The Truth About Tuberculosis
By Andrew B. Chung, M.D., Ph.D.
Last Revised: 06/09/06
Dr. Chung is a board-certified subspecialist in Cardiology and also in Internal
Medicine (a.k.a. Adult Medicine) who received his training at Emory
Affiliated Hospitals, which included Grady Memorial
Hospital, where hundreds of cases of tuberculosis have been and still are
being treated every year. He has had experience with tuberculosis
in both adults and children and has even had experience with treating
the dreaded multi-drug-resistant tuberculosis (MDR-TB).
Historical Perspective:
Tuberculosis (TB) is an *old* disease. There
is evidence from the mummified remains of the pharaohs of Egypt
that the germ that causes it (Mycobacterium tuberculosis or MTb)
was around even during their time. It seems to make a resurgence
whenever there are more human hardships such as overcrowding,
poverty, poor sanitation, starvation and war. The indigent population
of any city is usually the first people to be affected by such
a resurgence. Keep them healthy and the rest of the population
will have minimal rates of TB.
What is it exactly?
*Active* tuberculosis happens when one is infected with the germ, MTb, and
it causes things like fever, cough, nightsweats and dramatic weight
loss. It is the weight loss that earned this disease the slang
name "consumption." However, you do *not* have
to have all the symptoms to have active tuberculosis, just the infection and feeling sick.
Sometimes the infection may move from the lungs and cause more
serious problems elsewhere in the body. A person with active tuberculosis
is contagious only when there is active lung infection and detectable
MTb in what the person coughs up. Active tuberculosis can be lethal if untreated. Inactive tuberculosis, where the
body has walled off sites of infection before developing any symptoms is
detected by a special test (PPD skin test) and may still require treatment to
prevent the later development of active disease.
This is scary stuff. Am I over-reacting?
Yes and no. Yes if you think TB is as contagious
as Flu and as lethal as Ebola, Hantavirus, Bubonic Plague et cetera.
No if you are simply concerned about whether you
or those you care about have had significant exposure to someone
with active tuberculosis. Significant exposure is having been
in close proximity in an indoor setting with the affected individual
for more than a few hours or recalling being coughed on by same. All this
means is that there is a possibility of later developing active tuberculosis.
How large this possibility is depends on many factors such as the degree
of exposure and health of those concerned.
When there has been significant exposure, medications can be given
to prevent (prophylaxis) the development of active tuberculosis. These medications
are not without risk of side effects which primarily involve the liver so
the risks of prophylaxis has to be weighed with the true risk of developing
active tuberculosis. Though we have special antibiotics to cure active tuberculosis,
treatment last for several regimented months keeping up with several pills so we
prefer prophylaxis whenever feasible.
A case can be made for starting one of the effective prophylactic
anti-TB medications (INH) until one is more certain that an active
infection will not occur (a negative repeat PPD skin test in
about 4-6 weeks ). This is especially important if there are
any underlying medical conditions that would make someone more
susceptible to developing active tuberculosis. For these and additional considerations, the affected individuals should consult their primary physician.
Bottomline:Anyone what has had significant exposure to active tuberculosis
should notify their primary physician so that s/he can address the above issues.
Where can I go to find out more on-line information?
I have personally reviewed and found the following
websites both informative and accurate about tuberculosis:
http://www.cpmc.columbia.edu/tbcpp/abouttb.html#q7
http://www.pbs.org:80/ppol/tbfacts.html
http://www.cdc.gov/nchstp/tb/dtbe.html
And of course, you can always email me at andrew@heartmdphd.com
with any questions about tuberculosis that have not been answered
by the above on-line resources.
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