What is TB?
TB is an infection caused by a bacteria called Mycobacterium tuberculosis that spreads through the air from a person with active TB infection usually in their lungs. When infected, the bacteria commonly cause disease in the lungs but can also cause disease in many other parts of the body. The bacteria can cause two types of illness, an active form (active TB disease) and a latent form (latent TB infection). TB is a slow-growing bacteria that when spreading causes symptoms over a long period of time (weeks to months).

What are the symptoms of TB?
The symptoms of active TB are depend on where the infection occurs but usually causes individuals to have several of the following symptoms:

Unexpected weight loss
Night sweats
Weakness or fatigue
Loss of appetite
Persistent coughing more than 3 weeks often with sputum which may also include some blood (when the disease is in the lungs)
Shortness of breath (when the disease is in the lungs)

What is the difference between latent TB and active TB?
Latent TB is when the body’s immune system forms a wall around the TB bacteria so the TB bacteria cannot multiply or spread. The TB germs are essentially “asleep” in your body when you have latent TB. A person with latent TB is not contagious (cannot spread TB to other people) and has no symptoms. TB bacteria can stay latent for long periods of time (e.g. from many years to the rest of your life). Active TB is when the body cannot adequately fight the TB bacteria. The person has symptoms and can be contagious when TB infects the throat or lungs and the person has a cough.

Who gets TB?
Anyone can get TB. In Rhode Island, we see about 40 or 50 active TB cases every year (about 1 a week) and about 300 to 400 latent TB cases per year. We see TB cases in Rhode Island from all countries, in all ages and in all races.

How is TB spread?
TB is most commonly spread from a person with active TB in their lungs. When someone with active TB disease in their lungs or throat coughs, sings or speaks, TB bacteria may be released into the air. TB bacteria can stay in the air for a short to moderate amount of time. Breathing air with TB may result in a person developing TB – 90% of cases are latent TB. TB is not spread in food and cannot be killed by air fresheners. You do not get TB from the environment (such as desk tops). TB does not live very long outside of the body.You cannot get TB from someone’s clothes, drinking glass, eating utensils, cell phone, handshake, toilet, or other surfaces where a TB patient has been. TB is also killed by ultraviolet light from the sun, so it cannot survive in sunlight. This makes outdoor spread from person to person very rare.

Risk of getting TB

What is my risk of getting TB?
Active TB is a relatively uncommon disease in Rhode Island and the United States with only about 1 case of active TB per week in RI (40 to 50 cases per year) out of 1 million people. The risk of getting TB is very low but increases slightly when you have been exposed to a person with active TB. The risk increases the more often you are in close contact with a person with active TB, especially when you are in a poorly ventilated space. However, even then, most people do not develop TB.

What should I do if I have spent time with someone with latent TB infection?

A person with latent TB infection cannot spread germs to other people. You do not need to be tested if you have spent time with someone with latent TB infection. However, if you have spent time with someone with active TB disease or someone with symptoms of TB, you should be tested with a skin test.

Testing for TB

What should I do if I have been exposed to someone with TB disease?
People with TB disease are most likely to spread the germs to people they spend time with every day, such as family members, coworkers or close friends. If you have been around someone who has TB disease, you should go to your doctor or local clinic for a skin test. You will usually be asked to get two skin tests—one now and another one 8 to 10 weeks later.

Should I be screened for TB?
You should ask your doctor about being screened for TB if you:

Live or work closely with someone who has active TB disease
Were born outside the US (except Canada, Europe and some other areas with low TB incidence)
You live or work in a prison, residential institution or nursing home
Inject recreational drugs
Are immunocompromised
Are a healthcare worker that cares for people in any of the above groups

How is TB diagnosed?
Individuals suspected of having TB or are at-risk of getting TB usually get a TB skin test (called PPD) or a chest x-ray. For individuals with a positive TB skin test, your doctor may also try and get some phlegm to look for and grow TB in the laboratory.

What is in the TB skin test?
The TB skin test uses a small amount of purified protein derivative (PPD), which is a substance that your body’s immune system will respond to by creating a bump at the skin test site when you have TB.

How is a TB skin test done?
A small amount of PPD is injected with a small needle just under the skin on the forearm. This area of the arm is checked 2-3 days after the injection to see if a bump develops. A nurse or physician needs to measure the size of the bump to see if you have a positive skin test. A positive skin test does NOT mean that a person has active TB, but usually means that a person has been exposed to TB at some point in the past. The skin test may be repeated twice in some groups (e.g. elderly) or in individuals that are being screened for recent exposure to a person with active TB.

What is Bacille Calmette-Guérin (BCG)?
BCG is a vaccine for TB disease. BCG is used in many countries where TB is more common. BCG vaccination does not completely prevent people from getting TB. It may also cause a false positive TB skin test.

If I’ve had BCG, what should I do?
If you have had no previous adverse reaction to a PPD, you should be tested for TB using the skin test. If you have had a previous adverse reaction to the skin test, you will be referred for a chest x-ray.

Treatment for TB

What is the treatment for TB?
Latent TB is usually treated with one medication for several months. An evaluation of each patient is needed to determine the specific treatment that is best for you. Individuals with active TB usually receive several different types of medications for several months. Individuals with active TB in their lungs need to be kept away from other people until they are no longer at risk of spreading TB.

Where can I get treated for TB in Rhode Island?
The Department of Health helps support two TB clinics in Rhode Island – the RISE Clinic (the state’s TB specialty clinic) and the Hasbro TB Clinic (a pediatric clinic open on Wednesdays for the treatment of latent TB in young children). These clinics provide:

Diagnostic testing (chest x-rays, bacteriology tests)
Medications that treat TB

The Miriam Hospital’s RISE Clinic is a TB clinic sponsored by the Department of Health. Clinic staff members are experienced in TB care and know how to safely handle contagious patients. The clinic works to eliminate the chances that these patients will ever get ill from TB or be able to pass TB on to others.

How can I contact the RISE Clinic?
The Miriam Hospital RISE Clinic can be reached by calling 401-793-2427. They are located at 14 Third Street in Providence.

TB in the News

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