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Written by Michael Smith, MD

What Is Tuberculosis?

Tuberculosis, commonly referred to as TB, is a bacterial infection that can spread through the lymph nodes and bloodstream to any organ in your body but is usually found in the lungs. Most people who are exposed to TB actually never develop symptoms. The bacteria can live in an inactive form in the body. Medication can be given to help get rid of the inactive bacteria. However, if the immune system weakens, such as in people with HIV or as we age, the bacteria can activate. In their active state, TB bacteria cause death of tissue in the infected organs, possibly resulting in death.

Because the bacteria that cause tuberculosis are transmitted through the air, the disease can be quite contagious. However, it is nearly impossible to catch TB simply by passing an infected person on the street. To be at risk, you must be exposed to the organisms constantly, by living or working in close quarters with someone who has the active disease. Even then, because the bacteria generally stay dormant after they invade the body; only 10% of people infected with TB will ever come down with the active disease. The remaining 90% will show no signs of infection, nor will they be able to spread the disease to others. Dormant infections can eventually become active, though, so even people without symptoms should receive medical treatment.

Once widespread, TB became relatively rare with the help of antibiotics developed in the 1950s. Today, however, a new and highly resistant form has emerged, creating a public-health hazard in many large cities worldwide. If you have TB -- in its active or dormant state -- you must seek medical treatment.

What Are the Symptoms?

You will generally have no symptoms if you are infected with TB. In fact, you may not even be aware that you have the disease until it is revealed through a skin test, perhaps during a routine checkup. The Mantoux skin test -- performed in a doctor's office or health department -- is the most reliable detector of TB. A small amount of liquid material is injected just under the top layer of your skin on your arm. After two to three days, a doctor or nurse will read the test to see if it's positive -- a hard, red welt at the injection site of five to 15 millimeters, depending on your risk factors for developing active TB. A positive test means that you have been infected with TB at some point, though not necessarily in its active form. An X-ray of your lungs will help reveal if the disease is active.

If you are concerned that you have active TB, look for these symptoms:

  • Sensation of not feeling well
  • Cough, at first with yellow or green mucus and occasionally bloody later in the disease.
  • Fatigue
  • Shortness of breath
  • Weight loss
  • Slight fever, night sweats
  • Pain in the chest, back, or kidneys, and perhaps all three

What Causes It?

Tuberculosis is generally caused by exposure to microscopic airborne droplets containing the bacterium Mycobacterium tuberculosis. The disease is almost never transmitted through clothes, bedding or other personal items. Because most people with TB exhale only a few of these germs with each breath, you can contract the disease only if you are exposed to an infected person for a long time. If you spend eight hours a day for six months, or 24 hours a day for two months, with someone with an active case of TB, you have a 50% chance of getting infected.

People who are malnourished or who live in close quarters stand the greatest chance of contracting tuberculosis. Therefore, the conditions that accompany poverty, although not a cause of tuberculosis, certainly contribute to its ability to spread. Healthcare workers, long-term hospital patients, and prison workers or inmates also face a greater-than-normal risk of becoming infected with TB. The active form of the infection is more likely to occur in people with weakened immune systems, such as those with AIDS, or blood cancers, such as leukemia.

Call Your Doctor If:

  • You have any of the symptoms listed for TB, especially if you live in crowded conditions, are malnourished, or have HIV. (Note: Virtually all of the symptoms of tuberculosis can be confused with those of other diseases; bloody mucus, for example, can also be symptom of pneumonia.)
  • You have been exposed to someone with active tuberculosis.

What Are the Treatments?

Anyone with tuberculosis must be monitored by a doctor. If you have the infection -- but not the active disease -- your doctor will probably prescribe one antibiotic called isoniazid (INH) to help prevent the dormant infection from becoming active. If you have the active disease, your doctor will give you several antibiotics in order to prevent resistant bacteria from emerging in your body.

If you are infected with TB but do not have the active disease, your doctor will likely give you a daily dose of isoniazid and will see you regularly to ensure you are tolerating the drug without any side effects. Since people over 60 have more side effects from INH, you and your doctor might decide that the risks of INH may outweigh the risk of getting active TB.

If you have the active disease, regularly monitored treatment by a doctor is crucial. You will be given a combination of several antibiotics, which may include INH, rifampin, pyrazinamide, or ethambutol.

Two decades ago, the U.S. surgeon general announced that tuberculosis was a disease of the past. He spoke too soon: The disease has since resurfaced in a potent new form that has once again turned TB into a public-health hazard.

This new form, called multidrug-resistant TB (MDR-TB), is caused by strains of the bacterium M. tuberculosis that, through mutation, have developed the ability to resist two or more antibiotic drugs. Even with treatment, roughly half of all MDR-TB patients with active infection die. This death rate matches that of people with regular TB who received no medical care at all. Fortunately, this form of TB is still relatively rare. Most cases of TB are still highly treatable if the antibiotics are taken as directed.

Article taken from

All photographs taken by / content written by Rebecca S. Williams unless otherwise stated