Pulmonary Disease Services FAQs

A person with TB infection will have no symptoms. A person with TB disease may have any, all or none of the following symptoms:

• A cough that will not go away
• Feeling tired all the time
• Weight loss
• Loss of appetite
• Fever
• Coughing up blood
• Night sweats

These symptoms can also occur with other types of lung disease so it is important to see a doctor and to let the doctor determine if you have TB.

It is also important to remember that a person with TB disease may feel perfectly healthy or may only have a cough from time to time. If you think you have been exposed to TB, get a TB skin test.

Anyone can get TB. People of all races and nationalities. The rich and poor. And at any age. But for many reasons, some groups of people are at higher risk to get active TB disease. The groups that are at high risk include:

• People with HIV infection (the AIDS virus)
• People in close contact with those known to be infectious with TB
• People with medical conditions that make the body less able to protect itself from disease (for example: diabetes, the dust disease silicosis, or people undergoing treatment with drugs that can suppress the immune system, such as long-term use of corticosteroids)
• Foreign-born people from countries with high TB rates
• Some racial or ethnic minorities
• People who work in or are residents of long-term care facilities (nursing homes, prisons, some hospitals)
• People who are underfed
• Alcoholics and IV drug users

There are two possible ways a person can become sick with TB disease:

• The first applies to a person who may have been infected with TB for years and has been perfectly healthy. The time may come when this person suffers a change in health. The cause of this change in health may be another disease like AIDS or diabetes. Or it may be drug or alcohol abuse or a lack of health care because of homelessness.
  
  Whatever the cause, when the body's ability to protect itself is damaged, the TB infection can become TB disease. In this way, a person may become sick with TB disease months or even years after they first breathed in the TB germs.

• The other way TB disease develops happens much more quickly. Sometimes when a person first breathes in the TB germs the body is unable to protect itself against the disease. The germs then develop into active TB disease within weeks.

There are two types of tests for TB infection: the TB skin test and the TB blood test. A person’s health care provider should choose which TB test to use.

The TB skin test is also called the Mantoux tuberculin skin test (TST). For this test, a small amount of fluid (tuberculin) is injected just below the top layers of skin on the lower part of the arm. Two to three days later a health care worker checks the arm to see if a bump has developed and measures the size of the bump. If the bump is of a certain size, the test is positive and the person has TB infection.

TB blood tests are also called interferon-gamma release assays or IGRAs. Two TB blood tests are approved by the U.S. Food and Drug Administration (FDA) and are available in the United States: the QuantiFERON®–TB Gold In-Tube test (QFT-GIT) and the T-SPOT®.TB test (T-Spot). For this test, a health care provider will draw blood and send it to a laboratory for analysis and results. If the test results are positive, the person has TB infection.

TB blood tests are preferred for persons who have received the TB vaccine bacille Calmette–Guérin (BCG).

If either the TB skin test or blood test is positive, additional tests are needed to determine if the person has TB disease. These tests include a chest x-ray and possibly testing of a person’s sputum (the material that is sometimes coughed up from the lungs).

Treatment for TB depends on whether a person has TB disease or only TB infection.

A person who has become infected with TB, but does not have TB disease, may be given preventive therapy. Preventive therapy aims to kill germs that are not doing any damage right now, but could break out later.

If a doctor decides a person should have preventive therapy, the usual prescription is a daily dose of isoniazid (also called "INH"), an inexpensive TB medicine. The person takes INH for six months (up to a year for some patients), with periodic checkups to make sure the medicine is being taken as prescribed.

What if the person has TB disease? Then treatment is needed.

Years ago a patient with TB disease was placed in a special hospital for months, maybe even years, and would often have surgery. Today, TB can be treated with very effective drugs.

Often the patient will only have to stay a short time in the hospital and can then continue taking medication at home. Sometimes the patient will not have to stay in the hospital at all. After a few weeks a person can probably even return to normal activities and not have to worry about infecting others.

The patient usually gets a combination of several drugs (most frequently INH plus two to three others), usually for six to nine months. The patient will probably begin to feel better only a few weeks after starting to take the drugs.

It is very important, however, that the patient continue to take the medicine correctly for the full length of treatment. If the medicine is taken incorrectly or stopped the patient may become sick again and will be able to infect others with TB.

If the medicine is taken incorrectly and the patient becomes sick with TB a second time, the TB may be harder to treat because it has become drug resistant. This means that the TB germs in the body are unaffected by some drugs used to treat TB.

Multi-drug resistant TB is very dangerous, so patients should be sure that they take all of their medicine correctly.

Regular checkups are needed to see how treatment is progressing. Sometimes the drugs used to treat TB can cause side effects. It is important both for people undergoing preventive therapy and people being treated for TB disease to immediately let a doctor know if they begin having any unusual symptoms.

Yes, if they have TB disease and it is not being treated. Once treatment begins, a patient ordinarily becomes quickly noninfectious; that is, they cannot spread the disease to others.

There is little danger from the TB patient who is being treated, is taking his or her medication continuously, and is responding well. The drugs usually make the patient noninfectious within days or weeks.

TB is spread by germs in the air, germs put there by coughing or sneezing. Infection is not spread by handling a patient's bed sheets, books, furniture, or eating utensils.

Brief exposure to a few TB germs rarely infects a person. It's day-after-day close contact that usually does it.

Multi-drug resistant tuberculosis (called MDR TB for short) is a very dangerous form of tuberculosis. Some TB germs become resistant to the effects of some TB drugs. This happens when TB disease is not properly treated.

These resistant germs can then cause TB disease. The TB disease they cause is much harder to treat because the drugs do not kill the germs. MDR TB can be spread to others, just like regular TB.

It is important that patients with TB disease follow their doctor's instructions for taking their TB medicine so that they will not develop MDR TB.

TB: What You Should Do

Find out if you're infected.

Everyone should be skin tested at least once and know whether their test result is positive or negative. You should also be tested if there's any chance you have been infected, recently or many years ago.

If the test is negative:
A negative reaction usually means that you are not infected and no treatment is needed. Sometimes, however, when a person has only recently been infected, or when his or her immune system isn't working properly, the test may be falsely negative.

If the test is positive:
A positive reaction usually means that you have been infected with the TB germ. It does not necessarily mean that you have TB disease. Cooperate with the doctor when he or she recommends a chest X ray and possibly other tests.

If the doctor recommends treatment to prevent sickness, follow the recommendations. If medicine is prescribed, be sure to take it as directed.

If you don't need treatment, do what the doctor tells you to do about follow-up. The doctor may simply say to return for another checkup if you get into a special risk situation for TB sickness or develop symptoms.

If you are sick with TB disease, follow the doctor's recommendations for treatment.

If you're a health worker:
Your local American Lung Association can provide you with more comprehensive information developed for health professionals on the diagnosis, treatment and control of TB.

Public Health provides tuberculosis (TB) skin testing at its Santa Ana Clinic. Private physicians and community clinics also provide TB testing. Two visits are required for a TB skin test. Skin tests are placed on one day and read two or three days later. TB blood tests require one visit.

Please Click here for clinic locations and hours.

Please Click here for clinic locations and hours.

Due to reduction of services, TB skin testing is no longer provided for pre-employment, school or volunteer clearances.

Chest X-rays for employment or volunteer work are no longer available.

No. Public Health services to treat person with tuberculosis are free to the patient. Insurance, Medi-Cal or other coverage is billed if available, but the patient is not billed for care or medication received.

Other frequently asked questions about tuberculosis, how it is spread, infection, disease, etc., are available on the Centers for Disease Control and Prevention website.