Adam’s Journal
My wife signed up to volunteer at a hospital, and as part of that process, she received a blood test for tuberculosis. It came back positive.
She’s undergone a chest x-ray, which came back negative. And she has no symptoms. So, what does this all mean?
Dr. Scofield Prescribes
While a positive TB test may sound frightening, it’s nothing to be alarmed about. Tuberculosis is one of the most common bacterial infections, and an estimated one-quarter to one-third of the world’s population has been infected.
What that means is that 2 billion or so people are in the same boat as Mary. And like her until very recently, the vast majority of them have no idea.
Most people who get infected with TB never manifest any symptoms. They have what’s known as latent tuberculosis, and their immune systems keep the bacteria in check. Importantly, they cannot spread the disease.
However, if at some point they become immunocompromised, things can change.
This can happen in a variety of situations. In the U.S., it most commonly occurs as a byproduct of diseases like HIV and diabetes or when treatments for cancer or other conditions weaken the immune system. Malnutrition, which is more common abroad, can also trigger immunodeficiency.
When someone with latent TB becomes immunodeficient, the TB bacteria present in the body can emerge as an active infection. This typically manifests as severe lung disease, and it can also spread to other parts of the body like the lymph nodes, brain, bones and kidneys. Some cases can have no lung disease but infection in these other areas, which can make diagnosis difficult.
Active TB is highly infectious, spreading through the air through coughing, sneezing or close contact. It carries an extremely high mortality rate if left untreated; the chances of survival increase greatly with treatment, which typically involves a combination of antibiotics.
Even though Mary’s TB is latent, she may opt to take antibiotics to rid her body of the bacteria. That’s what I did when I was a medical resident and, like her, tested positive for TB. (Mine was also latent.)
Back then, I had to take antibiotics for a full year. Now, that regimen can be completed in three months. The drugs carry few, if any, side effects.
If Mary opts to go this route, as with all antibiotics, it will be important for Mary to finish the full course of her prescription. If she doesn’t, she risks the possibility that the latent bacteria become resistant to antibiotics, which would be a problem if her TB ever becomes active.
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Dr. Hal Scofield is a physician-scientist at the Oklahoma Medical Research Foundation, and he also serves as Associate Chief of Staff for Research at the Oklahoma City VA Medical Center. Adam Cohen is OMRF’s senior vice president and general counsel. Send your health questions to contact@omrf.org.
