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Pulmonary Tuberculosis

What is pulmonary tuberculosis?

Key points

  1. Pulmonary tuberculosis (TB) is a contagious, infectious disease that attacks your lungs.
  2. Latent TB means you have the germ but you aren’t showing the symptoms and aren’t contagious.
  3. You can treat pulmonary TB with antibiotics, but you must finish all your medications to prevent it from returning.

The bacterium Mycobacterium tuberculosis causes TB, a contagious, airborne infection that destroys body tissue. Pulmonary tuberculosis (TB) is when M. tuberculosis primarily attacks the lungs. However, it can spread from there to other organs. Pulmonary TB is curable with an early diagnosis and antibiotic treatment.

Pulmonary TB, also known as consumption, spread widely as an epidemic during the 18th and 19th centuries in North America and Europe. After streptomycin, an antibiotic, was discovered in 1944, people were able to treat and control the spread of TB. Since then, TB has been in decline. It’s at its lowest recorded rate since 1953.

That said, it’s still important to protect yourself against TB. Over 9.2 million people have an active form of the bacteria, according to the American Lung Association (ALS). If left untreated, the disease can cause life-threatening complications like permanent lung damage.

What is latent TB?

Being exposed to M. tuberculosis doesn’t necessarily mean you’ll get sick. Among the 2.2 billion people who carry the germ, most have latent TB. This means your immune system protects you from getting sick. People with latent pulmonary TB aren’t contagious and have no symptoms, but they must still be tested.

It is possible for latent TB to develop into active TB. People with the germ have a 10 percent lifetime risk of getting sick with TB. When you start showing symptoms, you may become contagious and have pulmonary TB.

What are the symptoms of pulmonary TB?

If you or someone you know has pulmonary TB, they will commonly:

  • cough almost continuously
  • cough up blood
  • have a consistent fever, including low-grade fevers
  • have night sweats
  • have chest pains
  • have unexplained weight loss

There may also be other symptoms of pulmonary TB, such as fatigue. Your doctor will be able to give an accurate diagnosis after reviewing all your symptoms.

How pulmonary TB spreads

You can’t get pulmonary TB by:

  • shaking hands
  • sharing food or drink
  • sleeping in the same bed
  • kissing

TB is airborne, which means you can get pulmonary TB after breathing air exhaled by someone with tuberculosis. This can be air from:

  • coughing
  • sneezing
  • laughing
  • singing

The germs can stay in the air for several hours. It’s possible to inhale them even when the infected person isn’t in the room. But usually you have to be close to someone with TB for a long period of time to catch it.

Risk factors for pulmonary TB

The risk for getting pulmonary TB is highest for people who are in close contact with those who have TB. This includes being around family or friends with TB or working in places like medical facilities or institutions that house people with TB.

These places are often:

  • correctional facilities
  • group homes
  • nursing homes
  • hospitals
  • shelters

People also at risk for developing pulmonary TB disease are:

  • older adults
  • small children
  • smokers
  • people with an autoimmune disorder, such as Lupus or rheumatoid arthritis
  • people with lifelong conditions, such as diabetes or kidney disease
  • people who use drug injections
  • people who are immunocompromised, such as those taking chemotherapy, chronic steroids, or who have HIV or AIDS

How is pulmonary TB diagnosed?

During your examination, your doctor will:

  • conduct a physical exam to check for fluid in your lungs
  • ask about your medical history
  • schedule a chest X-ray
  • order a medical test to confirm pulmonary TB

The two medical tests for pulmonary TB are a skin test and a blood test. These tests won’t tell you if you’ve developed TB, only if you have the germ.

The skin test is the most common and it’s less expensive, but it requires two visits to your doctor. Your doctor will ask for a blood test if you’re unable to return for a second visit.

Skin Test

For the skin test, your doctor or nurse will inject a very small amount of the protein from TB under your skin. It’s important not to scratch the area, even if it itches. Scratching could make the test results harder to read.

Your doctor will ask you to come back in two or three days to see if the injection spot is swollen. Redness at the location of the injection is normal and is not a sign of a TB infection.

A hard, swollen lump of five or more millimeters may mean you have TB. Five millimeters is about the size of a pea.

Blood Test

Your doctor will take a sample of your blood, and then expose your blood to TB in a laboratory. This test measures how your immune system responds to bacteria that causes the disease. Blood test results are usually available within 24 hours.

Other exams

These exams can also look for pulmonary TB, which can be hard to diagnose in children, people who have HIV, and people who have multidrug-resistant TB (MDR-TB).

Test
Imaging testa CT scan to check lungs for signs of an infection
Bronchoscopyyour doctor inserts a scope through your mouth or nose to see your lungs and airways
Sputum examinationa lab examines a sample of your mucus
Thoracentesisa procedure that removes fluid from the space between the outside of your lungs and the wall of your chest
Lung biopsya procedure to remove a sample of lung tissue

Treatment for pulmonary TB

It’s important to get treatment even if you have no symptoms. You can still develop pulmonary TB disease in the future. You may only need one TB drug if you have latent TB.

If you have pulmonary TB disease, your doctor may prescribe several medicines. You’ll need to take these drugs for six months or longer for the best results.

The most common TB medicines are:

Your doctor might recommend an approach called directly observed therapy (DOT) to ensure that you complete your treatment. Stopping treatment or skipping doses can make pulmonary TB resistant to medicines, leading to multidrug-resistant (MDR-TB).

With DOT, a healthcare professional meets with you every day or several times a week to administer your medication so that you don’t have to remember to take it on your own.

If you aren’t on DOT, make a schedule for taking your medicines so that you don’t miss a dose. Here are some tips to help you remember to take your medicines:

  • Take medicines at the same time every day.
  • Make a note on your calendar each day to show that you’ve taken your medicine.
  • Ask someone to remind you to take your medicine every day.
  • Keep your medicines in a pill organizer.

You won’t need to go to the hospital unless you’re unable to take the medication at home or have a bad reaction to the treatment.

Pricing of TB medications

What is multidrug-resistant TB?

The primary cause for MDR-TB is inappropriate treatment or incorrect use of anti-TB drugs, but sometimes the TB strain someone has can already be resistant to an anti-TB drug.

People who develop MDR-TB also have fewer options for treatment. The second-line treatments can be expensive and take as long as 2 years. It’s also possible for MDR-TB to develop even further into extensively drug-resistant TB (XDR-TB). This is why it’s important to finish your medications, even if you feel better before you finish your dosage.

Outlook for pulmonary TB

Pulmonary TB is curable with treatment, but if left untreated or not fully treated, the disease often causes life-threatening concerns. Untreated pulmonary TB disease can lead to long-term damage to the:

  • lungs
  • brain
  • liver
  • heart
  • spine

New drugs and treatments are currently being developed to prevent latent TB and TB, especially as MDR-TB grows. In some countries, they use a vaccine called Bacillus Calmette-Guérin (BCG). This vaccine is useful for severe forms of TB in children, but not reliable enough for adults.

How to prevent pulmonary TB

It can be difficult to avoid catching TB if you work in an environment frequented by people with TB or if you’re caring for a friend or family member with TB.

To minimize your risk for pulmonary TB, you can:

  • Provide education on preventing TB like cleaning equipment and cough etiquette.
  • Avoid extended close contact with someone who has TB.
  • Air out rooms regularly.
  • Cover your face with a mask that is approved for protection against TB.

Anyone exposed to tuberculosis should be tested, even if they show no symptoms. The Centers for Disease Control and Prevention has detailed guidelines and precautions for people who work or visit a healthcare setting.

How to protect others

People with latent pulmonary TB aren’t contagious and can go about their day-to-day lives as usual.

But if you have pulmonary TB disease, you need to stay home and avoid close contact with others. Your doctor will tell you when you’re no longer contagious and can resume a regular routine. 

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