What Exactly Is Tuberculosis?
Everything You Should Know About TB
By Lisa Hanchey
A recent tuberculosis scare in Lafayette renewed interest in the disease which many considered to be obscure. Yet, this bacterial lung infection seems to have reared its ugly head, and Acadiana residents should be on the alert. After the Office of Public Health learned of a suspected TB case at Lafayette High School in December, more than 200 people were tested at that school, as well as Truman Elementary and Alice Boucher Elementary. Because results are confidential, OPH could not reveal whether any of those tested actually proved positive for TB.
Here at Acadiana LifeStyle, one of our very own staffers knows the serious impact of TB firsthand. Twenty years ago, her beloved grandmother was stricken with the disease, causing her to lose a lung. She had to rely on oxygen for 10 years before finally succumbing to the illness.
Because of the potential for exposure, the entire family was tested. Although the then 8-year-old and her uncle both tested positive, neither developed symptoms. However, they had to take medications for a year as a precaution. Today, both continue to be in good health.
While the source of the TB exposure was unknown, our staffer reveals that her father had worked in Malaysia and Abu Dhabi prior to the family’s diagnoses. In a recent well-publicized case, 15-year-old Alina Sarag from Birmingham, England died last year from the disease after being exposed to a classmate who had been diagnosed with TB. Tragically, one of her five physicians attributed her symptoms to “lovesickness.”
Diagnosis And Treatment
Acadiana LifeStyle got the latest on TB from Acadiana lung specialist Dr. Gary Guidry, whose pulmonology group, Guidry, Brown, Rosson and Broussard, manages the ICU at Lafayette General Medical Center. In his 28 years of practice, he has seen about one or two cases of TB a year. “It’s not rare, but the incidence is very low,” he reports.
What exactly is TB? “It is nothing more than just an infection,” he explains. “It’s not a virus, it’s not a typical bacteria, it’s a myco bacteria, which is a separate class of organism.”
Treatment of myco bacteria generally involves four types of antibiotics – isoniazid (INH), rifampin, pyrazinamide (PZA) and ethambutol. “You have to treat active disease with at least two effective antibiotics, otherwise the organism is very smart and it will develop resistance,” Guidry explains. “Once we have the culture and the sensitivity, then we know what will kill it. After two months, we generally drop down to two of them, which is usually INH or rifampin.”
Because TB is easily treatable, it no longer has the stigma from years’ past. Back in the 1920s through the 1940s, patients from Acadiana who were diagnosed with the disease were taken away to New Orleans and beyond to be quarantined for as long as a year. Nowadays, TB patients are treated with antibiotics at home. “The treatment is six to nine months, and then you are well,” Guidry says reassuringly. “People are still terrified of it, but it’s nothing more than an infection. And, it’s an infection that we have good antibiotics for. The old patients, would rather me tell them that they had syphilis than TB, because it just had such a negative connotation back then.”
One of the things that is scary about TB is that its symptoms mimic those of other sinus and pulmonary conditions. “Because it is a pulmonary infection, patients oftentimes will have cough with sputum that might be yellow, green or brown,” Guidry says. “They may run low grade fever. Right now, if you polled people in Lafayette who had low grade fever, cough and sputum, you’d probably get 50,000 people or more. Everybody is sick right now. So, none of the symptoms are unique.”
Left untreated, TB could lead to weight loss, night sweats and changes in women’s menstrual cycles. In really advanced cases, patients have bleeding from the lungs. “I’ve seen one or two in my practice lifetime where they can have enough coughing up blood to where they actually bleed out from their lungs,” he says. This, of course, is extremely rare.
How It Is Transmitted
Active TB is spread when an infected person coughs, sneezes, laughs or sings, and another person inhales the bacteria from the air. “It’s spread primarily by respiratory droplets,” Guidry explains. “For instance, when a person has active TB coughs, these TB bacilli can float suspended in the air for as long as 20 minutes.”
The majority of persons who have been exposed to an active case of TB and test positive for the disease do not develop symptoms. People who are at highest risk are children and the elderly. “Those that will be exposed to an active disease and then develop TB at that time is very small, maybe one and a half, two percent,” Guidry says. “And, that’s generally in people like the very young, before their immune systems have developed, and the elderly, because their immune systems are not good.”
Higher rates of TB occur in people with immune deficiencies, such as those with HIV infection, cancers and renal failure. Other high-risk groups include IV drug users, prisoners and populations in endemic areas such as Africa, the Western coast of South America and Asia. “One of the reasons that we had such a spike in cases of TB after the Vietnam War was because a lot of Asians came in to the U.S.,” Guidry explains. “That’s one of the reasons why we’ve had some drug-resistant cases of TB. Now, people travel all over the world, so they have a better chance of being exposed to someone with TB.”
Before traveling overseas to high-risk areas for TB, people should contact the local public health unit. Generally, physicians do not prescribe preventative medications for people prior to taking such trips. “If you know you are going to be around a population that has a significant amount of TB, such as if you are going on a mission trip in an area endemic for TB, then you should contact the health unit or a physician,” Guidry recommends.
Testing For Exposure
If you suspect that you have been exposed to TB, then you can take a simple test called purified protein derivative (PPD). These tests are available at the public health unit or at some physicians’ offices. “The doctor takes a tiny syringe and puts a little bit of the PPD under the skin, which is derived from the mycobacterium,” Guidry explains. “So, it’s giving you a little touch of it, but it’s not an active organism. If your body reacts to that, it means that you’ve been exposed to TB.”
Once a person tests positive for TB, a physician will treat the infection with antibiotics. Patients under 35 years of age with no active symptoms receive a six-month supply of one antibiotic to prevent the disease from developing (prophylaxis). Those who initially test negative then change to positive within a two-year period (a recent converter) are also treated with prophylaxis. Patients with an active infection typically take medications for six to nine months.
In Acadiana, most TB cases are referred to the public health unit, which provides medications and follow-up for free. Guidry’s partner, Dr. Billly Rosson, runs the local TB clinic. Patients can also be treated by a private pulmonologist.
At what point should you see a physician? “People should not be overly concerned about having TB unless they know they’ve been exposed to an infectious contact,” Guidry says. “It’s a relatively low, low chance of somebody coming down with TB unless they have been exposed to someone with active TB.” For more information about TB, contact the Office of Public Health at (337) 262-5311.