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Tuberculosis

GENERAL INFORMATION:

What is tuberculosis? Tuberculosis is also called TB. It is an infection that starts in the lungs and may spread to other parts of the body.The lungs are two hollow organs in your chest. They stretch like a balloon when you breathe in, filling up with air. The lungs collapse as you breathe out. Your lungs connect to the bronchial tubes or airways which bring air into the lungs.

It is called a latent TB infection if you have TB without symptoms. If you have symptoms, the disease is called active TB. Whether you have latent or active TB, you will need to take medicine for many months. TB is a serious disease that may be passed from one person to another.

What causes TB? TB is caused by a bacteria (germ) called Mycobacterium tuberculosis. These germs are spread in the air from person to person by coughing or sneezing. You are at a higher risk of getting TB if:

• You live with a person who has active TB.
  
  
• You live with many people in a small place.
  
  
• You have a human immunodeficiency virus (HIV) infection or acquired immune deficiency syndrome (AIDS).
  
  
• You are elderly and not physically active.
  
  
• You are a health care worker in close contact with people who have TB.
  
  
• You recently came from an area where TB is common, such as Africa, Asia, or Latin America.
  
  
• You have a long-term illness, such as diabetes, cancer, or kidney disease.

What are the signs and symptoms of TB? TB mostly affects the lungs, but almost any part of the body can be infected. Your symptoms may depend upon the part of your body that is infected.

• If TB infects the lungs, you may have:
  
  
  • A cough for three or more weeks.
    
    
  • Blood in your sputum (phlegm). With severe TB, you may cough up blood.
    
    
  • Chest pain, especially with breathing.
    
    
  • Shortness of breath.
  
  
• Other signs and symptoms include:
  
  
  • Fatigue (more tired than usual).
    
    
  • Loss of appetite for food.
    
    
  • Night sweats.
    
    
  • Persistent low-grade fever.
    
    
  • Unexplained weight loss.
    
    
  • Upper back pain.

How is TB diagnosed? Caregivers may suspect TB if you have symptoms. Tests are needed to see if you have active disease. You may need one or more of the following:

• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• Nucleic acid amplification assay: This sputum test is also known as NAA and is used to diagnose active TB infection.
  
  
• QuantiFERRON TB test: This blood test is also called a QuantiFERRON TB gold test or QFTB-G. The test checks for active TB disease.
  
  
• Sputum culture: This is a method to grow and identify TB germs that may be in your sputum. Caregivers will learn what is the best medicine to treat your infection.
  
  
• Sputum microscopy: This test is also called a sputum smear. Your sputum will be tested for TB using a microscope. You may need to give three samples of your sputum, usually first thing in the morning.
  
  
• Tuberculin skin test: A small amount of special liquid is put into your skin, usually on the forearm. Your skin is checked after 2 to 3 days for signs of TB.

How is TB treated? You may need to take 2 to 4 antibiotic medicines for 6 to 12 months or longer to treat TB. Treatments are grouped into two phases:

• Initial phase: During this phase, you may need to take 3 to 4 medicines for up to eight weeks.
  
  
• Continuation phase: You may need to take no fewer than two medicines for 18 to 31 weeks.

It may be difficult taking many medicines for several weeks. Caregivers may ask you to join a program to be certain that you take your medicines during these phases. This program is called directly observed therapy or DOT.

What is directly observed therapy? Directly observed therapy is a program that helps patients take their TB medicines. If you are in the DOT program, your caregiver will watch you take your medicines. You may have to meet a caregiver every day or several times a week. This program makes sure that you take your medicines correctly and that you finish all treatment.

How can I remember to take my medicines? TB can only be cured by taking your medicines exactly as caregivers tell you. This may not be easy because you will be taking your medicines for a long time. Following are some ways to remember to take your medicines:

• Get involved in the directly observed therapy or DOT program. Ask your caregiver for more information about the program.
  
  
• Ask someone else, such as a family member or a friend, to remind you to take your pills.
  
  
• Take your pills at the same time every day. Each night, put out the pills for the next day.
  
  
• Mark off on a calendar each day you take your pills.
  
  
• Keep the pills in a place where you cannot miss them, such as the bathroom or kitchen. Be sure they are out of reach of children.
  
  
• If you forget to take your pills one time, skip that dose and take the next scheduled dose. Write down that you missed a dose and tell your caregiver at your next visit.

How can I keep from spreading TB? To keep from spreading TB, it is very important that you do the following:

• The most important way to keep from spreading TB is to correctly take all your medicines.
  
  
• Keep all of your follow-up visits. Caregivers need to see how you are doing.
  
  
• If you are too sick with active TB, go to a hospital.
  
  
• Avoid close contact with others, especially babies and elderly people.
  
  
• Always cover your mouth and nose with a paper tissue when you cough or sneeze. Throw the used tissue away. If possible, flush used tissues down a toilet.
  
  
• Always wash your hands with soap and water after you cough or sneeze.
  
  
• Family members, friends, and co-workers should have a TB skin test. They may have the TB germ without being sick. To keep from getting TB, these contacts may need to take medicines.

Where can I find support and more information? Having TB is a life-changing disease for you and your family. Accepting that you have TB is hard. You and those close to you may feel sad, worried, and frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. You may also want to join a support group with other people who have TB. Ask your caregiver about contact information for support groups. Call or write one of the following organizations for more information:

• CDC National Prevention Information Network
  PO Box 6003
  Rockville, MD 20849-6003
  Phone: 1-800-4585231
  Web Address: http://www.cdcnpin.org
  

• American Thoracic Society
  61 Broadway
  New York, NY 10006-2755
  Phone: 1-212-315-8600
  Web Address: www.thoracic.org
  

• World Health Organization
  Web Address: www.who.int
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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