DEAR DR. GOTT: I am a 24-year-old student. Just recently I tested positive on a skin test for tuberculosis. I nearly fainted when I got the results back. After all, I’ve been healthy my entire life. I can pretty much say I thought I had a strong immune system. Well, nurses prescribed medication and told me after I completed my doses, I would have a 90% chance of never catching tuberculosis again.
Dr. Gott, would you please send me something educational on this condition and should I worry about getting it again?
DEAR READER: Tuberculosis (TB) is an infectious disease that commonly affects the lungs, although the kidneys, brain and spine can also be involved. When the disease occurs outside the lungs, the symptoms that present will vary according to the organ involved. For example, when the tissues around the heart are affected, inflammation and fluid buildup can occur, a critical condition known as cardiac tamponade. If the brain is affected, meningitis can occur. Because the liver and kidneys filter impurities from the bloodstream, their ability to function properly can be greatly diminished.
TB is spread through tiny droplets released into the air through coughing, sneezing, or simply speaking and spitting. While contagious, the disease isn’t particularly easy to catch. Further, once an infected individual is on medication for at least two weeks, he or she will no longer be contagious. Symptoms of the disorder include weight loss, fatigue, cough, fever, chills, loss of appetite, and more.
Those individuals at increased risk include those who live in parts of the world with a high incidence of the disease, as well as drug users, organ transplant recipients on medication to prevent rejection, people receiving chemotherapy or other cancer treatment, those having a diagnosis of diabetes, users of specific drugs for rheumatoid arthritis, the malnourished, or people who have a positive diagnosis of HIV/AIDS. The risk is also greater for individuals who don’t receive proper medical care or may have a weakened immune system because of substance abuse.
The number of cases of TB has increased substantially because of the spread of HIV, the virus that causes AIDS because they have a compromised immune system, making it extremely difficult for the body to control the bacteria associated with tuberculosis. This translates to people with HIV being at substantially greater risk for getting TB than those who aren’t HIV positive. Then too, drug-resistant strains of the disorder surface when an antibiotic fails to kill 100% of the bacteria and the bacteria that do survive become resistant to that particular drug and perhaps to others, as well.
Diagnosis is commonly made through a PPD test which resembles a skin prick on the inside of the forearm. A physician or nurse can perform the test in an office setting and must physically examine the site within 48-72 hours to determine if there is a specific reaction. This testing isn’t perfect and false negative as well as false positive results have been reported. With a positive result, a physician will order a chest X-ray, blood drawing, or sputum test for confirmation because a false positive is possible, especially in those who received a BCG vaccine (more commonly given outside of the US).
The treatment of choice for positive cases is medication that must be taken for up to nine months for complete eradication. The precise drug(s) and length of treatment will be dependent on a person’s overall health, age, portion of the body affected, and more. For those with latent tuberculosis (bacteria in the body in an inactive state without symptoms) only one drug will be prescribed, while active cases (those which are contagious to others and have symptoms) will require several drugs being taken simultaneously. Those who fail to complete the course of antibiotics run the risk of becoming reinfected and repeat cases will be substantially more difficult to treat.
Readers who would like related information can order my Health Report “Pulmonary Disease” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
