What is Tuberculosis?

Tuberculosis (TB) is a bacterial disease that is spread from person to person through the air. TB usually affects the lungs. The bacteria are put into the air when a person with TB of the lungs coughs, sneezes, laughs or sings. TB can also affect other parts of the body, such as the brain, the kidney or the spine.

What Happens After the Skin Test?

1. If the PPD test is negative, no further testing is required. 2. If the PPD test is positive, a chest X-ray will be needed to see if there is active disease in the lungs. 3. If the X-ray is normal and there are no symptoms, the TB bacteria are probably inactive (latent TB infection) and TB disease is not present. TB medication may be given to prevent future development of TB disease. 4. If the X-ray is normal but TB symptoms are present, other tests may be needed. 5. If the X-ray is not normal, more tests may be needed to see if TB or another disease is present.

TB Disease vs. Latent TB Infection (LTBI)

People with TB disease are sick from bacteria that are active in their body. They usually have one or more symptoms of TB. These people can spread TB to others. TB medication is prescribed. Death can result from the disease. People with LTBI have TB bacteria in their body. They are not sick because the bacteria are inactive in their body. They cannot spread the bacteria to others. In most cases, the bodys defenses control the TB bacteria by forming a capsule around the TB. TB bacteria can live inside the capsule for years in a latent state. While TB bacteria are latent, they cannot harm the person or spread to others, people with LTBI may develop TB disease in the future. Medicine is often prescribed to treat the LTBI, to prevent development of the TB disease.

How Can Active TB be Prevented?

INH is a medicine proven to treat latent TB infection from progressing to active TB disease in the future, if taken daily for 6 to 12 months (depending on individual circumstances). Periodic check-ups and x-rays are not effective alternatives to medication.

What are the Symptoms of Active TB?

Occasionally, early disease of the lungs may have few or no symptoms. Symptoms may include: Weight loss Fever and/or night sweats Cough Chest pain Cough up sputum or blood Other symptoms depend on the particular part of the body that is affected.

Should I Take INH?

Your clinician will advise you whether or not INH is recommended in your case. Generally, INH medication is recommended under the following circumstances for persons with LTBI: Recent immigrants from a country with a high prevalence of TB Known recent infection (within two years of negative PPD) Old TB on chest x-ray Other medical conditions that compromise the immune system and lower resistance to TB, including: Certain medications (e.g., insulin injections, Cortisone treatment, etc.) Certain types of cancer HIV infection Rapid weight loss

If Your TB Skin Test Is Positive: What is a Positive PPD?

A positive PPD refers to the size of the swelling (induration) that results 48 to 72 hours after PPD is injected. A positive result means that your immune system has antibodies to TB bacteria. You do not have TB disease and you are not contagious to others. However a positive PPD does mean that you are at increased risk for developing TB disease in the future, anytime during your life, unless adequate treatment for latent TB infection is given.

The Tuberculin Skin Test

The tuberculin skin test can show if the person has ever developed antibodies or been infected with TB bacteria. The most reliable test is called the Mantoux PPD. A small amount of tuberculin PPD (purified protein derivative) is injected under the skin on the forearm with a very small needle or syringe. The person must return in 48-72 hours to measure and record the results.

High Risk Conditions

These conditions may put you at higher risk for either TB infection or disease: Being in close contact with someone who has active TB Having previously lived in a country with a high incidence of TB Having a medical condition that weakens the immune system (like certain types of cancer, HIV/AIDS, diabetes, recent organ transplant, certain medications, etc.)

How Did I Get Infected?

You can get TB if you inhale TB bacteria into your lungs when you share breathing space for a prolonged time with someone with contagious TB disease. The most common places for becoming infected with TB are the home or routine living environment. Often the source of the infection is unknown, especially since infection with TB bacteria could have occurred years ago. 1. 2. 3. 4.

Latent TB Infection (LTBI)

Positive Tuberculin test Normal chest X-ray No symptoms Not contagious 5. Isoniazid (INH) is the most commonly used medicine in the US and may be recommended to prevent the development of active TB disease.

Pulmonary TB Disease
1. Positive Tuberculin test 2. Abnormal chest X-ray 3. Usually symptoms such as cough, weight loss, fever, fatigue are present 4. May be contagious 5. Curable by treatment with several medications in addition to INH taken for 6-12 months in most cases

Why is Treatment of LTBI Important?

Although only one person in 10-20 with a positive PPD skin test ever develops TB disease, the risk is lifelong. The symptoms of TB are common to many other illnesses. Without treatment, any cold or cough that lasts longer than usual could be a sign of TB disease. It may be weeks or months before you see your doctor and TB is diagnosed. In the meantime, you may infect those you live and work with, and care most about. Small children are especially likely to develop serious tuberculosis disease. LTBI treatment is important for your own health and for the health of your family, friends and co-workers.

What Are the Risks of INH?

Like all medicines, INH has possible side-effects. Fortunately, INH has been proved to be among the safest and most effective medicines, used for over 50 years. Rarely, some people experience a mild rash, while others may feel tired or irritable. Liver inflammation is an uncommon side effect, especially rare in younger people. It usually resolves when the medicine is stopped. Your clinician can tell you more about the safety of INH. INH should not cause you any side-effects, but occasionally persons will develop flu-like symptoms or liver inflammation while on the medicine. If you develop nausea and vomiting, yellow tinge to your skin, rash, fever, abdominal pain, numbness or tingling in your extremities, dark urine, fatigue, or decreased appetite, temporarily discontinue your INH and immediately notify your clinician at once for a check. Alcoholic beverages may increase the chance that side effects will occur and therefore should be avoided. An occasional drink (1-2 times/week) should not be problematic, but if you wish to drink more frequently, it should be discussed with your clinician. You will be checked monthly while you are taking your medication. Blood tests may be drawn periodically, depending on any symptoms that you might have. In addition, acetaminophen may increase the above-mentioned liver inflammation. If you need to use acetaminophen more than three times per week, contact your clinician for further advice. Aspirin or Ibuprofen are acceptable to use. It is very important that you complete all of your therapy, both to prevent you from developing active TB disease and to prevent the development of a resistant strain of TB that is not cured with the commonly available drugs. If you have any difficulty taking your medicine, or if you have difficulty with following up on appointments, please notify your clinician so alternative plans can be made. You should eat a balanced diet while taking INH. In addition, 25-50 mg of pyridoxine (Vitamin B6) every day can prevent neurological problems that are rarely associated with INH.

BCG Vaccination
The BCG vaccine (Bacillus of Calmette and Guerin) is not proven protection against TB. People who have had a BCG vaccine and have no record of ever having a Mantoux PPD TB test are required to have a Mantoux PPD skin test if it is a requirement for school or work. BCG vaccination generally does not result in a large positive skin test. If a TB skin test is positive, prior BCG vaccination is not considered an adequate explanation. The Centers of Disease Control recommends that BCG vaccinated persons who have a positive reaction to the TB skin test should have a chest x-ray to see if active TB is present.

The Facts About...

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Reasons to Not Take INH

Your clinician knows that not everyone with a latent TB infection can or should be given INH. Common reasons for not recommending INH to persons infected with TB are: Pregnancy Whenever it is unlikely that the person will be able to take INH every day for as long as prescribed If INH or other preventive medications are not recommended for you and you do develop prolonged symptoms (such as cough, weight loss, fever and fatigue) tell your clinician about your positive skin test so that TB can be considered.

Remember:
If a person with proof of a positive skin test reaction has symptoms of TB, or is in close contact with someone who has an active case of tuberculosis, s/he should not have a skin test but should have a chest x-ray and exam. If a person with proof of a positive skin test reaction is required to have TB testing for school or work, s/he should not have a skin test but should follow the requirements of the school or agency.

Possible Side Effects

Side effects are uncommon from the Mantoux PPD skin test. However, a person who has been exposed to TB germs may occasionally have a sizeable reaction, which may cause the arm to swell and may cause some discomfort. This swelling should disappear in about two weeks.
Produced by WCPHD with the permission of the Allergy and Immunization Clinic University Health Service (a Division of the Office of Student Affairs) 207 Fletcher Street Ann Arbor, MI 48109. www.uhs.umich.edu Copyright 1997 by the University of Michigan; revised 4/04.

Should I ever have another TB test?

Once the TB skin test is positive, it generally stays that way for many years, even after successful treatment. For most people, there is no need to repeat the test. If proof of TB test status is required inform your clinician. You may be required to repeat a chest x-ray (if required for verification).

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