Male1: It is in the news lately that there is a disease called tuberculosis, which most people thought was a thing in the past and yet, we are hearing about it in the news all over again, how come? Is it coming back or it never went away?
Male2: Tuberculosis never left us. Tuberculosis is a serious type of bacterial infection in the lung which can lead to very serious consequences. Tuberculosis at one point was being screened and treated very aggressively and during that period in our not so distant history, tuberculosis infections dropped very nicely, but they never told it clear. We are now seeing a resurgence of tuberculosis, not so much because we are not doing the screening properly but because the bacteria that causes the infection has evolved to the point where it is resistant to some of the common medications we used to use to treat this very serious infection.
Male1: Can babies be born with tuberculosis?
Male2: Babies can be born with tuberculosis if their mother has tuberculosis. That is why all pregnant women are screened for tuberculosis during their pregnancy. If babies are born with tuberculosis, there are very specific types of treatments and approaches for babies. More commonly, children develop tuberculosis after being exposed to another adult with tuberculosis some time after they are born.
Male1: So if you travel to different parts of the world, there are tuberculosis in certain parts of Asia and the like, you would have be very, very concerned about this, is that true?
Male2: There are parts of these world where tuberculosis is almost epidemic. We would say it is endemic. This means that there are many cases of tuberculosis and it means that when you travel to those areas of the world, certain precautions and certain additional vaccinations are recommended. We also would test people who are coming from those parts of the world to make certain that they are not bringing tuberculosis into the country and potentially spreading it to other people.
Male1: So if I get exposed to tuberculosis today, whatever the reason, a test cannot be done that day, can it?
Male2: There are several different types of test for tuberculosis, but the important thing to realize is that none of these tests become positive immediately. It takes a period of time for the body to develop the reaction so that the tuberculous test can be shown positive. If there is a suspicion of exposure to tuberculosis, we do the test as soon as that suspicion occurs, but if we are still suspicious, we would repeat the test three months later just to be certain that the patient has not been exposed to the bacteria.
Male1: So if you are exposed to someone in the same area, does not mean you are going to get it, is that true?
Male2: That is correct. Tuberculous is contagious certainly, but not 100%. IT takes fairly close contact to someone who is actively shedding the bacteria, in other words, the person needs to be coughing, congested, they need to appear to sick in order to be able to spread the bacteria. That bacteria is spread through coughing. As the patient coughs, the bacteria goes into the atmosphere, goes on a person's hands, their clothes. It is inhaled by another person and that is when the person is infected with the bacteria.
Male1: This thing we see sometimes with kids coming up all the time, they are going to think, BCG. What is BCG?
Male2: BCG is a vaccination that helps decrease the risk of serious tuberculosis infection. It is not 100% effective and that is why we do not use it here. But in areas where tuberculosis is endemic, where there are many cases of it, the protection that BCG affords the population is greater than any risk of the vaccination itself, and so there are areas of the world where BCG is given routinely to children to try to minimize their risk of developing the infection.
Male1: If someone had a BCG injection, their test of tuberculosis might be false positive?
Male2: Absolutely. BCG mimics the disease itself in the way the body's immune system reacts to the vaccine. Therefore, if we were to turn around and test that patient in a routine way for tuberculosis and he had been given BCG some years before, that test may be positive without the patient actually having the infection. There are certain parameters that we use to try to identify the patients that are truly positive even if they had BCG versus those where the tuberculous test is positive simply because of the vaccination and not because of exposure to the disease.
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