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Tuberculosis

Tuberculosis is an airborne infectious disease caused by the bacterium Mycobacterium tuberculosis that usually affects the lungs, although other organs and tissues such as the kidney, spine and brain can be affected as well. Fortunately, TB in these parts of the body is usually not infectious. TB can be spread by coughing, sneezing, laughing or singing. Repeated exposure to someone with TB disease is generally necessary for infection to take place.

  • In 2007, preliminary data shows the total number of new cases of tuberculosis in the United States (13,293) decreased for the fifteenth consecutive year, resulting in the lowest rate for reported TB cases (4.4 per 100,000) since national surveillance began in 1953.
  • In 2006, Non-Hispanic Asians had the highest TB case rate (25.6 per 100,000) followed by Non-Hispanic Native Hawaiians/Pacific Islanders (13.6 per 100,000), African Americans (10.2 per 100,000), Hispanics (9.2 per 100,000), American Indian/Alaska Native (7.4 per 100,000) and Non-Hispanic Whites (1.2 per 100,000).
  • For the fifth consecutive year, over half of new TB cases (57%) were in foreign-born persons. The case rate among foreign-born persons was 9.5 times higher than among U.S. born persons (22.0 vs. 2.3 per 100,000). More than half (56%) of the foreign-born cases in 2006 were reported in persons from Mexico, the Philippines, Vietnam, India and China.
  • In 2005, 646 people died of tuberculosis, a decrease of 1.7% from the 657 deaths in 2004.
  • The World Health Organization (WHO) estimated that there were 9.2 million new cases of active TB and approximately 1.7 million deaths resulted from TB in 2006 worldwide.
  • The AIDS epidemic is considered a major factor in the increase of TB cases. HIV’s suppression of the immune system both opens the door to new active infection and permits activation of latent disease. One-third of the increase in global TB cases over the last five years can be attributed to the HIV epidemic.
  • It is important to understand that there is a difference between being infected with TB and having TB disease. Someone who is infected with TB has the TB germs, or bacteria, in his/her body. The body’s defenses, though, are protecting them from the germs, and they are not sick. Someone with TB disease is sick and, if not treated, will spread the disease to an average of 10 to 15 people each year. A person with symptoms of TB disease or evidence of infection needs to be seen by a physician.
  • Several symptoms are associated with TB disease, including prolonged coughing (sometimes including coughing up of blood), repeated night sweats, unexplained weight loss, loss of appetite, fever, chills, and general lethargy. Because these signs may be indicative of other diseases as well, a person must consult a physician to determine the cause of these symptoms.
  • The simplest way to find out if you have a TB infection is to get a TB skin test, widely available at clinics or at a doctors’ office. The preferred Mantoux test should be used for screening and diagnosis. A small amount of testing material is injected under the very top layers of skin on the forearm. In 48 to 72 hours the test is read by a trained person, usually a nurse or doctor. If the test is significant, then you probably have TB infection and the doctor will run more tests, such as a chest x-ray, to determine whether you have active TB disease. In some groups, such as the elderly or those with impaired immunity, the skin test may not be significant in the presence of TB infection.
  • Tuberculin screening programs should be targeted to each community’s high risk groups. It is extremely important that these screening programs undergo regular evaluation of their usefulness.
  • Tuberculin skin-testing is recommended for diagnostic screening among the following high-risk groups:
    • persons with signs, symptoms, and/ or laboratory abnormalities suggestive of clinically active TB
    • people who interact with persons with active TB disease
    • poor and medically under-served people
    • homeless people
    • those who come from countries with high TB incidence rates
    • nursing home residents
    • alcoholics and intravenous drug users
    • people with HIV or AIDS, or who are otherwise immune-suppressed
    • people in jail or prison
    • health care workers and others such as prison guards who work with high-risk populations
    • teachers who come in contact with high-risk populations, although this decision is made by local health authorities
  • The FDA recently approved QuantiFERON-TB Gold, a new TB blood test. It is cleared for use in detecting both TB and latent TB infection and shows several potential advantages over the traditional skin test including a smaller chance of being affected by BCG vaccination, less error associated with giving and reading the skin test, and a shorter wait for the results (less than 24 hours).
  • Most TB can be cured. There are drugs that can kill the germs that cause TB, but a person must continually take the prescribed medication, usually for nine months. Some patients require a year or more for successful treatment.
  • If a person stops taking the medicine before completing treatment, the germs may come back more resilient than before. Surviving bacteria may become resistant to the drugs used to treat TB, causing multi-drug resistant tuberculosis (MDR TB).
  • Extensively-drug resistant tuberculosis (XDR TB) is a strain of TB with extensive resistance to second-line drugs. XDR TB has emerged worldwide as a threat to public health and TB control, raising concerns of a future epidemic of virtually untreatable TB. During 1993-2002, patients with XDR TB were 64% more likely to die or have treatment failure.
  • Because it is difficult for some people to successfully complete their tuberculosis treatment, several innovations have been developed. One of these is the use of incentives and enablers, which may be transportation, tokens or food coupons that are given to patients each time they appear at the clinic or doctor’s office for treatment. Incentives and enablers are combined with the use of directly observed therapy (DOT). DOT is a system of treatment in which the patient is administered his or her medication by a nurse or health worker and is observed taking the medication.
  • In June 1998, the U.S. Food and Drug Administration approved the first new drug for pulmonary tuberculosis in 25 years. The drug, rifapentine (Priftin), was approved for use with other drugs to fight TB. One potential advantage of rifapentine is that it can be taken less often in the final four months of treatment—once a week compared with twice a week for the standard regimen.

 

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