Is tuberculosis a contagious killer? Well, it depends on which type of tuberculosis (commonly called TB) we are talking about, active or inactive. Active tuberculosis (TB) is a contagious disease. Just like the common cold, it spreads through the air, but only people who are sick with TB in their lungs are infectious. This type of TB means the bacteria are active in the body and the immune system is unable to stop them from causing illness. People with active tuberculosis in their lungs can pass the bacteria on to anyone they come into close contact with. When a person with active tuberculosis coughs, sneezes, talks, spits or even sings, people nearby can breathe in the tuberculosis bacteria and become infected. If the disease remains untreated, each person with active tuberculosis will infect between 10 and 15 people every year on average. Inactive tuberculosis (also known as latent tuberculosis) means the body has been able to fight the bacteria and it stops the infection from making them sick. However, people with this type of TB can become infected if their immune system is compromised, for example those with HIV.
The symptoms of tuberculosis depend on where in the body the TB bacteria are growing. TB bacteria often grow in the lungs, causing pulmonary tuberculosis. Pulmonary tuberculosis may cause a bad cough that lasts longer than two weeks, pain in the chest and coughing up blood or sputum, weakness, fatigue, weight loss, lack of appetite, chills, fever and night sweats. If TB affects your joints, you may develop pain that feels like arthritis. If it affects your bladder, it may hurt to go to the bathroom and there may be blood in your urine. TB of the spine can cause back pain and leg paralysis. If it is in the brain, there may be headaches, nausea and brain damage (if left untreated). Inactive tuberculosis has no symptoms.
The most commonly used method to check for tuberculosis is the PPD skin test. A PPD skin test is also called a Mantoux test. If you have a positive PPD, it means you have been exposed to a person who has tuberculosis and you have been infected with the bacteria that causes the disease. If your PPD skin test is positive, you will likely have a chest X-ray and a physical exam to find out whether you have active TB and are currently contagious and able to spread the disease to other people. I remember in nursing school, during my psychiatric rotation, I actually was assigned to a patient with active tuberculosis. No one knew it at the time; I was studying bipolar disorder and this was the diagnosis of this particular patient. Luckily I had been through the med/surg rotation and had the knowledge of tuberculosis to some extent. As I spent more time with the patient, I knew something was not right. We were taught to do a complete history and physical, not just a psychiatric evaluation, but also to gather information on past medical problems, operations, social habits, etc. This patient happened to be a heavy smoker and had a horrific cough! Being around my grandfather who was also a smoker, I knew this cough was not just a smoker’s cough, rather something much worse and I reported it to the nursing staff and to my instructor. After testing the patient for tuberculosis by a skin test, sputum sample for a culture study and a chest x-ray, he was confirmed to have active tuberculosis (TB) and then I had to be tested for a period to 18 months to make sure I did not develop the disease. Thankfully I did not, and I still have never had a positive Mantoux test.
To treat active TB, it is necessary to take several antibiotics at the same time so that the TB does not become resistant to treatment. Medications are the cornerstone of tuberculosis treatment, but treating TB takes much longer than treating other types of bacterial infections. With tuberculosis, you must take antibiotics for at least six to nine months. The exact drugs and length of treatment depend on your age, overall health, possible drug resistance, the form of TB (latent or active) and its location in the body. The doctor will most likely recommend taking 4 medicines at the same time, which include Isoniazid, Rifampin, Ethambutol and Pyrazinamide. It is important to note that all medications must be taken that are prescribed. For the medicines to work effectively at curing tuberculosis, one must not skip a single dose. Avoiding alcohol or taking acetaminophen (brand name Tylenol) while taking the tuberculosis medicine is important because this could lead to liver damage. Doctors should also be alerted to any other medicines that are being taken. Finally, the doctor may order several sputum and blood tests to be done while being treated for tuberculosis.
As nurses, we must remember the universal precaution that thorough handwashing is the single most important factor in preventing the spread of infectious diseases. This includes washing before preparing food, before and after eating, after using the restroom, before and after administering treatment and after contact with any body fluids (blood, saliva, vomit, feces, urine, semen, menstrual flow, wound drainage, nasal discharge, etc.) The spread of tuberculosis can also be reduced by covering the mouth and nose when sneezing or coughing, insuring adequate ventilation, routine screening with a PPD (skin) test, wearing masks, using care when disposing of trash and by using single-use gloves. The use of gloves is crucial when touching any body fluids, particularly blood, examining the mouth or assisting with dental care or coming in physical contact with anyone who has open cuts, lesions, etc. Finally, disinfectants approved by the Environmental Protection Agency will further help the spread of TB.
The good news about tuberculosis is that it is on the decline here in the United States. According to the Centers for Disease Control and Prevention, there were 3.9 percent fewer cases of tuberculosis in the United States in 2010 than in 2009. However, we must always be aware, as medical professionals, that active tuberculosis continues to be a contagious killer and universal precautions must be practiced for treating a patient with the disease. There is growing recognition of the crucial role played by nurses in TB control and care. The United Nations Millennium Development Goal (MDG) for TB is to halt and begin to reverse incidence of the disease by 2015. The World Health Organization (WHO) Stop TB department target is a 70% case detection rate with successful treatment of 85% of those detected. Nurses are critical if global initiatives such as TB control programs are to be successful.