Tuberculosis is nothing to sneeze at.
By Kelly A. McCann
Ah, spring—my favorite time of year. I dearly love the fragrant, white blossoms on the pear trees, the photo-worthy fields of bluebonnets, and all those brightly colored azaleas, tulips, and daffodils. I enjoy the blustery days and the resulting music from the chrome and bamboo wind chimes on my patio. And I even like the cold fronts and thunderstorms that blow through our region during this season.
But all the flowers and wind bring an unwelcome visitor: pollen. Yes, springtime means increases in tree pollen, grass pollen, weed pollen—the whole pollen family. Most days, the pollen levels are extremely high, or simply high, or, at best, moderate (thank God for moderate).
And on all of those days, I feel miserable.Not just sneezy, but MIS-ER-A-BLE. Runny nose, itchy/watery eyes, wheezing, sinus headaches, blah, blah, blah. My allergies to the various pollens are so severe they also bring about an annual bout of bronchitis.
I don’t have a fever or night sweats, and darn it, there’s been no associated weight loss, but all the coughing and fatigue I’ve been experiencing due to my current case of bronchitis this spring is turning this woman’s fancy to not-so-fanciful thoughts of tuberculosis.
Tuberculosis (TB) is a common but potentially serious, infectious disease caused by Mycobacterium tuberculosis. The TB bacteria can infect various bodily organs and systems such as the kidneys, the bones, the skin, or the nervous system, and infection of these organs causes a myriad of symptoms. However, TB most often involves the lungs (75 percent of active cases are pulmonary).
The classic symptoms of pulmonary TB are a chronic cough (lasting at least three weeks) that produces blood-tinged sputum, chest pain, fever, night sweats, weight loss, pallor, and fatigue or weakness.
TB is an airborne illness that is spread when persons with active TB disease cough, sing, talk, sneeze, or spit, thus disseminating particles containing the bacteria into the air. Those particles, called droplet nuclei, can remain suspended in the air for several hours depending upon the environment. When the droplet nuclei are inhaled by another person, the bacteria first settles in the lungs, and at that point, the person is considered to have TB infection, not active TB disease.
In about 90 percent of infection cases, the TB remains inactive. The immune system helps to contain the TB in the lungs by forming nodules, or tubercles, around the bacteria, encasing it. This keeps the bacteria from doing further damage to the infected person’s body and prevents transmission to others. This is called “latent TB” and does not cause any symptoms or health concerns.
In most persons with latent TB, the bacteria can remain inactive for a lifetime without ever causing illness. However, it is usually recommended those persons receive treatment with an antibiotic medication to ensure they never develop TB disease.
How does latent TB become active TB? Active TB disease occurs when the TB bacteria overcome the immune system’s defenses (they break out of the tubercles) and start to multiply. The bacteria can then spread throughout the lungs, and potentially to other bodily organs, causing damage, loss of function, permanent disability, and even death.
How does one prevent TB? The best way to elude TB infection is to avoid people with TB. This sounds harsh, but studies have shown those most at risk for TB infection are those persons who have close and prolonged contact with persons who have TB disease. So if your family member, lover, roommate, or co-worker has TB disease, you’ll likely be exposed to the airborne bacteria for long periods of time, and that exposure increases your chances of infection.
People who live in congregant living facilities, like prisons, barracks, or dormitories, are also at increased risk for TB infection due to sharing the air with so many other people.
And it is also risky to spend lots of time in poorly ventilated areas where the bacteria can linger in the air for longer periods of time. Remember, fresh air and sunshine are great weapons in the battle against TB infection.
As you might expect, persons with weakened immune systems from substance abuse, malnutrition, or HIV, for example, are at higher risk for TB infection. And if they do become infected, their impaired immune systems make the progression to TB disease more likely. (In fact, TB disease is considered an AIDS-indicating illness in people infected with HIV.) Therefore, TB testing is strongly recommended for persons living with HIV/AIDS.
TB testing is done in a variety of ways. The definitive diagnostic test involves microscopic examination of sputum. If that is not possible, a probable diagnosis can be obtained using either chest X-ray or tuberculin skin test methods. Your doctor can inform you of the best testing method for you depending upon your history, your symptoms, and the health of your immune system.
Despite the serious nature of TB disease, successful treatment can be achieved in most cases. However, it can be a difficult course of treatment requiring multiple antibiotic medications that must be taken for a period of several months to one year, and possibly even longer for HIV-positive persons. Since TB is an airborne disease, treatment can be mandated and enforced by public health officials, for the protection of all citizens.
Kelly A. McCann is the chief executive officer of AIDS Foundation Houston. To learn more about TB and other opportunistic infections, including HIV, contact AFH at 713/623-6796 or AIDSHelp.org.
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