Tuberculosis

What is tuberculosis?

Tuberculosis (TB) is a chronic bacterial infection that usually infects the lungs, although other organs are sometimes involved. TB is primarily an airborne disease (spread by air droplets from infected people when they cough or sneeze).

There is a difference between being infected with the TB bacterium without illness and having active tuberculosis disease.

There are three important ways to describe the stages of TB. They are as follows:

  • Exposure: This occurs when a person has been in contact, or exposed to, another person who is thought to have or does have TB. The exposed person will have a negative TB skin test, a normal chest x-ray, and no symptoms of the disease.
  • TB infection: This occurs when a person has the TB bacteria in his/her body, but does not have symptoms of the disease. This person would have a positive skin test, but a normal chest x-ray, and no illness.
  • TB disease: This describes the person who has symptoms of an active infection. The person would have a positive skin test, a positive chest x-ray, and might be ill.

The cause of TB is the bacterium Mycobacterium tuberculosis (M. tuberculosis). Most people infected with M. tuberculosis never develop active TB. However, in people with weakened immune systems, including those with HIV (human immunodeficiency virus), TB organisms can overcome the body's defenses, multiply, and cause an active disease.

Who is at risk for developing TB?

TB affects all ages, races, income levels, and both genders. Those at higher risk include the following:

  • People who live or work with others who have TB
  • Medically underserved populations
  • Homeless people
  • People from other countries where TB is prevalent
  • People in group settings, such as nursing homes
  • People who abuse alcohol
  • People who use intravenous drugs
  • People with impaired immune systems
  • The elderly
  • Healthcare workers who come in contact with high-risk populations

What are the symptoms of TB?

Different symptoms are TB are present depending upon the age of the child affected. The following are the most common symptoms for TB. However, each child may experience symptoms differently.

In children

  • Fever
  • Decrease in weight
  • Sweating at night
  • Cough
  • Chills
  • Enlarged lymph nodes

In adolescents

  • Cough that lasts greater than three weeks
  • Productive cough
  • Pain in the chest
  • Blood in their sputum
  • Fatigue
  • Weight loss
  • Decrease in appetite
  • Fever
  • Night sweats

The symptoms of TB may resemble other lung conditions or medical problems. Always consult your child's physician for a diagnosis.

What causes TB?

The TB bacteria are spread through the air; however, repeated exposure to the germs is usually necessary before a child will become infected. It is not likely to be transmitted through personal items, such as clothing, bedding, or other items that a person with TB has touched. Adequate ventilation is the most important measure to prevent the transmission of TB.

How is TB infection diagnosed?

TB is diagnosed with a TB skin test. In this test, a small amount of noninfectious testing material derived from the TB bacterium is injected into the top layer of the skin. If a certain size bump develops within two or three days, the test may be positive for tuberculosis infection. Additional tests to determine if a child has TB disease include x-rays and sputum tests.

TB skin tests are suggested for those:

  • In high-risk categories
  • Who live or work in close contact with people who are at high risk
  • Who have never had a TB skin test

Recommendations for skin testing in children, from the American Academy of Pediatrics (AAP), are as follows/

Immediate testing:

  • If the child is thought to have been exposed in the last five years
  • If the child has an x-ray that indicates possible TB
  • If the child has any symptoms of TB
  • A child that is coming from countries where TB is prevalent

Yearly skin testing:

  • Children with HIV
  • Children that are in jail

Testing every 2 to 3 years:

  • Children that are exposed to high-risk people

Consider testing in children from ages 4 to 6 and 11 to 16 if:

  • A child's parent has come from a high-risk country
  • A child has traveled to high-risk areas
  • Children who live in densely populated areas

Treatment

Specific treatment will be determined by your physician based on:

  • Age, overall health, and medical history
  • Extent of the disease
  • Tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Opinion or preference

Treatment may include:

  • Short-term hospitalization
  • Medications - isoniazid, rifampin, pyrazinamide, ethambutol, or streptomycin, may be prescribed for a period of time up to six months or more for the medication to be effective. Patients usually begin to improve within a few weeks of the start of treatment. The patient is not usually contagious once treatment begins, provided that treatment is carried through to the end, as prescribed by a physician.
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Infectious Disease

Our Division of Infectious Diseases is the major referral center for infectious disease in the Washington, DC, area, helping thousands of patients each year, and actively promoting prevention through community outreach and education.

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