TB (tuberculosis) is out of control worldwide, and drug-resistant strains are on the rise, according to the World Health Organization. Hot spots of resistant strains are in India and Brazil, and the rates are increasing along the west coast of South America, all of sub-Saharan Africa, Pakistan, India, China, Indonesia, and the former Soviet Union. TB has increased in the United States because of slackened control efforts due to the mistaken belief that drugs developed in the 1940s would control the infection.
People visiting the above countries are at risk, as are anyone who flies on commercial airlines. A person with active TB on an aircraft can spread airborne particles to other passengers and crew via the air recycling system. Many countries require a PPD (skin test for exposure to the TB bacteria) before travel to their country is permitted. This is to protect the country from in-coming cases. However, it may be of more importance to you to have a TB test after returning home to know if you were exposed during travel abroad.
TB is caused by a hardy bacterium, Mycobacterium tuberculosis, which can infect (or live in) a host for months to years before becoming active (or causing illness). The body's natural defense system attempts to resist the disease by walling off the bacteria, usually in the lungs, but other parts of the body are also susceptible. The walling-off process does not actually kill the organisms, and they can become active at any time, particularly if you become weak, ill, undernourished, or immunocompromised. This is why the resurgence of TB has paralleled the AIDs epidemic. The primary stage of the disease often causes either no symptoms or a flu-like illness. Some people never even discover that they have become infected. If TB becomes active, the bacteria begin to replicate, resulting in lung damage that reduces your ability to breathe. Pockets of trapped bacteria elsewhere in the body can also become active, destroying tissue wherever they are located. Symptoms include slight fever, night sweats, weight loss, fatigue, and dry cough. If other parts of the body are affected, you may experience other symptoms as well. If you are sick from tuberculosis, several medications will be prescribed for you for several months. Untreated secondary tuberculosis can be fatal. Even with successful treatment, infected organs may be left with severe damage.
Protect yourself: (1) Get a TB skin test (PPD) whenever it is recommended to you, or yearly if you are in a high-risk group (health care worker, employee of a nursing home or prison, or traveler to afar). If your TB skin test is read as positive, it is presumed you have been exposed to the TB bacteria. It would be recommended that you get a chest x-ray to make sure there were no active foci of infection. But whether your chest x-ray is positive or negative, it would be recommended that you take a medication to eradicate the bacteria from your body. The medication is often monitored through a state health department. (2) Consult your physician if you experience symptoms of weight loss, fevers, persistent cough, or general illness.
Melanie Thompson, M.D.
