North Central Health District

COUNTY HEALTH DEPARTMENTS

Tuberculosis

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The District Tuberculosis Section provides case management for all clients identified with TB disease, suspected of having TB disease, or Latent TB Infection. The District TB Personnel in conjunction with local Health Departments work together to identify, monitor, and treat TB clients. The County TB Nurses and District Personnel collaborate with hospitals, private physicians, district contract physicians, and the State TB Program to provide quality care and appropriate treatment regimens to all individuals with TB. Contact investigations are conducted in order to evaluate and provide care to persons who have been exposed to active TB Disease. Educational workshops and training are made available to the Health Departments and community facilities to ensure the utmost in care for all TB clients.

What is TB?
Evidence of Tuberculosis (TB) has been found dating back to the Egyptian mummies, ancient Greece and Imperial Rome. It was known as consumption or white plague during the first half of the 20th century. In 1882, Dr. Robert Koch discovered the cause of tuberculosis.

Tuberculosis (TB) is a disease caused by the TB bacillus germ that spreads from person to person through the air. Approximately 85% of TB cases are pulmonary (affecting the lungs). Extrapulmonary (outside of the lungs) TB occurs in other parts of the body, such as the lymph nodes, the brain, the kidneys, or spine. Without treatment a person with TB can die.

What are the Symptoms of TB?
Fever, chills, night sweats, significant weight loss without trying, weakness, and/or tiredness are some of the symptoms of TB disease.. TB disease of the lungs will also include coughing, chest pain, and coughing up blood. Extrapulmonary TB symptoms will include some of the above symptoms along with pain or other problems in the area that is affected.

How is TB Spread?
TB is spread person to person through the air. When a person with infectious TB disease coughs or sneezes, tiny particles containingMycobacterium Tuberculosis may be expelled into the air. These particles called droplet nuclei can remain in the air for several hours depending on the environment. If a person inhales the droplet nuclei, transmission has occurred. Not everyone who is exposed to the TB germ actually becomes infected with the TB germ.

What is the Difference Between Latent Tuberculosis Infection (LTBI) and Tuberculosis Disease?
LATENT TUBERCULOSIS INFECTION (LTBI)

  • The person has NO SYMPTOMS.
  • The person is NOT CONTAGIOUS.
  • The TB Skin Test (also known as PPD) is POSITIVE.
  • The Chest X-Ray is NORMAL.
  • Sputum Smears are NEGATIVE.
  • Sputum Cultures are NEGATIVE
  • With LTBI TB germs are in the body but are sleeping or dormant.
  • The persons immune system is healthy.
  • The immune system creates a hard shell around the TB germ and contains it.
  • Because of the potential for the bacilli to become active, multiply and lead to TB disease it is called Latent TB Infection.
  • A person with LTBI cannot spread TB germs to other people.
  • You DO NOT need to be tested if you have spent time with a person with LTBI.
  • LTBI medication is started on persons who are at risk for developing TB Disease.

The decision to treat depends on several risk factors. These include people with HIV Infection, people who were recently exposed to someone with active TB Disease, and people with certain medical conditions. Routine treatment for LTBI consists of 9 months of daily Isoniazid (INH) or 4 months of daily Rifampin (if INH cant be used.)

ACTIVE TUBERCULOSIS DISEASE (TB)

  • TB germs are in the body and GROWING.
  • The Tuberculin Skin Test (PPD) USUALLY POSITIVE. This depends on the persons immune system.
  • Chest X-Ray Usually ABNORMAL
  • Sputum Smears may be POSITIVE.
  • Sputum Cultures are POSITIVE.
  • The person has SYMPTOMS.
  • The person may be CONTAGIOUS (before an adequate amount of TB medications are taken by the person).
  • The person is considered to be an ACTIVE TB CASE.
  • Active TB Disease is CURABLE.
  • TB germs become active if the immune system cant stop them from growing.
  • The active germs begin to multiply in the body and cause activeTB disease.

The treatment for TB Disease is a 4-drug therapy that includes Isoniazid (INH), Rifampin (RIF), Pyrazinamide (PZA) Ethambutol (EMB) for 2 months. After drug susceptibility is known the Doctor can drop the medication to INH and RIF for 4 months. A Physician who follows the TB person throughout his/her plan of care orders these medications. A healthcare worker from the Health Department delivers the TB medication to the person and watches the person swallow the medication. This is known as Directly Observed Therapy (DOT), which is the standard of care for the State of Georgia TB Program. TB is not a casual contact disease like the common cold. A person has to spend a lot of time with the person with active TB disease. You may get a Tuberculin Skin Test (PPD) from your doctor or the local Health Department if you have been around someone who has TB disease.

What Does a Positive Tuberculin Skin Test Mean?
It only tells that a person has been infected with TB germs.

What Is Bacille Calmette Guerin (BCG)?
BCG is a vaccine currently used in many parts of the world to protect infants and children from severe TB disease, especially TB Meningitis. It does not confer lifelong immunity and is not completely effective. There is no reliable way to distinguish a positive tuberculin reaction caused by the vaccine with BCG from a reaction caused by a true TB infection. People who have a positive reaction should be further evaluated for TB disease, regardless of whether they were vaccinated with BCG. BCG wanes over the years.

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