TB Carriers?

[AnthonyM83]

Someone was just telling me that their family is from a country where TB is much more common. She said most have it, but many are just immune to it, so it's not a big deal. She said it in the context of how hospital rushed to put a mask on her and get her tested when she came into ER with a family member who had active TB.

Now, would such a person be a carrier? Would transmission be the same? Are they a health risk (they cough, everyone at their school gets TB)?

While we're on the topic . . . what are some common TB meds that would alert first responders that patient has active TB versus inactive . . .

[FormerEMSLT297]

Perhaps one of the Doc's on this forum could explain it better, but just because you are exposed to TB does not mean you have it or will get it ..

In the 1980's in NYC, a large percentage of medics at a certain facility , i think the # was like 75% tested positive to TB exposure, because we went into and out of tons of homeless shelters, correctional facilities, etc. and from my recollection no one ever came down with TB, it just meant we had been exposed.....

That is why the TB test is so misleading, you get someone who was given INH as a child, and they test positive,,,, check their X-ray, and they get a clean bill of health....

Docs, please help ,, i'm not doing justice to this topic.

[FormerEMSLT297]

I.N.H is the one i remember as a street medic seeing all the time

[VentMedic]

The most common meds:

Isoniazid (IHN, Nydrazid)

Rifampin (Rifadin, Rimactane)

Pyrazinamide

Ethambutol (Myambutol)

Other meds for the TB that does not respond to the above:

Rifapentine (Priftin)

Streptomycin (STM)

Ethionamide (Trecator-SC)

Cycloserine (Seromycin)

Capreomycin (Capastat Sulfate)

Levofloxacin (Levaquin, Quixin)

Moxifloxacin (Avelox, Vigamox)

These same meds may be used to treat extrapulmonary Tuberculosis as well. This could involve the pleura, lymph nodes, genitourinary tract, skeleton, meninges, peritoneum, or pericardium. If someone lists Tuberculosis as one of their diseases, you should ask if it is in the lungs or elsewhere.

People who have active TB will take the meds for many months and there are some that require treatment up to two years. That does not mean they are infectious to others during this time if they are compliant with their drug regime.

When first diagnosed with TB, the patient will be in isolation until he/she shows response to the drug therapy which can vary from a few days to a few weeks. If it is multi-drug resistant TB, they may need to be monitored closely for several months, usually by sputum tests for AFB, to see if there is a relapse.

You will find people, including healthcare workers that test postive (convert) but are not considered to be Active with TB. This is Latent TB. You may have to take one of the antibiotics for 4 to 9 months the first time you test positive.

Absolutely we take every precaution when a suspected TB patient arrives in the ED, clinic or anywhere in the hospital. Americans are usually not vaccinated against TB which in itself is not a guarantee since there are many different multi drug resistant strains coming from many different populations. The US is a multi-national commuter country which leads us to many possible exposures. The reason we do not have the problem other countries have with their vast TB population is through strict precautions and the continuing education of HCWs. Other countries do not practice these same preventitive measures and that is why TB is "common" in those areas.

People in other countries may have taken the BCG vaccine, so yes, they will test positive and will have some immunity. However, they can still get TB and that is why they also must be tested after significant exposure and regularly if they are healthcare workers.

These patients are isolated for the protection of all including HCWs and the sick people in the hospital environment who have weakened immune systems as well as the protection of any children that might be around. For some, TB is still deadly.

TB is still very much active (but not "common") in some parts of the U.S. Florida still has a TB hosptial, A.G. Holley, located in Palm Beach county.

http://www.doh.state.fl.us/AGHolley/index.html

Everything you want to know about TB:

http://www.cdc.gov/tb/

http://www.cdc.gov/tb/pubs/mmwr/Maj_guide/default.htm

Casual exposure to a patient with Active TB for a short time may not present a high risk. Most HCWs or just about anyone have been around Active TB and did not know it. Those that convert to Latent TB may not know when they where exposed. For RRTs, RNs and EMT(P)s it could have been during that neb treatment for a cough. Your risk factors are determined by your age, health status and type/length of exposure.

EMS providers may have the most unprotected exposure to TB and other infectious diseases but get the least amount of education about them when compared to any other health care profession. Other professions have a good initial education in their curriculum. They may also be required to attend yearly updates or take a couple CEUs on infectious diseases with each license renewal. Even the education on HIV/AIDS has gotten lax and we are again seeing more people in their early 20s being diagnosed.

[firedoc5]

In the late 80's we had one regular pt. with active TB. Gloves, masks, sometimes gowns, were used all the time, even if we were called on someone else in the house, which happened frequently. We were all tested twice a year. One Medic, who is now a Capt. did develop a "spot" on his lung. It just needed to be watched. As far as I know he hasn't had any problems.

At our main resource hospital, on their campus, they had a huge facility in the 50's and 60's that was a TB sanitarium. It's now used for office and classrooms. But most of it is just abandoned. We always wanted to play laser tag in there.

[AnthonyM83]

What are the chances of spontaneous conversation from latent to active TB? Are the chances different if they were initially treated with antibiotics when they tested positive or were those just in case it was going to develop into active AT THAT TIME and no effect on future?

Taking this further. . . should one be concerned about relationships with someone who has been exposed to active TB for long periods of time, but no symptoms?

[VentMedic]

What are the chances of spontaneous conversation from latent to active TB? Are the chances different if they were initially treated with antibiotics when they tested positive or were those just in case it was going to develop into active AT THAT TIME and no effect on future?

There could be cause for concern if they had something serious that might compromise their immune system somewhere in the future. This could be a disease process, traumatic injury or some very stressful event. Other than that, TB should stay dormant.

Many of the RRTs and RNs that have been in the profession for more than 20 years converted long ago. With stricter precautions and better filtration systems in the hospital, this does not happen that often today in the U.S.

Taking this further. . . should one be concerned about relationships with someone who has been exposed to active TB for long periods of time, but no symptoms?

I've been exposed to patients with Active TB while working as a Paramedic and RRT for 30 years. It wasn't TB that messed up any of my relationships. Although, in the 1980s I described my job as, "I test patients for TB in an AIDS clinic" to scare away undesirable suitors. The public has since become more educated and unfortunately that line no longer works.

Seriously though, even the people living in the same household with someone diagnosed with active TB rarely test positive for TB. The factors influencing this could be the health and age of the other family members and if the patient has common social skills when it comes to coughing on others. The ventilation of the living quarters also can play a big role which is why homeless shelters, jails and prisons have a higher rate of TB.