Learn About Tuberculosis

Host: It's in the news lately, there's a disease called tuberculosis, which most people thought was a thing in the past, and yet we're hearing about it in the news allover again, how come? Is it coming back or it never went away? Guest: 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're not doing the screening properly, but because the bacteria that causes the infection has evolved to the point where it's resistant to some of the common medications we used to use to treat this very serious infection. Host: Can babies be born with tuberculosis? Guest: Babies can be borne with tuberculosis if their mother has tuberculosis. That's 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, sometime after they are born. Host: So if you travel to different parts of the world, there are tuberculosis in certain parts of Asia and what not, you have to be very, very concerned about this, is that true? Guest: There are parts of this world where tuberculosis is almost epidemic. We would say it's 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're not bringing tuberculosis into the country and potentially spreading it to other people. Host: So if I get exposed to tuberculosis today, whatever the reason, a test can't be done that day, can it? Guest: There are several different types of tests 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're still suspicious, we would repeat the test three months later just to be certain that the patient has not been exposed to the bacteria. Host: So if you are exposed to someone in the same area, doesn't mean you're going to get it, is that true? Guest: That is correct. Tuberculous is contagious certainly, but not a 100%. It takes fairly close contact to someone who's actively shedding the bacteria. In other words, the person needs to be coughing, congested, they need to appear 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's inhaled by another person and that's when the person is infected with the bacteria. Host: This thing we see sometimes with kids coming up all the time, they are going to think, BCG. What's BCG? Guest: 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. Host: If someone had a BCG injection, their test for tuberculosis might be false positive? Guest: 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 the routine way for tuberculosis and he had been given BCG some years before, that test maybe 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. Host: Years ago, we used to get this three or four Papule called the TB Tine, and they don't do anymore. It was such an easy thing to -- how come they stop doing it? Guest: It's unfortunate, because it truly was a quick and easy and pretty much painless test, especially for children, the problem was it wasn't reliable. When we took a look at the data, we found that the Tine test missed many cases of tuberculosis. A test that doesn't pick up the disease that we're looking for is not a test that's worthwhile. Nowadays we use a test called a PPD, the PPD is a test where the serum is actually injected with a very small needle directly under the skin, raising a bubble. That bubbles get smaller over the first 24 hours. If the patients actually has been infected with the bacteria, he will then get a raised red mark at the area where the bubble had previously been. That raised red mark is seen between 48 and 72 hours after the test is applied. Host: If you have a test that shows to be positive and the doctor takes a chest X-ray, he does the same with TB, it sends you a sort of like list and he likes to give you some treatment just to prevent you from getting the disease, is that true? Guest: There are two different types of disease from TB, that's tuberculosis infection and tuberculosis disease. The first stage of the process is tuberculosis infection. Once the bacteria enters the body, the body is infected. And that's where the test first becomes positive. The body fights the infection. Many times the body can fight the infection effectively so that tuberculosis never spreads to the lungs or the other organs. If the tuberculosis spreads to the lungs and the other organs, that's tuberculosis disease, and that's when the chest X-ray shows the changes of tuberculosis that we commonly expect. The difference is that if the person has tuberculosis infection, the treatment is different than if the person has tuberculosis disease. The antibiotics that we use are somewhat different, and the length of treatment is also different. So we need to differentiate between these two types of infection in order to know how to properly treat the patient. The other thing to realize is that a person with tuberculosis infection is not contagious. The only person who is contagious is the person with a full lung disease, not the infection itself. Host: Some doctors have took recent converter which implies, you just have to give a little bit of protection and it doesn't help to disease, is that true? Guest: Yes. The recent converter is the same as the person with tuberculosis infection. A recent converter or a person with tuberculosis infection has a positive test as a normal chest X-ray, that person needs only one medication for a period of nine months. Host: What medicine is what? Guest: The medicine we commonly use is called Isoniazid, the abbreviation is INH, and most of use the abbreviation, it's a whole lot easier to say. Host: If for some reason, the treatment with INH, you still get a lossy tuberculosis for a period of nine months? Guest: Well, you certainly watch the child carefully, you use INH for a period of nine months. You supervised the child to make sure that they're getting the medication properly. You do a physical examination on the child monthly at least for the first few months to make sure no side effects are occurring, and to make sure the patient is responding well to the treatment. Host: Doctor, probably, we'll check all close contacts that the kid was converting to see the resources. Guest: Absolutely! Since the child has gotten the tuberculosis from somebody else, he would be important to try to find out who gave the child the infection and who else may have developed the infection in that same circle of individuals. Host: Thank you very much.