By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

HEALTHY IMMUNE SYSTEMS CONQUER TB, IF NOT, ANTIBIOTICS NEEDED

Question: I have been around someone who might have tuberculosis and I am concerned that I may have caught it. I didn’t think people got that anymore. What are the symptoms of tuberculosis? How would I know if I had it?

Answer: Before answering your question, I need to give you a little background on tuberculosis, often simply called “TB.” This disease, also sometimes referred to as “consumption,” began to decline in the United States after the introduction of antibiotics in the 1940s. There was an increase in the incidence of TB in the ‘80s, but now the number of new cases is again in decline.

TB is spread through the air when a person with the disease sneezes, coughs, speaks or sings. The organism that causes TB, Mycobacterium tuberculosis, can remain suspended in tiny droplets in the air for several hours. A susceptible person can become infected with TB if they inhale these droplets. There are no immediate symptoms of inhaling these germs into your lungs.

In a healthy person, the TB infection does not take hold. The immune system kills the M. tuberculosis bacteria and you will not become ill. You may, however, end up with a positive TB skin test. There is a small risk that you may develop TB at a later point in your life. That’s why anyone who has had a positive skin test should have regular TB checkups from their physician, the local health department or a state TB program.

Some people, unfortunately, are not able to fight off the initial exposure to the bacteria. This is particularly true of people whose immune systems have been compromised in some way -- either through general ill health, nutritional deficits or a specific disease such as diabetes, cancer or AIDS. Active tuberculosis is also more common in African Americans and Hispanics.

While TB is primarily a disease of the lungs, it can also affect the central nervous system, lymphatic system, bones and joints. In some cases, it can even be widely spread throughout the body.

Now, finally, to answer your specific question. If you were to get TB of the lungs, you would probably have a cough that lasted longer than three weeks along with chest pain. Your cough would most likely be productive, and the phlegm you cough up would be tinged with blood. You might also experience fever, chills, night sweats, fatigue and weight loss.

After conducting a thorough history and physical exam, a physician would order a Mantoux tuberculin skin test, a chest X-ray and, possibly, a special sputum test to check for the presence of M. tuberculosis. There might be other tests as well to positively confirm the presence of pulmonary TB disease.

Active tuberculosis is treated with a multiple antibiotic regime, and the patient is monitored regularly to be sure the medicines are working. I would advise anyone who has ever had TB -- or even just a positive TB skin test -- to watch closely for symptoms like cough, fever and weight loss. You would need to do this for the rest of your life to quickly spot any recurrence of the disease in its early stage when successful treatment is more likely.

If you have internet access, you can find more information about TB at: http://www.cdc.gov/nchstp/tb/faqs/qa.htm.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.