Recognize the Signs and Symptoms of Tuberculosis

Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis and spread from person to person through the air. TB usually affects the lungs (typically the primary site of inoculation), though it can affect any organ. In the latent form, the bacteria remains dormant with no signs or symptoms, whereas the active form shows signs and symptoms. The vast majority of TB infections remain latent. If left untreated or treated improperly, TB can kill, so you must be able to recognize the signs of respiratory tuberculosis.

Steps

Knowing the Risk Factors

1. Beware of areas that leave you vulnerable to TB. If you live in or have traveled to these areas, or even if you come into contact with someone else who has, you could be at risk. In many parts of the world, the prevention, diagnosis or treatment of TB is a challenge due to health care policy, financial/resource constraints, or overpopulation. This allows TB to go undetected and untreated, causing it to spread. Traveling on an airplane to and from these areas can also harbor the bacteria due to isolated ventilation.
   • Sub-Saharan Africa
   • India
   • China
   • Russia
   • Pakistan
   • Southeast Asia
   • South America
2. Examine your working and living conditions. Overcrowded conditions and places with poor ventilation allow the bacteria to spread easily from one person to another. A bad situation can be made even worse if the people around you have poor health background checks or screenings. Conditions to be wary of include:
   • Prisons
   • Immigration offices
   • Retirement/nursing homes
   • Hospitals/clinics
   • Refugee camps
   • Shelters
3. Consider your own immune health. Having a medical condition that lowers your immune system's natural defenses can be problematic. If your immune system can't function properly, you're vulnerable to all sorts of infections, including TB. Such conditions include:
   • HIV/AIDS
   • Diabetes
   • End-stage kidney disease
   • Cancers
   • Malnutrition
   • Age (the very young lack developed immune systems, and the aged may have less than optimal immune health)
4. Determine whether drugs might interfere with immune function.Any drug abuse, including alcohol, tobacco, and IV substances, can lower your body's natural defenses. While some cancers put you at higher risk for TB, so too does the chemotherapy treatment for cancer. Long-term use of steroids, as well as drugs to prevent the rejection of transplanted organs can also affect immune function. So too can drugs used to treat autoimmune conditions such as rheumatoid arthritis, lupus, inflammatory bowel disease (Crohn's and Ulcerative Colitis), and psoriasis.

Recognizing the Signs and Symptoms of Respiratory TB

1. Notice any unusual coughing. TB usually infects the lungs, breaking down the tissue there. Our body's natural response is to remove the irritant by coughing. Figure out how long you've been coughing; TB usually lasts for more than 3 weeks and may include such worrisome signs as bloody sputum.
   • Consider how long you've taken over the counter cold/flu medications or antibiotics for a respiratory infection with no relief. TB needs very specific antibacterial drugs, and to start therapy requires screening and confirming TB.
2. Look for discharge when coughing. Have you noticed any sputum (sticky discharge) when coughing? If it smells and is dark, it can be any type of bacterial infection. If it's clear and odorless, it can be a viral infection. Take notice if there's been any blood when coughing into your hands or tissues. When TB cavities and nodules form, nearby blood vessels may get destroyed, leading to hemoptysis — coughing up blood.
   • You should always seek expert medical advice when you cough up blood. He or she will be able to advise you on how to proceed.
3. Pay attention to chest pain. Chest pain can suggest a wide variety of issues, but when taken together with other symptoms, they can point to TB. If you feel a sharp pain, it can you point to a specific, localized area. Note particularly if it hurts when you apply pressure to that area, or if it hurts when you breath in and out or when you cough.
   • TB forms hard cavities and nodules against the lungs/chest wall. When we breath, these hard masses cause damage to the area, leading to inflammation at the site. Pain tends to be sharp, localized to a specific area, and reproducible when we put pressure on it.
4. Take note of unintentional weight loss and lack of appetite. The body has a complex response to the Mycobacterium tuberculosis bacteria that results in poor nutrient absorption and altered protein metabolism. These changes might persist for months without your noticing them.
   • Look in the mirror and note any changes to your body. If you can see the outline of your bones, this indicates you don't have enough muscle mass due to lack of protein and fat.
   • Measure your weight on a scale. Use a previous but recent weight from when you were feeling healthy as a comparison. Weight changes vary, but you should address any drastic changes with your healthcare provider.
   • Note whether your clothes feel looser
   • Keep track of how often you've been eating and compare it to when you last felt healthy.
5. Do not ignore fever, chills and night sweats. Bacteria usually reproduce at around normal body temperature (98.6 F). The brain and immune system respond by raising the body's temperature to stop the bug from reproducing. The rest of the body detects this change, then attempts to adjust to this new temperature by contracting muscles (shivers), making you feel chills. TB also causes specific inflammatory proteins that aid in fever production to be produced.
6. Beware of latent TB infection. A latent TB infection is dormant and not infectious. The bacteria simply resides in body with no harm. Reactivation can occur in those with reduced immunity, as listed above. It can also occur with increased age due to weakening of the immune system. Reactivation sometimes also occurs for other, unknown reasons.
7. Be able to distinguish TB from other respiratory infections. There are many other conditions that TB could be mistaken for. You don't want to wait out a simple cold virus only to find out that you have something more serious on your hands. To differentiate between TB and other conditions, ask yourself the following questions:
   • Is there clear mucus liquid dripping from my nose? A cold will cause congestion/inflammation of the nose and lungs that leads to mucus dripping or running out from the nose. TB will not present with a runny nose.
   • What is being produced by my coughing? Viral infections and the flu tend to have a dry cough or produce a white mucus. Bacterial infections found in the lower respiratory tract produce brownish sputum. TB, though, typically produces a cough over 3 weeks and can produce a hallmark bloody sputum.
   • Am I sneezing? TB does not cause sneezing. This is usually a sign of the cold or flu.
   • Do I have a fever? TB can cause a fever of all levels, but those who have the flu typically have fevers of more than 100.4°.
   • Do my eyes appear watery/itchy? The cold typically presents with these symptoms, but not TB.
   • Do I have a headache? The flu typically presents with headaches.
   • Do I have joint and/or body aches? The cold and flu can cause this but it is more severe with the flu.
   • Do I have a sore throat?Look inside your throat and see if it appears red, swollen and painful when swallowing. This is seen mainly with cold but can appear with the flu as well.

Getting Tested for TB

1. Know when to seek immediate medical attention. Certain signs and symptoms require immediate help. Even if these TB symptoms don't result in a TB diagnosis, they might point to other severe illness. Many conditions, both harmless and dangerous, can cause chest pain, but you should always report it and allow a doctor to perform an EKG exam.
   • Consistent weight loss might indicate malnutrition or cancer.
   • When combined with bloody cough, weight loss can more specifically suggest lung cancer.
   • High fever and chills can also be caused by an underlying blood infection or sepsis, though this usually causes a drop in blood pressure, dizziness, delirium and high heart rate. If left untreated, it can be potentially deadly, or lead to severe dysfunction.
   • The doctors will order IV antibiotics and blood work looking at the white blood cells (immune cells that fight infection).
2. Arrange for latent TB infection screening if called for. Even if you don't suspect you have tuberculosis, there are cases in which you may have to be screened for latent TB anyway. Those starting work in a healthcare environment require a test followed by yearly screening. If you're traveling to or returning from at-risk countries, have decreased immunity, or work or live in crowded, poorly ventilated conditions, you should also get screened. Simply make an appointment with your primary care doctor to get tested for TB.
   • A latent TB infection will not cause any symptoms or sickness, and cannot be spread to other people. However, five to ten percent of people with a latent TB infection will eventually develop TB.
3. Ask for a purified protein derivative (PPD) test. This test is also referred to as tuberculin skin test (TST) or Mantoux test. The doctor will clean the area with a cotton swab and water, then inject you with a purified protein derivative (PPD) near the top of your skin. A small bump will appear from the liquid injection. Do not cover the location with a bandage as this may alter the liquid in place. Instead, give the liquid a few hours to be absorbed.
   • If you have antibodies to TB, it will react to the PPD and form an "induration" (thickening or swelling around the area).
   • Note that it is not the redness that gets measured but the size of the induration. After 48 to 72 hours you will return to the doctor for measurement of the induration.
4. Understand how to interpret the results. For different categories of people, there is a maximum induration size considered negative for screening. However, any induration over that size indicates that the patient has TB. If you have no risk factors for TB, an induration of up to 15mm (0.59 inches) is considered a negative result. However, if you have any of the risk factors listed earlier in this article, an induration of up to 10 mm (0.39 inches) is considered negative for screening. If any of the following describes you, an induration of up to 5 mm is considered a negative result:
   • Immunosuppressive drugs like chemotherapy
   • Chronic steroid use
   • HIV infection
   • Close contact with a TB-positive individual
   • Organ transplant patients
   • Those who show fibrotic changes on a chest x-ray
5. Request an IGRA blood test as an alternate to a PPD. IGRA stands for "interferon gamma release assay," and this blood test is more accurate and quick than a PPD. However, it does cost more to perform. If your doctor opts for this test, he will take a sample of your blood and send it to a lab for analysis. Your results should be ready within 24 hours, and a subsequent appointment will be made to go over test results. A high level of interferon (determined by a preset normal range by the lab) is a positive result that indicates you have TB.
6. Follow up on test results. A positive result in either the skin or blood test indicates, at minimum, a latent TB infection. To determine whether you have active TB, your healthcare provider will order a chest x-ray. A patient with a normal chest x-ray will be diagnosed with a latent TB infection and given preventive treatment. An abnormal chest x-ray on top of a positive skin or blood test indicates active TB.
   • The doctor will also order a sputum culture. A negative result indicates latent TB infection, and a positive result indicates TB.
   • Note that sputum can be difficult to collect from infants and young children, and diagnosis is often made without it for children.
7. Follow your doctor's advice after diagnosis. If the x-ray and sputum cultures confirm active tuberculosis, your doctor will prescribe a multi-drug regimen. However, if the x-ray is negative, patients are considered to have latent TB. Follow your doctor's treatment directions carefully to prevent latent TV from becoming active. TB is an infection that is reported to the CDC, and treatment may include Directly Observed Therapy (DOT), which consists of a healthcare worker observing a patient take each dose.
8. Consider getting the Bacillus Calmette–Guérin (BCG) vaccine. The BCG vaccine may decrease the risk of infection, but does not eliminate it. BCG vaccination causes a false-positive PPD test, so individuals who have been vaccinated should be screened for TB with the IGRA blood test.
   • The BCG vaccine is not recommended in the US, which has a low incidence of TB, because of its interference with PPD screening. However, individuals from other, less developed countries are commonly vaccinated.

Tips

• TB is spread by coughing and sneezing.
• Not everyone infected with TB becomes sick. Some people have a "latent TB"; although such people are not contagious, they can go on to become sick much later it their immune system weakens. It is possible to have latent TB for a lifetime and never develop active TB disease.
• Tuberculosis has had a resurgence, and the CDC has changed its guidelines about who must be treated. The prior cut off age of 34 for being treated with Isoniazid has been lifted-virtually anyone testing positive is prescribed medication as a precaution for themselves and others. For your own health and those around you, take the course of medicine.
• military TB can have the same symptoms as respiratory TB in addition to organ specific signs and symptoms.
• It is important to be aware, albeit controversial, that even people who are have latent TB and have received a course of treatment can retest positive for TB. It is something to be discussed and assessed with your doctor.
• BCG (bacille calmette-guerin) vaccines may contribute to false positives on the PPD test. A false positive calls for a chest x-ray.
• Those with military TB require more testing, including MRI imaging of the suspected organ involved and a biopsy.
• For those with history of BCG vaccination and false-positive PPD tests, an IGRA is recommended. However, your doctor may still prefer the PPD test due to the cost and availability.
• PPD is preferred over IGRA for children under 5 years due to lack of studies.

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