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TUBERCULOSIS

TRAINING

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Tab le o f Con ten t Wh at is Tu bercu los is? TB: An An cien t Disease Th e Global Th reat of TB TB in th e Un ited Stat es TB Tran sm iss ion TB Tran sm iss ion an d th e Develop m en t of TB Disease Risk of Develop in g TB Disease How TB Develop s in th e Bod y Sym p tom s of TB Disease Differen ces between Laten t TB In fect ion an d TB Disease TB Con tact s In fect ion Con t ro l Targeted Tes t in g Grou p s at High Risk for TB In fect ion Grou p s at High Risk for Develop in g TB Disease Grou p s at High Risk for Develop in g TB Disease Two-Step Tes t in g Occu p at ion al Set t in g Ch es t Rad iograp h y In terferon -Gam m a Release Assays Determ in in g Wh ich Tes t t o Use Treatm en t

Ob ject iv e s

• At th e en d of th is les son , you will be ab le to:

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• Defin e tu bercu los is (TB) d isease. • Trace th e h is tory of ear ly TB t reatm en ts . • Exp lain th e p revalen ce, t ran sm iss ion , an d p ath ogen es is of TB. • Id en t ify h igh -p riorit y grou p s for t es t in g an d exp lain th e ap p rop ria te

t es t in g m eth od ologies . • Dis t in gu ish between laten t TB in fect ion (LTBI) an d TB d isease. • Su m m ariz e LTBI an d TB t rea tm en ts . • Id en t ify th e bes t m ed icat ion regim en for each sp ecial circu m stan ce of TB. • Ou t lin e th e ap p rop riate s tep s for TB in fect ion con t ro l in h ealth care

set t in gs . • Discu ss t h e p rim ary con s id erat ion s an d m easu res for com m u n ity TB

con t rol. • Con n ect th e in creased in cid en ce of TB d isease with HIV in fect ion .

Wh at is Tu b er cu los is ?

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Tu bercu los is (TB) is cau sed by a bacter iu m called Mycobacter iu m tu bercu los is . Th e bacter ia u su ally at tack th e lu n gs , bu t TB bacter ia can at t ack an y p art of th e bod y su ch as th e kid n ey, sp in e, an d b rain . If n ot t reated p rop erly, TB d isease can be fat al.

TB: An An cien t Dis e ase TB is an an cien t d isease t h at h as p lagu ed h u m an s for th ou san d s of years . Evid en ce of TB in h u m an s d ates back to over 4 ,000 years ago in an cien t Egyp t ian m um m ies . His torically, TB was kn own by a variety of n am es , in clu d in g:

• Con su m p t ion • Wast in g d isease • Wh ite p lagu e

Before th ere was t reatm en t for TB, a d iagn os is of TB was con s id ered by m an y to be a d eath sen ten ce. Th e Glob a l Th r ea t of TB

Page 4 o f 12 Alth ou gh TB is p reven tab le an d t reat ab le, it is n ot ju s t a d isease of th e p as t . It is s t ill on e of th e world 's d ead lies t d iseases .

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An es t im ated 2 b illion p eop le , o r on e th ird of th e world 's p op u lat ion , a re in fected with M. tu ber cu losis

• Each year , ap p roxim ately • 9 m illion p eop le d evelop TB d isease • 1.4 m illion p eop le d ie of TB d isease

Sou r ce : CDC TB in th e Un ited Sta te s

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TB d isease was on ce th e lead in g cau se of d eath in th e Un ited States . After t h e d iscovery of d ru gs t h at cou ld t reat TB in th e 1950s , d eath rat es began to d rop d ram at ically.

• Ap p roxim ately 9 to 14 m illion p eop le are in fected with M. tu ber cu losis • Over 11 ,000 p eop le d evelop ed TB d isease in 2010 • TB is rep orted in alm os t every s t ate an d is actu ally in creas in g in som e

areas • TB affect s racial an d eth n ic m in orit ies d isp rop ort ion ately • Dru g-res is t an t TB is in creas in gly ch allen gin g to t reat • Man agem en t of p at ien ts with com orbid it ies , su ch as HIV, d iabetes , an d

oth er im m u n e com p rom is in g con d it ion s , is d ifficu lt • More th an h alf of all p erson s in t h e Un ited States wh o h ave TB d isease

are foreign -born res id en ts

Rep orted TB Cases by Age Grou p , Un ited States , 2013

Sou r ce : CDC

Rep orted TB Cases by Race/ Eth n icit y, Un ited Sta tes , 2013

<15 yrs (5%)

15-24 yrs(10%)

25-44 yrs(31%)45-64 yrs

(31%)

≥ 65 yrs(23%)

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Sou r ce : CDC Alth ou gh th e n u m ber of p eop le with TB d isease in th e Un ited States h as been d eclin in g over th e p as t severa l years , th ere rem ain con t in u in g ch allen ges t o con t rollin g TB. Accord in g to th e In s t itu te of Med icin e’s 2001 rep or t , “Tu bercu los is in th e workp lace” Tb rem ain s a th rea t to som e h ealth care an d oth er workers in th e Un ited States . Alth ou gh th e r isk h as been d ecreas in g in recen t years , vigilan ce is s t ill n eed ed with in h osp it als , s im ilar workp laces , as well as th e com m u n ity at la rge. It was con clu d ed in th e rep or t th at th e p rim ary r isk to workers tod ay is from p at ien t s , in m ates , o r oth ers with u n su sp ected an d u n d iagn osed in fect iou s tu bercu los is . Risk is in flu en ced by th e p revalen ce of tu bercu los is in th e com m u n ity th at th e workp lace serves an d by th e exten t an d typ e of workers ’ con tact with th e p eop le wh o h ave in fect iou s tu bercu los is . TB Tr an sm is s ion TB is sp read th rou gh th e air from p erson to p erson . Tin y water p art icles con tain in g M. tu ber cu losis m ay be exp elled in to th e air wh en a p erson with in fect iou s TB of th e lu n gs , airway, or la ryn x:

• Cou gh s

Black or African

American22%American

Indian or Alaska Native

1%

Asian32%

Hispanic or Latino29%

Native Hawaiian or Other Pacific

Islander1%

White15%

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• Sn eez es • Sp eaks • Sin gs

Th ese p art icles , ca lled d rop let n u clei, can rem ain in th e air for several h ou rs , d ep en d in g on th e en viron m en t

TB Tr an sm is s ion an d th e Dev e lop m en t o f TB Disea s e If an oth er p erson in h ales air t h at con tain s d rop let n u clei, th ey m ay becom e in fected . However, n ot every p erson th at is exp osed to TB becom es in fected with M. tu ber cu losis. Ad d it ion ally, n o t everyon e in fected with M. tu ber cu losis becom es s ick. Peop le wh o are in fected bu t n ot s ick h ave laten t TB in fect ion . Som e p eop le with laten t TB in fect ion go on to d evelop TB d isease. Th u s , th ere are two TB-rela ted con d it ion s :

• Laten t TB in fect ion • TB d isease

Abou t 5% to 10% of p erson s with n orm al im m u n e sys tem s will d evelop TB d isease at som e p oin t in th eir lives . Th e r isk of d evelop in g TB d isease is th e h igh es t in th e firs t 2 years after in fect ion .

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Risk o f Dev e lop in g TB Disea se Th e r isk of d evelop in g TB d isease is m u ch h igh er for p erson s with weaken ed im m u n e sys tem s th an for p erson s with n orm al im m u n e sys tem s . For exam p le, for p eop le with TB in fect ion an d u n t reat ed HIV in fect ion an d with n o t reatm en t for TB in fect ion , t h e r isk is abou t 7% to 10% p er year , a very h igh r isk over a lifet im e. HIV in fect ion is th e s t ron ges t kn own r isk factor for p rogres s in g to TB d isease. Oth er p eop le th at h ave weak im m u n e sys tem s th at p u t th em at h igh r isk for d evelop in g TB d isease in clu d e:

• Ch ild ren you n ger th an 5 years of age • Person s wh o are receivin g im m u n osu p p ress ive th erap y • Person s with s ilicos is , d iabetes , ch ron ic ren al failu re, leu kem ia,

lym p h om a, or can cer of th e h ead , n eck, or lu n g • Person s wh o h ave h ad a gas t rectom y or jeju n oileal byp ass • Person s wh o weigh less t h an 90% of t h eir id eal bod y weigh t • Person s wh o abu se d ru gs an d alcoh ol

Ad d it ion al in form at ion regard in g grou p s at h igh r isk for p rogres s ion to TB d isease after in fect ion with M. tu ber cu losis is d iscu ssed fu rth er

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How TB Dev e lop s in th e Bod y Person s becom e in fected with TB wh en th ey in h ale d rop let n u clei th at con tain tu bercle bacilli an d th e bacilli begin t o m u lt ip ly in th e sm all a ir sacs of th e lu n gs . A sm all n u m ber of bacilli en ter th e b lood s t ream an d sp read th rou gh ou t t h e bod y. Usu ally with in 2 to 8 weeks , t h e im m u n e sys tem in terven es , p reven t in g fu rth er sp read . At th is p oin t , th e p erson is con s id ered to h ave laten t TB in fect ion . Sin ce th e im m u n e sys tem is keep in g th e t u bercle bacilli u n d er con t ro l, p eop le with laten t TB in fect ion d o n ot feel s ick an d th ey can n ot sp read TB to oth ers . If, h owever , t h e im m u n e sys tem can n ot keep th e tu bercle bacilli u n d er con t rol, th e bacilli m u lt ip ly an d d es t roy t is su e. Th e bacter ia u su ally at tack th e lu n gs , bu t can at tack an y p art of th e bod y su ch as lym p h n od es , bon es an d join t s , t h e b rain , an d oth er organ s . At th is p oin t , th e p erson h as TB d isease. Peop le with TB d isease m ay feel s ick an d m ay sp read TB to oth ers . Sy m p tom s o f TB Dis ea se Person s with TB d isease u su ally h ave on e or m ore sym p tom s. Becau se d ifferen t p ar t s of th e bod y can be affected by TB, sym p tom s can vary. Gen eral sym p tom s of TB d isease:

• Fever • Ch ills • Nigh t sweat s • Weigh t loss • Ap p et ite los s • Fat igu e • Malaise

Sym p tom s of p u lm on ary TB d isease:

• Cou gh las t in g 3 or m ore weeks • Ch es t p ain • Cou gh in g u p b lood or sp u tu m (p h legm )

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Sym p tom s of ext rap u lm on ary TB d isease d ep en d on th e p art of th e bod y th at is affected . For exam p le:

• TB d isease in sp in e m ay cau se back p ain • TB d isease in kid n eys m ay cau se b lood in u rin e • TB d isease in lym p h n od es m ay cau se swellin g in th e n eck

Diffe r en ces b e tw ee n Laten t TB In fect ion an d TB Disea se Pe r son s w ith La ten t TB In fect ion :

• Do n ot feel s ick • Do n ot h ave an y sym p tom s • Can n ot sp read TB to oth ers • Are at r isk for d evelop in g TB d isease

Pe r son s w ith TB Dis ease :

• Usu ally feel s ick • Usu ally h ave on e or m ore sym p tom s • May be ab le to sp read TB bacter ia t o oth ers

TB Con tact s An yon e can get TB. Person s wh o sp en d a lot o f t im e in en closed sp aces with p eop le wh o h ave TB d isease are a t th e h igh es t r isk of becom in g in fected with M. tu ber cu losis. Th is m ay in clu d e fam ily m em bers , fr ien d s , room m ates , o r coworkers . Th ese p erson s , o r con tact s , a re id en t ified by p u blic h ealth workers t h rou gh in terviews with p at ien ts wh o h ave TB d isease. Pu blic h ealth workers are resp on s ib le for en su rin g th a t th ese h igh -r isk in d ivid u als are evalu ated for TB in fect ion an d TB d isease, an d t reated wh en ap p rop riate . Th is act ivit y is called a con tact in ves t igat ion . In fect ion Con t r o l

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Sin ce TB is an airborn e d isease th at can be t ran sm it ted from on e p erson to an oth er , it is im p ort an t t o p ract ice ap p rop riate in fect ion con t ro l p roced u res to p ro tect oth ers from get t in g TB. Th is is esp ecially im p or tan t for h ealth care facilit ies an d oth er con gregate set t in gs . All h ealth care facilit ies n eed an in fect ion -con t ro l p rogram . Th is p rogram sh ou ld be d es ign ed to en su re:

• Prom p t d etect ion of TB • Airborn e p recau t ion s to p reven t t h e sp read of TB • Treatm en t of p erson s wh o h ave su sp ected or con firm ed TB d isease

Person al resp irators sh ou ld be worn by h ealth care workers t o p reven t t h e in h alat ion of d rop let n u clei. Su rgica l m asks sh ou ld be worn by in fect iou s TB p at ien ts to p reven t d rop let n u clei from bein g exp elled in to th e air . Ta r ge ted Te s t in g

Targeted tes t in g is an essen t ial TB p reven t ion an d con t rol s t rategy in th e Un ited States . Target ed tes t in g is u sed to id en t ify an d t rea t p erson s wh o are at h igh r isk for laten t TB in fect ion or a t h igh r isk of d evelop in g TB d isease on ce in fected with M. tu ber cu losis. Id en t ifyin g an d t reat in g p erson s wh o h ave laten t TB in fect ion is im p ort an t becau se t reatm en t can p reven t th ese p erson s from d evelop in g TB d isease in th e fu tu re. Th is h elp s to s top th e fu r th er sp read of TB in com m u n it ies . All TB tes t in g act ivit ies sh ou ld be accom p an ied by a p lan for follow-u p care, m ed ical evalu at ion , an d t reatm en t for p erson s d iagn osed with laten t TB in fect ion or TB d isease. Targeted tes t in g sh ou ld be u sed to id en t ify an d t reat p erson s wh o are at h igh r isk for:

• In fect ion with M. tu ber cu losis • Develop in g TB d isease on ce in fected with M. tu ber cu losis

Becau se of d ifferen ces in p op u lat ion s from on e com m u n ity t o an oth er , d efin it ion s of h igh -r isk p op u lat ion s are m ad e at th e local level accord in g to local d em ograp h ics an d TB ep id em iology. Grou p s a t High Risk fo r TB In fect ion In gen eral, p eop le a t h igh r isk fo r in fect ion with M. tu ber cu losis in clu d e:

• Con tact s of p erson s kn own or su sp ected to h ave in fect iou s TB d isease

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• Peop le wh o h ave com e to th e Un ited Sta tes with in th e las t 5 years from areas of th e world wh ere TB is com m on (for exam p le, As ia, Africa, Eas tern Eu rop e, Lat in Am erica, an d Ru ss ia)

• Person s wh o vis it a reas of t h e world wh ere TB is com m on , esp ecially if vis it s a re freq u en t or p rolon ged

• Peop le wh o live or work in con gregate set t in gs wh ose clien t s are at in creased r isk for TB d isease

• Health care workers wh o serve clien t s wh o are at in creased r isk for TB d isease

• Pop u lat ion s d efin ed locally as h igh r isk for laten t TB in fect ion or TB d isease, su ch as m ed ically u n d erserved , low-in com e p erson s , or p erson s wh o abu se d ru gs or alcoh ol

• In fan ts , ch ild ren , an d ad olescen t s exp osed to ad u lt s at in creased r isk for in fect ion or d isease

Grou p s a t High Risk fo r Dev e lop in g TB Dis ea se In gen eral, p eop le a t h igh r isk fo r d e v e lop in g TB d isea se on ce in fected with M. tu ber cu losis in clu d e:

• Peop le livin g with HIV/ AIDS • Ch ild ren you n ger th an 5 years of age • Person s wh o are receivin g im m u n osu p p ress ive th erap y • Person s wh o were recen t ly in fected with M. tu ber cu losis (with in th e p as t 2

years ) • Person s with a h is tory of u n t reated or in ad eq u ately t reated TB d isease • Person s with s ilicos is , d iabetes , ch ron ic ren al failu re, leu kem ia,

lym p h om a, or can cer of th e h ead , n eck, or lu n g • Person s wh o h ave h ad a gas t rectom y or jeju n oileal byp ass • Person s wh o weigh less t h an 90% of t h eir id eal bod y weigh t • Cigaret te sm okers an d p erson s wh o abu se d ru gs or alcoh ol • Pop u lat ion s d efin ed locally as h avin g an in creased in cid en ce of TB

d isease, p oss ib ly in clu d in g m ed ically u n d erserved or low-in com e p op u la t ion s

Te s t in g fo r TB In fect ion Diagn os t ic t es t s th at can be u sed to d etect TB in fect ion in clu d e:

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• Th e Man tou x tu bercu lin skin tes t (TST) • In terferon -gam m a release as says (IGRAs)

A p os it ive TST or IGRA resu lt on ly in d ica tes if som eon e h as been in fected with M. tu ber cu losis. Th ese tes t s can n ot id en t ify if a p erson h as TB d isease.

Man tou x Tu b er cu lin Sk in Tes t

Th e TST is d on e by u s in g a n eed le an d syrin ge to in ject t u bercu lin between th e layers of skin on th e forearm . Most p eop le wh o h ave TB in fect ion will h ave a react ion at th e in ject ion s it e. Th e react ion is th e area of in d u ra t ion . A p erson given th e TST m u st h ave a t rain ed h ealth care worker exam in e th eir forearm with in 48 to 72 h ou rs . If th e p erson d oes n ot retu rn with in 72 h ou rs , th e tes t resu lt s a re n ot valid an d th e p erson will n eed an oth er skin tes t . To d eterm in e wh eth er a TST react ion sh ou ld be con s id ered p os it ive, a h ealth care worker n eed s to in terp ret t h e react ion based on :

1 . Siz e of in d u rat ion (m easu red in m illim eters [m m ]) 2 . Pat ien t ’s r isk factors for TB

Red n ess arou n d th e in ject ion s it e is n o t m easu red . Th is is becau se t h e p resen ce of red n ess d oes n ot in d icate th at a p erson h as TB in fect ion . An in d u rat ion of 5 o r m or e m m is con s id ered p os it ive for:

• Peop le livin g with HIV • Recen t con tact s of p erson s with in fect iou s TB d isease • Person s with ch es t x-ray fin d in gs su gges t ive of p reviou s TB d isease • Pat ien ts with organ t ran sp lan t s an d o th er im m u n osu p p res sed p at ien t s

An in d u rat ion of 10 o r m or e m m is con s id ered p os it ive for:

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• Peop le wh o h ave com e to th e Un ited Sta tes with in th e las t 5 years from areas of th e world wh ere TB is com m on (for exam p le, As ia, Africa, Eas tern Eu rop e, Lat in Am erica, an d Ru ss ia)

• In ject ion d ru g u sers • Resid en ts an d em p loyees of h igh -r isk con gregate set t in gs • Mycobacteriology laboratory p erson n el • Person s with con d it ion s t h at in crease r isk for p rogres s in g to TB d isease • Ch ild ren les s t h an 4 years of age • In fan ts , ch ild ren , an d ad olescen t s exp osed to ad u lt s in h igh -r isk

categories An in d u rat ion of 15 o r m or e m m is con s id ered p os it ive in an yon e, in clu d in g p erson s with n o kn own r isk factors for TB.

Tw o-Step Te s t in g

Two-s tep tes t in g is a s t rategy u sed to red u ce th e likelih ood th at a boos ted react ion (d u e to in fect ion in th e p as t o r recen t TST) will be m is in terp reted as a recen t in fect ion .

If th e react ion to th e firs t t es t is class ified as n egat ive, a secon d tes t is rep eated on e to th ree weeks la ter . A p os it ive react ion to th e secon d tes t p robably rep resen ts a boos ted react ion . On th e bas is of th is secon d tes t resu lt , th e p erson is class ified as p reviou s ly in fected . Th is is n ot con s id ered a skin tes t con vers ion or a n ew TB in fect ion ; h owever, th e p at ien t m ay s t ill be a can d id ate for LTBI t reatm en t . If th e secon d tes t resu lt is a lso n egat ive, th e p erson is class ified as h avin g a n egat ive baselin e TST resu lt (CDC, 2013d ).

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Occu p a t ion a l Se t t in g

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High -risk con gregate facilit ies are set t in gs wh ere th ere is a h igh r isk of TB t ran sm iss ion ; exam p les m ay in clu d e correct ion al facilit ies , n u rs in g h om es , h om eless sh elters , h osp itals , res id en t ial facilit ies for in d ivid u als livin g with AIDS, an d oth er h ealth care facilit ies . Res id en t s an d em p loyees of h igh -r isk con gregate facilit ies are t es t ed for TB u p on em p loym en t or en t ry in to th e facilit y an d th ereafter at in tervals d eterm in ed by th e r isk of t ran sm iss ion in t h at facilit y. Th is t es t in g is d on e for two reason s :

• To d etect TB in fect ion or d isease in s taff or res id en t s so t h at t h ey m ay be t rea ted

• To su rvey TB t ran sm iss ion in th e facilit y

Ch es t Rad iogr ap h y

An x-ray of t h e ch es t is th e s t an d ard view u sed for th e d etect ion an d d escrip t ion of ch es t abn orm alit ies . A su sp iciou s ch es t m ay be followed by com p u teriz ed tom ograp h y (CT) of th e ch es t to bet ter view if su sp ected of TB.

(Sou r ce : CDC, 2 0 1 3 e .) Ch es t r ad iogr ap h w ith low er lob e cav ity .

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In te r fe r on -Gam m a Re lease As sa y s In terferon -gam m a release as says (IGRAs) are b lood tes t s th at m easu re a p erson ’s im m u n e react ivity to M. tu ber cu losis. Th ere are two IGRA t es t s availab le in t h e Un ited States :

• Qu an t iFERON®-TB Gold In -Tu be (QFT-GIT) • T-SPOT®.TB

To con d u ct an IGRA, a b lood sam p le is t aken from th e p at ien t an d sen t to a labora tory. If t h e p at ien t is in fected with M. tu ber cu losis, th eir b lood cells will release in terferon -gam m a (IFN-γ) in resp on se to th e tes t .

• A p os it ive resu lt su gges t s M. tu ber cu losis in fect ion is likely. • A n egat ive resu lt su gges t s in fect ion is u n likely. • An in d eterm in ate resu lt su gges t s th e tes t can n ot be in terp ret ed .

If th e tes t resu lt is in d eterm in ate, t h e tes t sh ou ld be rep eated with a n ew blood sam p le. Or , an oth er t es t m ay be u sed to t es t for TB in fect ion (su ch as an oth er IGRA or t h e TST).

De te r m in in g Wh ich Te s t to Us e It is u p to t h e h ealth care worker an d th eir o rgan iz at ion to d et erm in e wh ich typ e of t es t sh ou ld be u sed to tes t for TB in fect ion (TST or IGRA). Th ere are ad van tages an d d isad van tages to each typ e of t es t , an d th e d ecis ion of wh ich tes t t o u se sh ou ld be based u p on th e con text . It m ay be u sefu l for th e h ealth care worker to seek gu id an ce from th eir local or s tate h ealth d ep artm en t TB p rogram to d eterm in e wh ich tes t is m os t ap p rop riate . Gu id elin es regard in g tes t in g for TB in fect ion m ay a lso be accessed via th e CDC Divis ion of Tu bercu los is Elim in at ion 's webs ite . Tr ea tm en t

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Tu bercu los is bacter ia u su ally a t tack th e lu n gs , bu t TB bacter ia can at tack an y p ar t o f t h e bod y su ch as th e kid n ey, sp in e, an d b rain . If n ot t reated p rop erly, TB d isease can be fa tal. Not everyon e in fected with TB bacter ia becom es s ick. As a resu lt , two TB-related con d it ion s exis t : la ten t TB in fect ion an d TB d isease. Both laten t TB in fect ion an d TB d isease can be t reated . Tr ea tm en t fo r La ten t TB In fect ion Peop le with laten t TB in fect ion h ave TB bacter ia in t h eir bod ies , bu t t h ey are n ot s ick becau se th e bacter ia are n ot act ive. Peop le with laten t TB in fect ion d o n ot h ave sym p tom s, an d th ey can n ot sp read TB bacter ia to oth ers . However , if TB bacter ia becom e act ive in t h e bod y an d m u lt ip ly, th e p erson will go from h avin g laten t TB in fect ion to bein g s ick with TB d isease. For th is reason , p eop le with laten t TB in fect ion are often p rescribed t reatm en t to p reven t th em from d evelop in g TB d isease. Treatm en t of laten t TB in fect ion is es sen t ial for con t rollin g an d elim in at in g TB in t h e Un it ed States . Becau se t h ere are les s bacter ia in a p erson with la ten t TB in fect ion , t reatm en t is m u ch eas ier . Fou r regim en s are ap p roved for th e t reatm en t of laten t TB in fect ion . Th e m ed icat ion s u sed to t reat laten t TB in fect ion in clu d e:

• ison iaz id (INH) • r ifam p in (RIF) • r ifap en t in e (RPT)

Certain grou p s of p eop le (su ch as p eop le with weaken ed im m u n e sys tem s) are at very h igh r isk of d evelop in g TB d isease on ce in fected with TB bacter ia . Every effort sh ou ld be m ad e to begin ap p rop riate t reatm en t an d to en su re com p let ion of th e en t ire cou rse of t reatm en t for laten t TB in fect ion . More: Treatm en t for Laten t TB In fect ion Tr ea tm en t fo r TB Dis ea se TB bacter ia becom e act ive (m u lt ip lyin g in th e bod y) if th e im m u n e sys tem can 't s top th em from growin g. Wh en TB bacter ia are act ive, th is is called TB d isease. TB d isease will m ake a p erson s ick. Peop le with TB d isease m ay sp read th e bacter ia to p eop le with wh om th ey sp en d m an y h ou rs . TB d isease can be t reated by takin g severa l d ru gs for 6 to 9 m on th s . Th ere are 10 d ru gs cu rren t ly ap p roved by th e U.S. Food an d Dru g Ad m in is t rat ion (FDA) for t reat in g TB. Of th e ap p roved d ru gs , t h e firs t -lin e an t i-TB agen ts t h at form th e core of t reatm en t regim en s in clu d e:

• ison iaz id (INH) • r ifam p in (RIF) • eth am bu tol (EMB) • p yraz in am id e (PZA)

Regim en s for t reat in g TB d isease h ave an in it ial p h ase of 2 m on th s , followed by a ch oice of severa l op t ion s for th e con tin u a tion ph a se of eith er 4 or 7 m on th s (tot al of 6 to 9 m on th s for t reatm en t ).

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It is very im p or tan t t h at p eop le wh o h ave TB d isease fin ish th e m ed icin e, t akin g th e d ru gs exact ly as p rescribed . If th ey s top takin g th e d ru gs too soon , t h ey can becom e s ick again ; if th ey d o n ot t ake t h e d ru gs correct ly, t h e TB bacter ia th at are s t ill a live m ay becom e res is tan t to th ose d ru gs . TB th at is res is tan t t o d ru gs is h ard er an d m ore exp en s ive t o t rea t . Tr ea tm en t Com p le t ion Treatm en t com p let ion is d eterm in ed by th e n u m ber of d oses in ges ted over a given p eriod of t im e. Alth ou gh bas ic TB regim en s are b road ly ap p licable, t h ere are m od ificat ion s th at sh ou ld be m ad e u n d er sp ecia l circu m stan ces (su ch as p eop le with HIV in fect ion , d ru g res is tan ce, p regn an cy, or t rea tm en t of ch ild ren ).

Re sou r ce s

Am er ican Lu n g As s ocia t ion lu n g.org/ lu n g-d isease/ tu bercu los is /

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Cen te r s fo r Disea se Con t r o l an d Pr ev en t ion (CDC) Tu bercu los is : cd c.gov/ tb / TB gu id elin es : cd c.gov/ tb / p u blica t ion s / gu id elin es / Treatm en t .h tm State TB con t rol offices : cd c.gov/ tb / lin ks / tboffices .h tm TB Region al Train in g an d Med ical Con su lt at ion Cen ters (RTMCCs): cd c.gov/ tb / r tm cc.h tm

Fin d TB Re sou r ce s fin d tb resou rces .org

Na t ion al Tu b er cu los is Con t r o lle r s As s ocia t ion (NTCA) / Na t ion al Tu bercu los is Nu rse Coalit ion (NTNC) tbcon t rollers .org

Ne w Je r se y Me d ica l Sch ool Glob al Tu b er cu los is In s t itu te u m d n j.ed u / globaltb

Stop TB Par tn e r sh ip s top tb .org

TB Allian ce: Glob al Allian ce fo r TB Dr u g Dev e lop m en t tballian ce.org/ h om e/ h om e.p h p

Wor ld Hea lth Or gan iz a t ion (WHO) Tu b er cu los is Pr ogr am wh o.in t / tb / en /

Refe r en ces

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Cen ters for Disease Con t ro l an d Preven t ion (CDC). (2013a). Tes t in g for TB in fect ion . Ret r ieved from h t tp :/ / www.cd c.gov/ tb / top ic/ tes t in g/ d efau lt .h tm .

Cen ters for Disease Con t ro l an d Preven t ion (CDC). (2013b). TB tes t in g an d d iagn os is : wh o sh ou ld get t es ted ? Ret r ieved from h t tp :/ / www.cd c.gov/ tb / top ic/ tes t in g/ d efau lt .h tm #wh o.

Cen ters for Disease Con t ro l an d Preven t ion (CDC). (2013c). TB an d p regn an cy. Ret r ieved from h t tp :/ / www.cd c.gov/ tb / top ic/ p op u la t ion s / p regn an cy/ d efau lt .h tm .

Cen ters for Disease Con t ro l an d Preven t ion (CDC). (2013d ). Laten t tu bercu los is in fect ion : a gu id e for p rim ary h ealth care p rovid ers . Ret r ieved from h t tp :/ / www.cd c.gov/ tb / p u blicat ion s / LTBI/ t reatm en t .h tm .

NOTES

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