Tuberculosis

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American Thoracic Society

PATIENT EDUCATION | INFORMATION SERIES

Who Gets Tuberculosis (TB) Infection and TB Disease?


Tuberculosis (TB) is an infection from a type of bacteria call
Mycobacteria tuberculosis. It is different than many common bacteria
as it is very slow growing and may not cause symptoms for a long
time after a person gets infected. Anyone can get TB, but those who
are more exposed and/or who have an immune system that is less
able to fight it are at higher risk.

Greater exposure can occur when people are exposed to of weeks, months, or sometimes years. Symptoms are often
others who are coming from areas where many people are initially mistaken for a smoker’s cough, allergies, or chronic
infected with TB. This would include persons from countries bronchitis from a lingering cold or flu infection. Classic
with high rates of TB (often poor countries), those living symptoms of TB in the lungs include:
with an infected person in close quarters either in a home or ■ Cough lasting more than three weeks
prisons, and healthcare workers who may have been exposed ■ Unexplained weight loss
to someone with TB.
■ Low-grade fever
People who have less ability to fight the disease would ■ Night sweats
include those with immune-related disorders, such as HIV If you have these symptoms, especially if you think you may
infection, those taking immunosuppressive medicine, such as
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have been exposed to someone with TB or have an immune


chemotherapy or medicines for auto-immune conditions. and system that is less able to fight disease, you should check with
even people who have conditions such as diabetes or kidney your healthcare provider. Although these symptoms are initially
disease are at higher risk of developing active TB disease. mild, without out treatment they usually get much worse.
Progression from an asymptomatic infection (latent or
“sleeping” TB) to active disease occurs in only about 10% of
How is TB diagnosed?
people, but treating it generally prevents active disease from Given that people with latent TB infection have no symptoms,
occurring. This fact sheet talks about TB infection and disease. infection must be diagnosed using a screening test. This can
be either a tuberculin skin test (TST) or a blood test called an
What is the difference between TB infection interferon gamma release assay (IGRA). The TB skin test is also
(i.e., latent or “sleeping” TB) and TB disease called a Mantoux test or a PPD skin test because the material
(i.e., active TB)? used in the skin test is called purified protein derivative (PPD).
TB infection is when the TB mycobacteria infect a person The TST/PPD is a small amount of fluid injected under the skin
but don’t initially cause that person to feel sick. The immune of the arm. It is interpreted by a medical provider 2-3 days later.
system in 90% of people will control, and sometimes even A positive test will be red and raised. The IGRA blood test done
eliminate the infection. However, the TB infection can persist on a tube of blood. These tests detect the immune response our
for many years or even decades. Then when a person’s body mounts to components of Mycobacterium tuberculosis,
immune system becomes weaker (i.e., they start a new the bacteria that causes TB. A positive result indicates that a
medicine, they develop diabetes, or other conditions), the person has been infected, i.e., they have latent TB infection,
immune system is no longer able to control the infection and with the tuberculosis bacteria at some point in his or her life.
the person develops TB disease. When a person develops TB TB disease is suspected clinically when a person presents
disease, they feel sick and develops symptoms of TB. We can with the symptoms mentioned above usually together with
diagnose and cure both TB infection and TB disease. However, abnormal findings on a chest x-ray. If TB disease is suspected,
it is safer to treat and cure the TB infection before a person the person should be isolated from the public until the
gets sick with TB disease. TB infection is very common – 1/3 diagnosis is made and treatment is started as he or she can be
of people in the world likely has TB infection, but only a small contagious and spread Mycobacterium tuberculosis to others.
proportion will progress to TB disease.
TB disease is often diagnosed by microscopic examination of
What are the signs and symptoms of TB disease? three separate samples of coughed-up sputum (phlegm) often
Symptoms are usually mild and tend to present over a period collected on different days. The sputum is first looked at under a

Online version updated December 2021


ATS Patient Education Series © 2021 American Thoracic Society
www.thoracic.org
American Thoracic Society

PATIENT EDUCATION | INFORMATION SERIES

microscope using a special dye (acid fast bacillus (AFB) stain) to or having sex. Covering the mouth and nose when coughing
see if any tuberculosis bacteria can be found. It can be difficult is an important way to stop the spread of TB and other
to see the TB organisms so this test is not always positive as airborne diseases. If you have TB disease and are coughing,
there may be only a small number of bacteria. Therefore, a it is important to wear a mask and limit contact with others
culture is always needed in addition to the AFB test. Sputum until your healthcare provider tells you that you are no longer
cultures are done to grow the bacteria to confirm the diagnosis contagious while on treatment. Seeking care right away and
and determine the best combination of drugs for treatment. finding out you have TB is the best way to stop its spread since
TB grows very slowly so they may take up to 2 months to grow. treatment of disease helps you not be contagious, decreasing
Newer tests use sputum to detect the DNA of the TB organism. transmission. Treatment of latent TB prevents the spread of
If TB DNA is present, this means a person has TB disease. TB by stopping it before contagious disease develops.
Flexible bronchoscopy, putting a small tube with a camera into
the lungs, is sometimes needed to obtain lung sputum samples Authors: Monica Campo, MD, MPH, L. Masae Kawamura MD
if a patient is unable to produce sputum. (To learn more about Reviewers: Christopher Berger MD, Dean Schraufnagel MD,
flexible bronchoscopy, see the ATS Patient Information Series Marianna Sockrider MD, DrPH
Previous reviewers: Charles Dela Cruz, MD, PhD, Hrishkesh
“Flexible bronchoscopy” at www.thoracic.org/patients.)
Kulkarni, MD, Jeffrey Starke, MD
In addition to these tests, chest X-ray and CT chest imaging
are performed to evaluate for any lung abnormalities. While
TB usually occurs in the lungs it can infect any organ in the R Action Plan
body. If TB is suspected in a different part of the body, a
different sample or a tissue biopsy may be needed. 4 Symptoms of TB should prompt you to see your
healthcare provider without delay.
How is TB treated?
Latent TB infection is usually treated with 1 or 2 oral 4 You should ask about the possibility of TB because the
diagnosis may not be on your healthcare provider’s
medications (rifampin, rifapentine, and isoniazid). It greatly
mind.
reduces the risk of developing active TB later in life. Preventing
the development of active disease stops TB transmission to 4 Contact your healthcare provider if you have had
other people. Current treatment options include daily isoniazid exposure to a person with TB. You should also contact
(shortened to INH) for six to nine months, daily rifampin your provider if you have symptoms of TB and if you
(shortened to RIF) for 3 to 4 months, or weekly isoniazid and have lived, worked, or had prolonged travel in a country
rifapentine for 12 doses. Researchers are currently doing or area where TB is common. For example, Asia, Africa,
studies to find safer and shorter treatment plans so these Eastern Europe, Central and South America are endemic
medication combinations may change in the future. for TB, as are some inner cities where the poor and
homeless congregate.
Currently active TB is treated with at least 4 anti-TB
4 TB disease is often preventable! Knowing your “TB
medications for 2 months followed by 2 drugs for 4 months
status” is important because, if needed, treatment of TB
for total of at least six months. If it involves certain organs or is
infection will kill the few TB bacteria in your body before
more advanced, the treatment is usually longer. This can mean
it progresses into active TB disease.
taking 6-12 pills every day! TB disease can be quite difficult
to treat so healthcare workers must monitor patients closely Healthcare Provider’s Contact Number:
with repeat chest x-rays, sputum tests, and exams to make
sure they are getting better. Many people with TB disease
find this difficult without the support of workers trained in
providing directly observed treatment (DOT). DOT is the
standard for treating TB worldwide and is when a healthcare Resources:
worker or trained person watches a person take their anti-TB American Thoracic Society
medicines every day. DOT helps detect side effects early and • www.thoracic.org/patients/
prevents missed doses and breaks in treatment that reduce – Flexible bronchoscopy
the benefit of treatment and can lead to drug-resistant strains World Health Organization
of bacteria. New, shorter, treatments for active disease may • http://www.who.int/tb/en/
also be coming in the near future. Your healthcare provider U.S. Centers for Disease Control
or infectious disease specialist will help decide what the best • https://www.cdc.gov/tb/
treatment plan is for you. Sometimes a treatment needs to U.S. National Library of Medicine–Medline Plus
be adjusted based on how sensitive the bacteria is to various • https://medlineplus.gov/tuberculosis.html
antibiotics.
This information is a public service of the American Thoracic Society.
How can I prevent getting or spreading TB? The content is for educational purposes only. It should not be used as a
substitute for the medical advice of one’s health care provider.
TB is spread by tiny airborne droplets created by coughing.
It is not spread by sharing food, utensils, drinks, touching,

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