TUBERCULOSIS

TUBERCULOSIS

Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal.

How TB Spreads:

TB is spread through the air from one person to another. The TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected.

TB is NOT spread by:

* Shaking someone hand

* Sharing food or drink

* Touching bed linens or toilet seats

* Sharing tooth brushes

* Kissing

Latent TB Infection & TB Disease.

Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection & TB Disease.

Latent TB Infection

TB bacteria can live in the body without making you sick. This is called latent TB infection. In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. People with latent TB infection do not feel sick and they do not have any symptoms. People with latent TB infection are not infectious and cannot spread TB bacteria to others. However, if TB bacteria become active in the body and multiply, the person will go from having latent TB infection to being sick with TB disease.

TB Disease

TB bacteria become active if the immune system can’t stop them from growing. When TB bacteria are active, this is called TB disease. People with TB disease are sick. They may also be able to spread the bacteria to people they spend time with everyday.

Many people who have latent TB infection never develop TB disease. Some people develop TB disease soon after becoming infected (within weeks) before their immune system can fight the TB bacteria. Other people may get sick years later when their immune system becomes weak for another reason. For people whose immune systems are weak, especially those with HIV infection, the risk of developing TB disease is much higher than for people with normal immune systems.

TB Symptoms

* a bad cough that lasts 3 weeks or longer

* pain in the chest

* coughing up blood or sputum

* weakness or fatigue

* weight loss

* no appetite

* chills

* fever

* sweating at night

TB Risk Factors

Once a person is infected with the TB bacteria, the chance of developing TB disease is higher if the person:

* has HIV infection;

* has been recently infected with TB bacteria;

* has other health problems, like diabetes, that make it hard for the body to fight bacteria;

* abuses alcohol or uses illegal drugs;

* was not treated correctly for TB infection in the past

Testing for TB Infection

There are two kinds of tests that are used to detect TB bacteria in the body: the TB skin and the TB blood tests. These tests can be given by a health care provider or local health department. If you have a positive reaction to either of the tests, you will be given other tests to see if you have the latent TB infection or TB disease.

Exposure to TB

If you think you have been exposed to someone with TB disease, contact your health care provider or local health department to see if you should be tested for TB infection. Be sure to tell the doctor or nurse when you spent time with the person who has TB disease.

Treatment for Latent TB Infection

If you have latent TB infection but not TB disease, your health care provider may want you to be treated to keep you from developing TB disease. Treatment of latent TB infection reduces the risk that TB infection will progress to TB disease. Treatment of latent TB infection is essential to controlling and eliminating TB in the United States. The decision about taking treatment for latent TB infection will be based on your chances of developing TB disease.

Treatment for TB Disease

TB disease can be treated by taking several drugs, usually for 6 to 9 months. It is very important to finish the medicine and take the drugs exactly as prescribed. If you stop taking the drugs too soon, you can become sick again. If you do not take the drugs correctly, the germs that are still alive may become resistant to those drugs. TB that’s resistant to drugs is harder and more expensive to treat.

Fundamentals of TB Infection Control

An effective TB infection control program requires early identification, isolation, and effective treatment of persons who have active TB. The primary emphasis of the TB infection-control plan should be on achieving these three goals. In all health care facilities, particularly those in which persons who are at high risk for TB work or receive care, policies and procedures for TB control should be developed, reviewed periodically, and evaluated for the effectiveness to determine the actions necessary to minimize the risk for transmission of M. tuberculosis.

The TB infection-control program should be based on a hierarchy of control measures. One measure is to use administrative measures intended primarily to reduce the risk for exposing uninfected persons to persons who have infectious TB. The first level of hierarchy include: a) developing and implementing effective written policies and protocols to ensure the rapid identification, isolation, diagnostic evaluation, and treatment of persons likely to have TB; b) implementing effective work practices among HCWs in the health care field c) educating, training, and counseling HCWs about TB; d) screening HCWs for TB infection and disease.

The second level of the hierarchy is the use of engineering controls to prevent the spread and reduce the concentration of infectious droplet nuclei.

The first two levels of the hierarchy minimize the number of areas in the health care facility where exposure to infectious TB may occur, and they reduce, but do not eliminate, the risk I those few areas where exposure to M. tuberculosis can still occur. Because persons exposed to such patients may be exposed to M. tuberculosis, the third level of the hierarchy is the use of personal respiratory protective equipment in these and certain other situations in which the risk for infection with M. tuberculosis may be relatively higher.

Specific measures to reduce the risk for transmission of M. tuberculosis include the following:

* Assigning to specific persons in the health care facility the supervisory responsibility for designing, implementing, evaluating, and maintaining the TB infection-control program.

* Conducting a risk assessment to evaluate the risk for transmission of M. tuberculosis in all areas of the healthcare facility, developing a written TB infection control program based on the risk assessment, and periodically repeating the effective treatment of patients who may have infectious TB.

* Providing prompt triage for and appropriate management of patients who may have infectious TB.

* Developing, implementing, maintaining, and evaluating a respiratory protection program.

* Using precautions while performing cough-inducing procedures.

* Educating and training HCWs about TB, effective methods for preventing transmission of M. tuberculosis, and benefits of medical programs.

Developing and implementing a program for routine periodic counseling and screening of HCWs for active TB and latent TB infection.

Promptly evaluating possible episodes of M. tuberculosis transmission in health care facilities, including tuberculosis skin test conversions among HCWs, epidemiologically associated cases among HCWs or patients, and contacts of patients or HCWs who have TB and who were not promptly identified and isolated.

Coordinating activities with the local public health department, emphasizing reporting, and ensuring adequate discharge follow-up and the continuation and completion of therapy.

TB precautions may be appropriate in a number of health care settings. The specific precautions that are applied will vary depending on the setting. At a minimum, a risk assessment should be performed yearly for these settings; a written TB infection-control plan should be developed, evaluated, and revised on a regular basis; protocols should be in place for identifying and managing patients who may be have active TB; HCWs should receive appropriate training, education, and screening; protocols for problem evaluation should be in place; and coordination with the public health department should be arranged when necessary. Other recommendations specific to the following:

Home Health Care settings:

* HCWs who provide medical services in the homes of patients who have suspected or confirmed infectious TB should instruct such patients to cover their mouths and noses with a tissue when coughing or sneezing. Until such patients are no longer infectious, HCWs should wear respiratory protection when entering these patients’ homes.

* Precautions in the home may be discontinued when the patient is no longer infectious.

* HCWs that provide health care services in their patient’s homes can assist in preventing transmission of M. tuberculosis by educating their patients regarding the importance of taking medications as prescribed and by administering DOT.

* Cough-inducing procedures performed on patients who have infectious TB should not be done in the patients’ home unless absolutely necessary. When medically necessary cough-inducing procedures must be performed in a health care facility in a room or booth that has the recommended ventilation for such procedures. If these procedures must be performed in patients’ home, they should be performed in a well ventilated area away from other household members. If feasible, the HCW should consider opening window to improve ventilation or collecting the specimen while outside the dwelling. The HCW collecting these specimens should wear respiratory protection during the procedure.

* HCWs that provide medical services in their patients’ homes should be included in comprehensive employer-sponsored TB training, education, counseling, and screening programs. These programs should include provisions for identifying HCWs who have active TB, baseline PPD skin testing, and follow-up PPD testing at intervals appropriate to the degree of risk.

Patients who are at risk for developing active TB and HCWs who provide medical services in homes of such patients should be reminded periodically of the importance of having pulmonary evaluated promptly to permit early detection of and treatment for TB.