Tuberculosis (TB)

How It Spreads

TB that's in the lungs can spread when a person who has active TB breathes out air that has the TB bacteria in it. Another person may breathe in the bacteria. Things like coughing can also release even more bacteria. TB that isn't in the lungs can't spread easily to others.

What Increases Your Risk

Some people are more likely than others to get TB. This includes people who have a weak immune system, have close contact with someone who has active TB, have poor access to health care, or have a substance use disorder. People who travel or live where untreated TB is common are also at risk.

Prevention

TB in the lungs is spread very easily. To avoid getting TB:

• Don't spend long periods of time in close contact with someone who has active TB until that person has been treated for at least 2 weeks.
• Use measures to protect yourself if you work somewhere that cares for people who have untreated TB. An example is wearing a face mask. Face masks must be certified by the CDC and National Institute for Occupational Safety and Health (NIOSH), such as an N95 or higher-level mask.
• If you live with someone who has active TB, help the person follow treatment instructions so they can't spread TB.

The TB vaccine

A TB vaccine is used in parts of the world where the risk of getting TB is higher. But it's almost never used in the United States.

Symptoms

People with latent TB don't have symptoms.

Symptoms of active TB in the lungs include:

• A cough with thick, cloudy, and sometimes bloody mucus from the lungs (sputum).
• Fever, chills, and night sweats.
• Fatigue and weakness.
• Loss of appetite and losing weight without trying.
• A rapid heartbeat.
• Shortness of breath and chest pain.

These symptoms start gradually and develop over weeks or months. You may have one or two mild symptoms and not know that you have the disease.

Symptoms of TB outside the lungs vary widely, depending on which part of the body is infected. For example, back pain can be a symptom of TB in the spine. Or your neck may get swollen when lymph nodes in the neck are infected.

What Happens

TB develops when you breathe TB bacteria into your lungs. The infection usually stays in the lungs. But the bacteria can move through the bloodstream to other parts of the body. The symptoms of the infection depend on the part of the body affected.

In a person who has a healthy immune system, the body usually fights the infection by walling off the bacteria into tiny capsules. (These are called tubercles.) This stage is called latent TB. Most people feel fine and don't have symptoms and cannot spread latent TB. A small number of people who have latent TB may develop active TB at some point in their lives.

If a person's immune system can't stop the bacteria from growing, the TB is active. If the TB is active, make sure to take all the medicine your doctor tells you to and on schedule to prevent problems.

Without treatment, active TB can cause other serious health problems, such as lung damage.

When to Call a Doctor

Contact your doctor now if you:

• Have symptoms (such as a cough that may produce bloody mucus along with fever, fatigue, and weight loss) that could be caused by tuberculosis (TB).
• Were in close contact with someone you think or know has untreated active TB, which can be spread to others.
• Have blurred vision or changes in how you see colors and are taking ethambutol for TB.
• Notice yellowing of your skin and the whites of your eyes (jaundice), or you have belly pain and you are taking isoniazid or other medicines for TB.

Follow up with your doctor if you:

• Recently had a TB skin test. You need to have a skin reaction measured by a health professional within 2 to 3 days after the test. This measurement is important in deciding whether you need more tests or treatment.

Exams and Tests

TB is found by doing a tuberculin skin test. A nurse will inject TB antigen fluid just under your skin. It will cause a small bump that then becomes flat within an hour. If you have TB bacteria in your body, within the next 2 to 3 days you will get a firm, red bump where the needle went into your skin. The test can't tell when you became infected with TB or if it can be spread to others.

A blood test also can be done to look for TB.

To find TB in the lungs, doctors test a sample of mucus from the lungs to look for TB bacteria. Doctors sometimes do other tests or take a chest X-ray to help find TB in the lungs.

To find TB that's not in the lungs, doctors may check a tissue sample (biopsy) or do imaging tests.

Treatment Overview

TB is treated with antibiotics to kill the TB bacteria. These medicines are given to everyone who has TB. This includes infants, children, and people who have a weakened immune system. Before taking any TB medicines, talk with your doctor if you think you are or may be pregnant.

TB can only be cured if you take all the doses of your medicine. If you miss doses, or if you stop taking your medicine too soon, your treatment may not work. Or it may have to go on longer. Your doctor will make a treatment plan that includes the types of medicines to take, how much, how often, for how long, and what side effects to watch for and report back to them.

You may have directly observed therapy (DOT). This means that a health care worker watches either in person or on a video call (vDOT) when you take your medicine. DOT helps you remember to take your medicine. And it helps you complete your treatment as soon as possible.

Surgery is rarely used to treat TB. But it may be used in severe or drug-resistant TB.

Self-Care

Home treatment for TB focuses on taking the medicines correctly, taking good care of yourself, and protecting others from infection.

• Take your medicines as prescribed. Taking your medicines correctly reduces your risk of getting multidrug-resistant TB.
• Avoid drinking alcohol. Alcohol may interact with your medicine and cause side effects.
• Work with your doctor.
  • Go to all of your medical appointments.
  • Report any side effects of the medicines, especially vision problems.
  • If you plan to move during the time that you are being treated, let your doctor know. Your doctor can help arrange for you to keep getting treatment.
• Help your body fight the infection. During treatment, eat healthy foods and get enough sleep and some exercise to help your body fight the infection. Ask your doctor when it's safe for you to exercise. When you can go outside, walking is a good way to get exercise for many people. Start slowly if you haven't been active. Try to walk for a few minutes. Slowly increase your time as you feel stronger. Try to walk as often as you can.
• Try to avoid too much weight loss. If you are losing too much weight, eat balanced meals with enough protein and calories to help you keep weight on. If you need help, talk with a registered dietitian.
  • If you don't feel like eating, try smaller meals several times a day instead of a few large ones.
  • Drink high-calorie protein shakes between meals. Or try nutritious drinks, such as Ensure.
  • If you feel sick to your stomach, try drinking peppermint or ginger tea.
• Protect others from TB. Until you've been on antibiotics for about 2 weeks, you can easily spread the disease to others.
  • Don't go to work or school while you can spread the TB infection.
  • Sleep in a bedroom by yourself until you can no longer infect other people.
  • Open windows, if the weather allows it. This can help get rid of TB bacteria from the air in the room.
  • Cover your mouth when you sneeze or cough. After you cough, dispose of the soiled tissue in a covered container. Be sure to wash your hands afterward to prevent spreading TB.
  • Wear a face mask when you are around other people.
  • Talk with your doctor about other things you can do to prevent the spread of TB.
• Get support for emotional issues. TB treatment can last for months, and you need to take your medicines on schedule. This may cause stress. Your doctor or health department can help you find a counselor or social worker to help you cope with your feelings. If you can't afford counseling or treatment, there may be places that offer free or less costly help.