Tuberculosis: Symptoms, Exposure and Testing Explained

What it involves

MedlinePlus explains that pulmonary tuberculosis, or TB, is a contagious bacterial infection that involves the lungs and may spread to other organs. It is caused by Mycobacterium tuberculosis and spreads through air droplets from the cough or sneeze of an infected person. Most people recover from a primary infection without further evidence of disease, but the infection can stay inactive for years and then reactivate.

Who this is for

• Adults with a cough lasting weeks, especially with fever, night sweats or weight loss.
• People who have been around someone with active TB and want to be tested.
• Patients with diabetes or a weakened immune system who want to understand their risk.
• Adults who need TB screening for a job, school or health care requirement.

What to expect

• Questions about symptoms, how long they have lasted, travel, work and anyone you were exposed to
• A lung exam and a check of the neck for swollen lymph nodes
• A TB skin test or blood test, which a provider can order or arrange, and a chest x-ray ordered elsewhere
• Sputum tests if needed, and a plan that includes the local health department if TB is confirmed

Infection versus active disease

MedlinePlus says the primary stage of TB does not cause symptoms, and that the infection may stay inactive for years. A positive skin test means you have come into contact with the bacteria, not that you have active TB or are contagious. That distinction drives everything that follows: someone with an inactive infection and someone with active lung disease are handled very differently. Your provider explains which category the results point to and what each means for family and coworkers.

Symptoms of active pulmonary TB

When symptoms occur, MedlinePlus lists breathing difficulty, chest pain, a cough usually with mucus, coughing up blood, excessive sweating especially at night, fatigue, fever, weight loss and wheezing. These overlap with many common illnesses, which is why the pattern and duration matter. The persistent cough guide, night sweats guide and unintentional weight loss guide each describe the other possibilities. Coughing up blood needs 911.

Who is at higher risk

MedlinePlus says people at higher risk of active TB or reactivation include older adults, infants, and people with weakened immune systems from HIV/AIDS, chemotherapy, diabetes or immune-suppressing medicines. Risk also rises with time around people who have TB, crowded living conditions and poor nutrition. If you have diabetes, the diabetes management page explains how the practice follows it. Tell your provider about any medicine that lowers immunity, because it affects both testing and how closely you are watched. A regular provider can go over your risk factors and discuss whether testing makes sense, and the primary care office in Port St. Lucie is one place to call for that conversation.

How testing works

MedlinePlus lists a tuberculin skin test, an interferon-gamma release blood test, a chest x-ray or CT, and sputum examination and cultures, with bronchoscopy and biopsy rarely required. The exam may show swollen or tender lymph nodes, which the swollen lymph nodes guide explains. Serenity By A Dr. Sareen lists blood work among its services; imaging and sputum cultures are arranged by referral. People who have had the BCG vaccine can still be skin-tested, and a positive result should be discussed with a provider.

Treatment is long and must be completed

According to MedlinePlus, active pulmonary TB is treated with a combination of usually four medicines, taken for six months or longer, until lab tests show which work best. Skipping doses can lead to drug-resistant bacteria that are much harder to treat, and a nurse or public health worker may watch the person take the pills. Some people stay home or in the hospital for two to four weeks until no longer contagious. Side effects include rash, orange-colored tears and urine, vision changes and liver inflammation.

Reporting, outlook and protecting others

MedlinePlus says providers are required by law to report TB illness to the local health department, which supports contact tracing and care. Symptoms often improve in two to three weeks after starting treatment, and the outlook is excellent when TB is found early and treated quickly. Untreated, it can cause permanent lung damage and spread to other organs. If you have been exposed, ask for testing soon and a follow-up test later if the first is negative. The pneumonia guide covers other lung infections. Swollen lymph nodes in the chest with cough and fever can look similar to another condition, which the sarcoidosis guide describes.

Sources

• MedlinePlus: Tuberculosis (health topic)
• MedlinePlus: Pulmonary tuberculosis (medical encyclopedia)