Tuberculosis Information

What is tuberculosis (TB) disease?

Tuberculosis (TB) is a disease caused by TB bacteria (germs) infecting the lungs and
sometimes spreading to other parts of the body. The infection is spread through the air
when a person with infectious TB disease of the lungs breathes, coughs or sneezes
into the air. To become infected with TB bacteria you have to breathe the TB bacteria
into your lungs.

The TB bacteria can enter the lungs and multiply, which can damage the lungs. People
with TB growing in their lungs can spread TB bacteria to other people. TB can also
affect other parts of the body like lymph nodes (lymph glands), bones and kidneys.

TB disease is not likely to be spread to others when it does not affect the lungs.

What is the difference between TB infection and TB disease?

You have TB infection (also called latent TB infection or sleeping TB) when you have
breathed TB bacteria into your lungs but your body's immune system defenses have
stopped the bacteria from spreading. The TB bacteria in the body do not cause you to
feel sick, and you cannot spread TB bacteria to others. TB infection is fairly common,
affecting thousands of people in Canada and billions of people in the world.

You have TB disease (also called active TB disease) when the TB infection changes
into TB disease. When this happens, the TB bacteria in your body overcome the
bodys defenses and start to multiply and spread. Those who have TB disease inside
their lungs can spread TB bacteria to those around them.

Out of ten people who get infected with TB bacteria, only one person will progress to
TB disease in his or her lifetime.

What are the symptoms of TB disease?

When people have TB disease they may have symptoms such as coughing, weight
loss, loss of appetite, night sweats and fever. Someone with TB disease may have
several of these symptoms, or very few.

What if I am a contact to TB disease?

Usually you only need to be assessed if you have spent a great deal of time with a
person with infectious TB disease (e.g., weeks or months). A public health nurse will
assess you to see if you have either TB disease or TB infection.

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 The public health nurse will start by asking you a series of questions about your past
medical history, and whether you have any symptoms of possible TB disease (e.g.,
cough, weight loss). The public health nurse will then perform a special test called a
tuberculin skin test (TST, also called a Mantoux test), and may do additional tests if
these are needed.

Why do I need a tuberculin skin test (TST)?

A TST is done to determine if you have latent TB infection. It is possible to have TB

bacteria in your body and not feel sick. The TST is the only way to test for latent TB
infection.

How is the TST done?

The TST is a two-part test. For the first part, the nurse uses a needle to inject a small
amount of a test substance (called tuberculin) under the skin on your forearm. Two or
three days later you need to return to the nurse to have the area of the injection
assessed. Some individuals will have a small bump under the skin that will then be
measured. Some individuals will not have any reaction at all. If a bump is present, and
if it is of a certain size, this may indicate the presence of latent TB infection.

Some people will require two TSTs: one as soon as possible, and a second one two
months or more after the last contact with the infectious individual. If it has already
been two or more months after the last contact with the infectious individual a person
will only need to have a single TST.

Who should not be given a TST?

You should not have a TST if any of the following apply:

- You had a severe allergic reaction to a TST in the past

- You had active TB disease in the past
- You had a positive TST reaction in the past.

If you have had an immunization (vaccine) in the last four weeks, please tell your
Public health nurse. Some immunizations may interfere with the TST results.

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Are there any side effects to the TST?

The TST is a very safe test. Pain, itchiness and discomfort at the test site may occur
and usually goes away soon; this can be treated with cloths soaked in cool water
applied to the area. The area should not be scratched or covered with any bandage.

There is a small risk of blisters or ulcers at the test site in highly sensitive persons.
These sorts of reactions may result in scarring at the test site.

There have been very rare reports of severe allergic reactions to the TST. Allergy
medications are available at all Public Health clinics for immediate treatment of any
severe allergic reactions.

What does the TST result mean?

Your TST reaction size will be measured by the public health nurse, and recorded in
millimeters (mm). For most people recently exposed to TB disease a reaction size of 5
mm or larger is a positive test, and means that TB bacteria are probably within your
body. If your TST is less than 5 mm, you probably do not have TB bacteria in your
body.

What can cause a positive TST reaction?

A positive TST reaction can be caused by one of the following:

- TB infection (latent TB infection): If you were a recent contact to someone

with infectious TB disease, this is the most likely cause of a positive TST.
- TB disease (active TB disease): Most people who have TB disease would
test positive if a TST were administered, however some people with TB
disease do not have a positive TST. This is why the TST is not a good test for
TB disease.
- TB vaccination: A vaccine called BCG (Bacille CalmetteGurin) sometimes
can cause a positive TST reaction, even years after it was given. Not everyone
has received this vaccine.

What other tests need to be done?

Sometimes a chest X-ray is done as part of the TB assessment of an individual to

make sure that TB disease is not present. Not all people require a chest X-ray; it is
offered in the following situations:

- A positive TST reaction is identified

- A person has symptoms that might mean TB disease is present
- Children less than five years of age require a chest X-ray routinely as part of
the TB assessment
- A medical condition is present that greatly reduces the ability of the body to
fight infections (e.g., human immunodeficiency virus [HIV] infection)

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 Sometimes the public health nurse will also collect from a person sputum (phlegm)
coughed up from the lungs, and have this tested for TB bacteria. This is done if a
person is found to have symptoms that might be TB disease, or if a chest X-ray is
obtained and shows an abnormal finding that might be TB disease.

What is the treatment for TB disease and TB infection?

Both TB infection and TB disease can be treated with medications and both can be
cured. All treatment and medications are offered free of charge.

If a person is found to have TB disease or TB infection the person will be referred to a

doctor with expertise in TB for further assessment and consideration of treatment.

Treatment of TB disease consists of taking several types of pills, usually for six to nine
months. Treatment of TB infection consists of taking one type of pill, usually for nine
months. All TB therapy is carefully monitored by a team of doctors and nurses with
expertise in TB.

Can TB disease be prevented?

The best way of preventing TB disease from spreading is to make sure that everyone
with the disease is treated with the right medication for the right length of time. Another
way to prevent TB disease is to detect TB infection in its early stages, using the TST.
Doctors may prescribe medication to be taken to prevent the latent TB infection from
ever developing into active TB disease.

Where can I get more information?

For more information, please contact your local public health office (listed at
http://www.gov.mb.ca/health/publichealth/offices.html) or call Health Links/Info Sant
at 204-788-8200.

Internet Resources

Manitoba Health Tuberculosis Fact Sheet:

http://www.gov.mb.ca/health/publichealth/factsheets/tuberculosis.pdf

Public Health Agency of Canada Tuberculosis Fact Sheet:

http://www.phac-aspc.gc.ca/tbpc-latb/fa-fi/index-eng.php

Centers for Disease Control and Prevention:

http://www.cdc.gov/tb/topic/testing/default.htm

Information in many languages from Toronto Public Health:

http://www1.toronto.ca/wps/portal/contentonly?vgnextoid=02195dc06f002410VgnVCM
10000071d60f89RCRD

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