Tuberculosis Control Program - Frequently Asked Questions
42 FAQ(s) have been entered for this Program.
What if I have latent TB infection and HIV infection together?
Answer: Because HIV infection weakens the immune system, people with latent TB infection and HIV infection are at very high risk of developing active TB disease. All persons with HIV infection should be tested to find out if they have latent TB infection. If they do, they need treatment as soon as possible to prevent them from developing active TB disease. If they have active TB disease, they must take medicine to treat the disease.
NOTE: Active TB disease can be prevented and treated, even in people with HIV infection.
Even though I have latent TB infection and feel fine, why does my doctor want me to take medication?
Answer: Your doctor has prescribed an antibiotic called Isoniazid to prevent the dormant bacteria in your lungs from becoming active and causing TB disease. A six to nine month course of treatment greatly reduces the lifetime risk of developing TB disease.
If I have latent TB infection, how can I keep from developing active TB disease?
Answer: Many people who have latent TB infection never develop active TB disease. But some people who have LTBI are more likely to develop active TB disease than others. Those at high risk for active TB disease include:
People with HIV infection
People who became infected with TB bacteria in the last 2 years
Babies and young children
People who inject ilegal drugs
People who are sick with other diseases that weaken the immune system
Elderly people
People who were not treated correctly for TB in the pastIf you have latent TB infection (a positive TB skin test or positive TB blood test) and you are in one of these high-risk groups, you need to take medicine to keep from developing active TB disease. This is called treatment for latent TB infection. There are several treatment options. You and your health care provider must decide which treatment is best for you.
The medicine usually taken for the treatment of LTBI is called Isoniazid (INH). If taken for 6 to 9 months, INH kills the bacteria that are in your body. If you take your medicine as instructed by your doctor or nurse, it can keep you from developing active TB disease. Children, adolescents, and HIV-infected person with LTBI need to take INH for 9 months.
Because there are less bacteria, the treatment for latent TB infection is much easier than treatment for TB disease. Usually, one drug is needed to treat latent TB infection. A person with active TB disease has a large amount of bacteria in the body. Several drugs are needed to treat active TB disease.
Sometimes people are given treatment for LTBI even if their skin test reaction is negative. This is often done with infants, children, and HIV-infected persons who have recently spent time with someone who has active TB disease. This is because they are at very high risk of developing active TB disease soon after they become infected with TB bacteria.
What does it mean to have latent infection?
Answer: In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. Even though there are TB germs in the body, they are not active but are in a dormant or sleeping state. The bodys defenses control the bacteria by building a wall around them the way a scab forms over a cut. The germs can stay inside these walls for years, alive but not active. Since these TB germs are not active, they cant do damage to the person and they cant spread to other people. The person is infected, but is not sick and has no symptoms. Also, many people are not even aware that there is an infection unless they are is tested for TB. Many people who have latent TB infection never develop active TB disease. The bacteria can remain alive for a lifetime without causing disease. But in other people, especially those who have a weak immune system, the bacteria become active and multiply. The result is TB disease.
The difference between Latent TB Infection and Active TB Disease:
A person with Latent TB Infection
- Does not feel sick
- Has no symptoms
- Cannot spread TB bacteria to others
- Usually has a positive skin test or positive blood test
- Has a normal chest x-ray and a negative sputum smear
- Should consider treatment for latent TB infection to prevent active TB disease from developing
A person with Active TB Disease
- Usually feels sick
- Has symptoms described above
- May spread TB bacteria to others
- Usually has a positive skin test or positive blood test
- May have an abnormal chest x-ray, or positive sputum smear, or culture
- Needs treatment for active TB disease
What is a TB skin test?
Answer: A "TB Skin Test" is a test to see if TB germs are present in the body. L.A. County uses the Mantoux method only for testing.
Why would someone need a skin test?
Answer: A skin test is used to see if a person has been exposed and infected by M. tuberculosis or tubercle bacilli. A test may also be required by an employer as an employment screening or to enter school.
Who should be tested for TB?
Answer: People who have symptoms of active TB disease
- People who have spent a long time with someone who has active TB disease (a family member, friend, or co-worker)
- People who have HIV infection, lowered immunity, or certain medical conditions such as diabetes or chronic kidney failure
- People who have worked or lived in a homeless shelter, prison, or other group setting
- People who have come to the United States recently from a county where there is a lot of TB
How is a person tested to determine if they have TB?
Answer: A TB skin test is used to help detect TB infection. A small needle is used to put a liquid testing material under your skin. In 2 3 days, you return to your health care provider who will check to see if there is a reaction to the liquid. In some cases, a special TB blood test is given to test for TB infection. Other tests are needed to show if you have TB disease. An x-ray of your chest can tell if there is damage to your lungs from TB. The phlegm (flem) you cough up can be tested in a lab to see if there are TB germs in your lungs. If TB disease is in your lungs, you may cough a lot, cough up phlegm, cough up blood, or have chest pain when you cough or breathe. You may also feel weak, lose your appetite, lose weight, have a fever, or sweat a lot at night.
When should a TB test be examined? (read or checked)
Answer: The skin test should be examined (or read) 48-72 hours after it is administered. It is acceptable to read the skin test up to 96 hours after administration if it is not possible to read it earlier. After 96 hours, a skin test of less than 10 mm of induration should be repeated. A skin test of 10 mm or more is positive at any time.
What does a positive TB skin test mean?
Answer: A positive skin test means that a person has been exposed to TB germs sometime during their lifetime. It does not indicate that a person has TB or is contagious.
Should a person who had a BCG vaccination get a TB skin test?
Answer: Yes. Not all BCG vaccinations are effective. A history of BCG vaccination does not exempt students or employees from the skin test.
Can a person who has previously had a positive skin test reaction be re-tested?
Answer: Yes, but repeated TB skin testing is not necessary once a person has a previous positive reaction. However, some people may forget the result of their test, especially if it was given many years ago. Therefore, if there is no previously documented positive test result to be found, the test should be repeated and properly recorded.
Can my skin test be read if I return to the clinic after 72 hours?
Answer: It is acceptable to read the test up to 96 hours after administration if it is not possible to do it earlier. After 96 hours, a skin test of less than 10 mm of induration (swelling) should be repeated. A skin test of 10mm or more is positive at any time.
Can I get tuberculosis from getting the skin test?
Answer: No. The testing fluid that you are receiving, known as PPD (Purified Protein Derivative) does not contain any live TB bacteria and, therefore, cannot infect you with TB. It merely contains some of the protein that is removed from the bacteria and then purified.
After the test, can I work, play, exercise, or take a shower?
Answer: Yes. The small blister that appears at the site of the injection (called a wheal) should disappear in about 15 minutes.
Does a positive TB test mean that I am going to get tuberculosis?
Answer: The skin test can only tell if you are infected with TB bacteria. To determine if you have active TB disease, you will need a chest x-ray and other tests of your sputum. If you doctor determines that you do have active TB disease, you will be given medicines to cure you of the disease. If left untreated, however TB can be fatal. Since TB is curable and preventable, this is all the more reason to see your doctor for a complete medical evaluation.
Can a pregnant woman be skin tested?
Answer: Yes, Pregnancy is not a reason to not have a TB test and, in fact, is recommended as part of good prenatal care. The skin test is valid and safe throughout pregnancy.
Are these tests safe if you are pregnant or trying to conceive?
Answer: Yes. A TB skin test does not interfere with your attempt to become pregnant nor does it have any negative impact on the development of your unborn baby.
How is TB spread?
Answer: TB is spread through the air from one person to another by tiny airborne particles that contain the bacteria. They are put into the air when a person with active TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected. You cannot, however, catch TB from clothing, dishes, food, or body contact with someone who has TB.
If someone has TB, will everyone around him or her develop the disease?
Answer: Not necessarily. The likelihood that a person might inhale TB bacteria from someone who has TB disease depends on four factors:
- Infectiousness of the person who has TB. The more infectious a person is, the more bacteria he or she exhales with each breath. As a result, more TB bacteria are put into the air for others to inhale.
- The virulence or strength of the organism that they exhale from their lungs. A more virulent bacteria has the ability to remain alive and reproduce longer and to cause more damage to the lung once it is inhaled.
- Duration or length of time that a person is exposed to the bacteria that are present in the environment. The longer the exposure, the greater the opportunity to inhale more organisms.
- The environment in which the bacteria are suspended in the air. A small room with poor air circulation is an ideal environment for transmitting TB bacteria from one person to another. When air is allowed to circulate in a room (open window, fan, air conditioning, etc.) TB bacteria do not have an opportunity to remain suspended in the air and are more likely to end up in the exiting portion of the buildings ventilation system or sent out of doors through an open window.
How can I keep from spreading TB to others.
Answer: The most important way to keep from spreading TB is to take all your medicine exactly as directed by your healthcare provider. You also need to keep all of your clinic appointments. Your doctoror nurse needs to see how you are doing. You may need another chest x-ray or a test of the sputum (phlegm) you may cough up. These tests will show whether the medicine is working. They will also show whether you can still give TB bacteria to others.
If you are sick enough with active TB to go to a hospital, you may be put in a special room. This room uses air vents that keep TB bacteria from spreading to other rooms. People who work in these special roms must wear a special face mask to protect themselves from TB bacteria. You must stay in the room so that you will not spread TB bacteria to other people.
If you are infectious while you are at home, there are certain things you can do to protect yourself and others near you. Your doctor may tell you to follow these guidelines to protect yourself and others:
- The most important thing you can do is to take your medicine and finish the entire course of therapy
- Always cover your mouth and nose with a tissue when you cough, sneeze, or laugh. Put the tissue in a closed bag and throw it away.
- Do not go to work, to school, or out among other people until your doctor determines that you are no longer contagious. Sleep in a bedroom away form other family members.
Air out your room often and allow fresh air from outside to circulate. TB spreads in small, closed spaces where air doesnt move. Put a fan in your window to blow out (exhaust) air that may be filled with TB bacteria. If you open other windows in the room, the fan also will pull in fresh air. This will reduce the changes that TB bacteria will stay in the room and infect someone who breathes the air
When is TB contagious?
Answer: TB can be contagious in adolescents and adults, who are coughing, have a positive skin test, and an abnormal chest X-ray. TB medications will make the person non-contagious very quickly. Because of the efficacy of TB medicines, patients are not quarantined and are usually able to return to school or work within several weeks.
Are children with active TB contagious?
Answer: Children under the age of 12 rarely have contagious TB. This is because they have TB in a different area in the body and do not aerosolize or cough up their germs into the air. It is for this reason that the Los Angeles County Department of Public Health has been instructed to check the immunization record on these children as being free of communicable TB on the day that the x-ray is taken.
How, when, and where did I get infected?
Answer: TB is spread through the air from one person to another. It is not spread by sharing utensils, drinking glasses, or cups, or sharing cigarettes. TB bacteria are put into the air when a person with TB disease of the lungs coughs, sneezes, sings, or speaks. People nearby may breathe in the bacteria and become infected. The TB skin test, however, does not tell us when a person was infected, or who infected them.
I read about this new strain of TB where the drugs do not work. Am I in danger of getting this?
Answer: There is really not a new strain of TB. There have always been people in which some of the medicines do not work. If this is the case, we use additional medicines and patients take them for a longer period of time. Cases where medicines are not completely effective are uncommon in Los Angeles County.
Should someone with TB disease be restricted from work, school, or other social contacts?
Answer: If TB disease is in your lungs or throat, you can give TB germs to your family, friends, and co-workers. They may become infected with TB germs and get sick with TB disease. That is why you may have to be separated from other people until you cant spread TB germs. Taking your medicines as your healthcare provider instructs will shorten the time you need to be separated from other people.
Should someone with latent TB infection be restricted from work, school, or other social contacts?
Answer: No. People with TB infection are not contagious and cant spread TB to others.
What can be done to prevent the spread of TB?
Answer: If you have TB disease, you need to take all your medicines as directed by your healthcare provider. You should always cover your mouth when you cough or sneeze. Your healthcare provider may recommend that your family and others with whom you have spent a lot of time have a TB skin test. If these people have a positive reaction to the test, their health care provider will probably order a chest x-ray to see if they have TB infection or TB disease. If they have a negative reaction to the TB skin test, they should have their TB skin test repeated after 2 to 3 months.
If I were exposed to someone with active TB disease, could I give TB to others?
Answer: Simply being exposed to someone who had active TB disease does not guarantee that you too will become infected with TB disease. In order for you to give TB to someone else, you first have to become infected yourself and then develop TB disease. Exposure to a disease refers to being in the same environment where the infectious organisms are present (bacteria, in the case of TB) so that you have the opportunity to inhale them into your lungs. Even after inhaling TB bacteria, not everyone becomes infected and not every infected person develops active, contagious, TB disease.
What role does surgery play in treating TB?
Answer: Surgery has a very limited role to play in treating TB. It may be helpful in a patient with MDR-TB for which there are limited drugs available for treatment, to stop bleeding, or to drain a persistently infected space in the lung. Clinicians who are considering surgery on their patients should consult with physicians at the L.A. County Tuberculosis Control Program
Are TB patients put into isolation or quarantine, as they were many years ago?
Answer: Today, treatment of TB is almost universally done on an outpatient basis. Unless a patients TB is so severe that it requires hospitalization, the majority of patients receive their medications by Directly Observed Therapy and routine visits to their healthcare provider are scheduled in order to monitor the patients progress. Soon after a patient is diagnosed with TB, he or she is still contagious during the first few weeks after starting his or her course of medication. During these few weeks, patients are advised to remain at home and not interact closely with other people. This may mean time off work, being absent from school, and not socializing around others. This is not the same as the types of isolation and quarantine that were practiced many years ago when patients were placed in sanatorium facilities for treatment of their TB.
My pregnant wife needs to take TB medications. Are these drugs safe for her and the baby?
Answer: TB medications taken during pregnancy are safe for both mother and developing child. Anti-TB medications can also be given to breast-feeding mothers with no harmful effects to the nursing baby.
Is there a vaccination against TB?
Answer: There is currently no effective vaccine that protects people from developing TB infection and TB disease. However, BCG, or Bacille Calmette Guerin, is a vaccine that children often get in countries that have a lot of TB. It may protect them from severe forms of TB disease, such as TB meningitis. BCG shots are not used much in the United States. The vaccine may be effective for only about one year. It does not prevent people from getting TB, especially adult pulmonary TB (TB of the lungs).
How is active TB disease treated?
Answer: There is good news for people with active TB disease. It can almost always be treated and cured with medicine. TB disease can be treated by taking several anti-TB medicines. If you have TB disease, it is very important that you finish all of your medications and take them exactly as directed by your healthcare provider. It takes at least six months to one year to kill all the TB germs in your body. If you stop taking the medicines too soon, you can become sick again. If you do not take the medicines correctly, the germs that are still alive may become drug resistant and the disease may become very difficult to treat.
If you have active TB disease, you will be taking several different medicines. This is because there are many bacteria to be killed. Taking several medicines will do a better job of killing all the bacteria and preventing them from becoming resistant to the medicines than if you were to take only one drug alone. The most common medications used to treat TB are:
- Isoniazid (INH)
- Rifampin (RIF)
- Ethambutol
- Pyrazinamide
If you have active TB disease of the lungs or throat, you are probably infectious. You need to stay home from work or school so that you dont spread TB bacteria to other people. After taking your medicine for a few weeks, you will feel better and you may no longer be infectious to others. Your healthcare provider will tell you when you can return to work or school or visit with friends.
Having active TB disease should not stop you from leading a normal life. When you are no longer infectious or feeling sick, you can do the same things you did before you had active TB disease. The medicines you are taking should not affect your strength, sexual function, or ability to work. If you take your medicines as directed by your doctor or nurse, they should kill all the TB bacteria. This will keep you from becoming sick again.
What are the side effects of medicine for TB?
Answer: If you are taking medicines for TB, you should take it as directed by your doctor or nurse. The medicines may cause side effects. Some side effects are minor, while others are more serious. If you have serious side effect, call your doctor or nurse immediately. You may be told to stop taking your medicine or to return to the clinic for tests.
The side effects listed below are serious. If you have any of these symptoms, call your doctor or nurse immediately:
- No appetite
- Nausea
- Vomiting
- Yellowish skin or eyes
- Fever for 3 days or more
- Abdominal pain
- Tingling fingers or toes
- Skin rash
- Bleeding easily
- Aching joints
- Dizziness
- Tingling or numbness around the mouth
- Bruising easily
- Blurred vision or changes in vision
- Ringing in the ears
- Hearing loss
The side effects listed below are minor. If you have any of these side effects, you can continue taking your medicine:
- Rifampin can turn urine, saliva, or tears orange. The doctor or nurse may advise you not to wear soft contact lenses because they may get stained.
- Rifampin can make you more sensitive to the sun. This means that you should use a good sunscreen and cover exposed areas so you dont burn.
- Rifampin makes birth control pills and implants less effective. Women who take refampin should use another form of birth control.
- If you are taking rifampin as well as methadone (used to trat drug addiction), you may have withdrawal symptoms. Your doctor may need to adjust your methadone dosage.
Why do I need to take TB medicines regularly and not miss any doses?
Answer: TB bacteria die very slowly. It takes at least 6 months for the medicines to kill all the TB bacteria. You will probably start feeling well after a few weeks of treatment, but beware! The TB bacteria are still alive in your body. You must continue to take your medicines until all the bacteria are dead, even though you may feel better and have no more symptoms of active TB disease. If you dont continue taking your medicines or you arent taking all of your pills regularly, this can be very dangerous. The TB bacteria will grow and you will remain sick for a longer period of time. The bacteria may also become resistant to the medicines you are taking. You may need new, different medicines to kill the bacteria if the old medicines no longer work. These new medicines must be taken for a longer period of time and usually have more serious side effects. If you become infectious again, you could give TB bacteria to you family, friends, or anyone else who spends time with you. It is very important to take your medicines as directed by your doctor or nurse.
What is directly observed therapy?
Answer: The best way to remember to take your medicines is to get directly observed therapy (DOT). If you receive DOT, you will meet with a healthcare worker every day or several times a week and he or she will deliver your medicines to you. You will meet at a place you both agree on. This can be in the TB clinic, at your home or work, or any other convenient location. You will take your medicines at this place while the healthcare worker watches you swallow your pills.
DOT helps in several ways. The healthcare worker can help you remember to take your medicines and complete your treatment. This means you will get well as soon as possible. With DOT, you may need to take medicines only 2 or 3 times each week instead of every day.
The healthcare worker will make sure that the medicines are working as they should. This person will also watch for side effects and answer questions you have about TB.
Even if you are not getting DOT, you must be checked at different times to make sure everything is going well. You should see your doctor or nurse regularly while you are taking your medicines. This will continue until you are cured.
How can I remember to take my medicine if Im not on DOT?
Answer: The only way to get well is to take your medicines exactly as directed by your doctor or nurse. This may not be easy. You will be taking your medicines for a long time (6 months or longer), so you should get into a routine. Here are some ways to help you remember to take your medicines:
- Take you pills at the same time everyday for example, you can take them before eating breakfast, during a coffee break, or after brushing your teeth.
- Ask a family member or friend to remind you to take your pills
- Mark off each day on a calendar as you take your medicine
- Put your pills in a weekly pill dispenser. Keep it by your bed or in your purse or pocket.
What are multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB)?
Answer: Sometimes TB bacteria are resistant to the medicines use to treat TB disease. This means that the medicines can no longer kill the bacteria. Multidrug-resistant TB, or MDR-TB, is caused by bacteria that are resistant to two or more of the most important TB medicines Isoniazid (INH) and Rifampin (RIF).
A more serious form of MDR TB is called extensively drug-resistant TB (XDR-TB). XDR-TB is a rare form of TB that is resistant to nearly all medicines used to treat TB disease. If you do not take your medicines as directed by your healthcare provider, the TB bacteria may become resistant to a certain medicine. Also, people who have spent time with someone sick with MDR-TB or XDR-TB can become infected with these multidrug-resistant bacteria.
Drug resistance is more common in people who:
- Have spent time with someone with drug-resistant TB disease
- Do not take all of their medicines as directed by their healthcare provider
- Develop active TB disease again, after having taken TB medicines in the past
- Come from areas where drug-resistant TB is common
People with MDR-TB or XDR-TB must be treated with special medicines. Thee medicines are not as good as the usual medicines for TB, and they may cause moe side effects. Also, people with MDR-TB and XDR-TB must see a TB expert who can closely observe their treatment to make sure it is working. Treatment talks much longer than regular TB. Finally, people with either MDR-TB or XDR-TB are at greater risk of dying from the disease.
Who gets TB?
Answer: Anyone can get TB. You are more likely to get TB infection if you spent time with someone with TB disease, you recently came to the United States from a county with lots of TB, or if you spent time in a group living situation. You are more likely to get TB disease if you have TB infection and are HIV positive, are a substance abuser, are very young, are elderly, or have a medical condition that weakens your immune system, such as cancer or diabetes.
What are the symptoms of TB disease?
Answer: The symptoms depend on where in the body the TB bacteria are growing. TB in the lungs may cause symptoms such as:
- A bad cough that lasts 3 weeks or longer
- Pain in the chest when breathing in or out
- Coughing up blood or sputum (phlegm from deep inside the lungs)
Other symptoms of active TB disease include:
- Weakness or fatigue
- Loss of appetite
- Weight loss
- Chills
- Fever
- Sweating at night
What is tuberculosis?
Answer: Tuberculosis is a contagious disease caused by bacteria called Mycobacterium tuberculosis. These bacteria usually attack the lungs but can also attack any other part of the body such as the kidneys, spine, and brain. If not treated properly, TB disease can be fatal. TB disease was once the leading cause of death in the United States but now, in the 21st century, it has still not been eradicated and poses a very serious public health threat throughout the world.
TB is spread through the air from one person to another by tiny airborne particles that contain the bacteria. They are put into the air when a person with active TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected. You cannot, however, catch TB from clothing, dishes, food, or body contact with someone who has TB.
However, not everyone who is infected with TB bacteria becomes sick. People who are infected but are not sick have what is called Latent TB Infection (LTBI). People with LTBI do not feel sick, do not have any symptoms, and cannot spread TB to others. However, some people who have LTBI go on to develop active TB disease which is contagious and does have symptoms.