Tuberculosis (TB) has killed millions of people all over the world throughout history. In 1786, there were 300 TB deaths for every 100,000 individuals reported in Massachusetts alone. Thanks to medical advances and public health efforts, we are now able to prevent and cure most TB. Although we have dramatically decreased the rates of TB in Massachusetts, it has not disappeared.
Anyone can get TB, but most cases in Boston are in foreign-born residents. The reason? Even though the United States now has relatively low TB rates, TB is much more common in other countries and continues to be a serious international public health problem! That is why it is important for everyone to understand what TB is, how to recognize the symptoms, and to understand what can be done to prevent the spread of it.
TB is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidneys, spine, or brain. Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection (LTBI sometimes refer to as sleeping TB) and TB disease (active TB). If not treated properly, TB disease can be fatal.
Some people develop TB disease soon after becoming infected (within weeks). Other people may get sick years later, when their immune system weakens. Overall, about 5 to 10% of infected persons who do not receive treatment for latent TB infection will develop TB disease. For persons whose immune systems are weak, especially those with HIV infection, the risk of developing TB disease is much higher than for persons with healthy immune systems.
Symptoms of TB disease depend on where in the body the TB bacteria are growing. TB disease in the lungs may cause symptoms such as a bad cough that lasts 3 weeks or longer, pain in the chest, or coughing up blood or sputum (phlegm from deep inside the lungs). Other symptoms of TB disease of the lungs include weakness or fatigue, weight loss, no appetite, chills, fever and sweating at night. Symptoms of TB disease in the brain may include headaches, pain when moving the head, stiff neck and fever.
People with latent TB infection do not have symptoms, and cannot spread TB bacteria to others while it remains latent. However, if TB bacteria "wake up" in the body and multiply, the person will go from having latent TB infection to being sick with TB disease. For this reason, people with latent TB infection should be treated to prevent them from developing TB disease. Treatment of latent TB infection is important to control and eliminate TB in the United States. People who have TB disease need to be treated. It is important to not stop taking the medications until treatment is complete. If medication is stopped too soon, the TB germ can come back and become very hard to fight off.
A simple test on the arm (TB skin test) can tell if the TB bacteria are in the body. Additional tests such as a blood test, chest x-ray or sputum (phlegm) test may be needed for some people. People should be tested for TB if they have spent time with someone who has TB disease, are HIV positive or have another medical problem that weakens their immune system, have symptoms of TB disease (fever, night sweats, cough, and weight loss), are from a country where TB disease is common (most countries in Latin America, the Caribbean, Africa, Asia, Eastern Europe, and Russia), live or work somewhere in the United States where TB disease is more common (such as homeless shelters, prison or jails, or some nursing homes) or use illegal drugs.
The Boston Public Health Commission operates a TB clinic that offers both diagnostic and therapeutic services for TB. Healthcare providers can refer their patients to the TB clinic. To schedule an urgent appointment for a suspected tuberculosis case, healthcare providers should contact the TB Clinic Triage nurse at (617) 534-4875.