Health Info

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General Health - Tuberculosis

What is TB?

TB (tuberculosis) is a serious illness that most commonly affects the lungs, but can involve any major organ system. The cause is a bacteria, Mycobacterium tuberculosis.

Symptoms

Symptoms of the active disease include:

How do you become infected with TB?

TB bacteria are sprayed into the air in tiny moisture droplets when someone with active TB of the lung or larynx laughs, coughs, sneezes, speaks, or sings. If someone else inhales these infectious droplets, the bacteria can settle in the lungs where they begin to multiply.

In healthy people, as the germs increase in number and spread out from the lungs, the person's immune system recognizes the infection and mounts a response to prevent this infection from making them sick. Later on (can be just months or many years), if a person who has been infected with TB suffers a change in health and the body's immune defenses are damaged, the TB germs can once again multiply and make the person sick. This TB infection has now become TB disease. This occurs in roughly 10% of infected people.

Who is at particular risk of TB infection?

For many reasons, some groups of people are at higher risk to get active TB disease. The groups that are at high risk include people:

How do you check for TB infection?

There are two tests that can be used to help detect TB infection: a TB blood test or a skin test.

A positive test indicates past infection with TB, but not necessarily active TB disease. A chest X-ray will then be done to determine if active lung disease is present. Other tests may be done if TB disease is suspected to be present in other parts of the body (such as the kidneys or bones.) If the chest X-ray is normal, that means that the TB bacteria is not actively causing disease and the person is not infectious to other people at this time. That is considered a latent TB infection.

In healthy people who have been infected with TB, 5% will develop active TB disease during the first two years after infection, and an additional 5% will develop active TB during the remainder of their lifetime.

If you have had a previous positive test, please tell the health care worker prior to having the test repeated.

What about BCG vaccination?

BCG is given in some countries, but not generally in the United States, to improve the body's immune response to TB exposure. The BCG vaccine can only cause a person to have a positive PPD several years after vaccination. In individuals who have received a recent BCG vaccine testing with the blood test is preferred.

Treatment of Latent Tuberculosis:

Latent tuberculosis infection (LTBI) is treated with a medication or medications to kill the dormant bacteria. Treating LTBI greatly reduces the risk of the infection progressing to active tuberculosis later in life. While undergoing treatment for TB (either infection or disease), it is important to avoid drinking alcohol and taking acetaminophen (Tylenol). Both of these substances can make the liver work harder, potentially increasing the risk of liver injury from the medication.

Medications:

Isoniazid

INH is a pill that is taken once per day for nine months. It is the preferred regimen for HIV infected individuals taking antiretroviral medication and for children aged 2-11.

Isoniazid (INH) and Rifapentine (RPT) Regimen:

The 12- dose regimen of INH and RPT is another effective regimen option for otherwise healthy patients. It is recommended for patients aged ≥ 12 years who have had recent exposure to contagious TB, conversion from negative to positive skin or blood TB test or radiographic findings of healed pulmonary TB. It can also be used for certain other patients when it offers practical advantages.

This regimen is not recommended for:

Adverse Drug Reactions:

Vitamin B6 (pyridoxine) 25-50 mg daily may be recommended to prevent INH induced neuropathy, especially in pregnant and breast- feeding women.

Patients taking RPT will notice a normal orange discoloration of body fluids, including urine and tears. Contact lenses may be permanently stained.

Certain foods such as fish (skipjack, tuna, and sardines) or cheese (Swiss and Cheshire) have caused reactions in some people while taking INH. This may present as redness or itching of the skin, hot flashes, rapid heartbeat, sweating, chills or lightheadedness and should be reported.

It is recommended that you do not consume alcohol while on this medication due to increased risk of liver injury and/or Hepatitis.

These medications may interact with other medications that you are taking. Please inform your providers of any medication you are taking or start taking during your treatment.

Prior to starting any treatment of LTBI, all patients undergo an individual health history review and physical exam. The health care provider is particularly interested in identifying if a person has any history of drug allergies, liver or kidney disease, alcohol use, diabetes, seizure disorder, is or has taken any prescription or over the counter medications or has any other medical conditions. Occasionally blood testing is required prior to starting LTBI treatment.

If the 9 month treatment with INH is chosen, the individual will be followed regularly to check for any signs of problems. If the 12 dose option is chosen, the individual will be directly observed when taking his/her medication.
It is very important that full course of treatment be completed to adequately kill the TB bacteria and to prevent resistant strains of TB. Any reactions that may be possibly related to the use of these medications should be reported immediately.

Emergencies

In an emergency go to Mount Nittany Medical Center or call 911 for an ambulance.

Test Results and Advice Nurse

Please call the nurse for test results and advice: 863-4463

Appointments

Appointments can be made online via the UHS website, by phone or in person. If you are unable to keep your appointment, please call and cancel. Otherwise you will be charged for the visit.

To schedule or cancel appointments call 863-0774 or schedule your appointment online through the UHS website

This content is reviewed periodically and is subject to change as new health information becomes available. This information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

Approved by the UHS Patient Education Committee
Revised 6/15/2016

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