhealth.com/drugs/avelox), isoniazid (Nydrazid), and pyrazinamide
(https://www.everydayhealth.com/drugs/pyrazinamide)

The six- to nine-month RIPE TB treatment regimens, which consist of rifampin (Rifadin),
isoniazid (Nydrazid), pyrazinamide (/drugs/pyrazinamide), and ethambutol (Myambutol)
(https://www.everydayhealth.com/drugs/ethambutol)

One major concern in the treatment of active TB is making sure people continue to take the
medication even after symptoms have gone away. People typically need to take medication for
many months, so they often get tired of it and forget, says Robert Amler, MD
(https://www.nymc.edu/faculty/faculty-proples/by-name/amler-robert/), dean and professor of
public health at New York Medical College in Valhalla, New York.
Stopping the drugs early can cause the TB bacteria to return, and that bacteria may not respond
to drugs that worked the prst time. This is called drug-resistant TB, and it’s much harder to treat.

To make sure people with active TB pnish the full medication schedule, directly observed therapy,
or DOT, is used. In DOT, a trained healthcare worker provides each dose of medication, watches
the patient swallow it, and documents that the medication has been taken.

Resources We Love
Centers for Disease Control and Prevention (https://www.cdc.gov/)

World Health Organization (https://www.who.int/news-room/fact-sheets/detail/tuberculosis)

American Lung Association (https://www.lung.org/lung-health-diseases/lung-disease-

lookup/tuberculosis)

Editorial Sources and Fact-Checking