Tuberculosis not just a Third World disease

Though many see tuberculosis as a Third World problem, it can strike closer to home.

The Cape Girardeau County Public Health Center has seen one active case of TB per year in the county and is currently managing 34 latent, non-contagious tuberculosis infections with antibiotic treatment, according to Vanessa Landers, the center's communicable disease coordinator for the center.

With World TB Day and Tuberculosis Awareness Day in Missouri recently passing on March 24, the Health Center wants the public to be aware of tuberculosis infections, both in the county and around the world.

In 2009, Missouri had 80 cases of active tuberculosis infections according to the Department of Health and Senior Services. An active case means a person infected actually became ill. An estimated 3,300 people had latent infections.

Tuberculosis symptoms often begin in the lungs with a persistent cough. The disease is also known to cause fever, night sweats and loss of appetite. Eventually, the damage to the lungs done by an untreated case of tuberculosis can result in pneumonia and death.

There is currently no effective vaccine for tuberculosis available in the United States. According to the Centers for Disease Control and Prevention, BCG, or bacille Calmette-Guerin, is often given to infants and small children in other countries where TB is common. But the vaccine does not always protect people from getting TB.

Carol Jordan, infection and prevention control coordinator for Southeast Missouri Hospital, said employees are tested yearly, and the hospital isolates patients suspected of having tuberculosis.

Jordan said latent infections seem common for the area, but often patients who test positive at the hospital are referred to the health center for treatment, so many of the same cases are likely being seen by both. She said she knew of cases where a hospital stay was required to treat patients for symptoms of tuberculosis, but was not aware of any local cases resulting in death or transmission to family members.

Aside from hospitals, some employers, schools, federal agencies and prisons require testing for tuberculosis at least once a year. Landers said the general population should be tested at least once annually, especially if they know they have been in contact with someone who has an active case.

According to Landers, a lot of doctors don't recommend testing, and infections in the U.S. are not frequent, so people no longer consider tuberculosis much of a concern.

Strains of antibiotic-resistant tuberculosis have surfaced worldwide in recent years, according to a recent report from the World Health Organization, which estimates one in four strains don't respond to treatment.

The latent tuberculosis cases are still a cause for concern, Landers said. In a latent infection, the disease lies dormant, but if left untreated could eventually turn into an active case in some individuals.

"There is an antibiotic available, but when people don't feel sick, they feel that it's not important and do not seek treatment," she said.

"People in another scenario begin treatment but then stop it. Like with any other antibiotic, you can become resistant. We are seeing TB germs now that don't respond to proven methods of treatment. It's very important to finish the treatment."

According to Landers, some people undergoing antibiotic treatment locally had been traveling, while others had not. Jordan said the hospital tends to see more cases of active tuberculosis in people who may have had their immune system compromised by medications or diseases.

LOCAL LOOK

Gayla Tripp, RN, BSN, CIC, Infection Control Coordinator at Saint Francis Medical Center, took time to answer the following questions in an e-mail interview.

Question: Tuberculosis seems like a third world disease, but there were 80 active cases and roughly 3,300 latent cases in Missouri last year. What interaction do you have with TB? What do you think the public should know about it? How can we protect ourselves against this communicable

and deadly disease?

Answer: First of all, I wanted to give some basic information because TB can be confusing, even for those with backgrounds in health care.

Latent TB infection simply means that you have inactive TB germs in your body. This is usually diagnosed through a positive TB skin test (PPD). You are not contagious and you probably will not have any symptoms of TB disease. However, you will probably be prescribed medication to prevent you from developing active TB in the future.

TB disease means that you have active TB germs in your body. You probably have symptoms of TB disease. If you have TB disease of the lungs or throat, you are contagious to others. TB can also affect other parts of the body, such as the brain, the kidneys, or the spine. A person with TB can die if they do not get treatment.

For those with a positive TB skin test, the next steps for you to take is to get a chest x-ray and/or a sputum sample for TB. These tests will assist your doctor in determining if you have an active case of TB. The doctor may also ask you if you have any signs and symptoms of TB. Classic signs and symptoms of TB include feelings of sickness or weakness, weight loss, fever, and night sweats. The symptoms of TB disease of the lungs also include coughing, chest pain, and the coughing up of blood. Symptoms of TB disease in other parts of the body depend on the area affected.

Q: How often does the hospital test for TB?

A: Saint Francis Medical Center screens for TB upon hire, annually and after any known exposure.

Q:Who gets tested?

A: All employees are screened for TB. We may also test patients who come in with TB symptoms.

Q:Does the hospital use the PPD test?

A: Saint Francis uses a PPD skin test and a quantiferon gold (blood) test.

Q?What can someone do to avoid contracting TB?

A: If you have been in contact with someone with an active case of TB, you need to notify your physician or local health department. Most likely, they will recommend TB testing for you.

Q:I read that there is no fail-safe TB vaccination for adults, although there is one that seems to be effective for children. Is this the case, and what can you tell me about vaccinations?

A: BCG is a vaccine for TB disease. BCG is not generally recommended in the United States, though it is used in many other countries.

What can you tell me about drug resistant TB? Is it a cause for concern here?

A: Multidrug-resistant TB (MDR TB) is TB that is resistant to at least two of the best anti-TB drugs, isoniazid and rifampin. These drugs are considered first-line drugs and are used to treat all persons with TB disease. Resistance to anti-TB drugs can occur when these drugs are misused or mismanaged. Examples include when patients do not complete their full course of treatment; when health-care providers prescribe the wrong treatment, the wrong dose, or length of time for taking the drugs; when the supply of drugs is not always available; or when the drugs are of poor quality. Drug resistance is more common in people who do not take their TB medicine regularly, do not take all of their TB medicine as told by their doctor or nurse, develop active TB disease again after having taken TB medicine in the past, come from areas of the world where drug-resistant TB is common, or have spent time with someone known to have drug-resistant TB disease. The most important thing a person can do to prevent the spread of MDR TB is to take all of their medications exactly as prescribed by their healthcare provider. No doses should be missed and treatment should not be stopped early. Patients should tell their health care provider if they are having trouble taking the medications. If patients plan to travel, they should talk to their health care providers and make sure they have enough medicine to last while away.