TB or not TB. Since the beginning of 2021, doctors and public health officials in the state of Washington may have been asking this type of question much more often. And that not be good. The state had 199 reported cases of TB, which is short for tuberculosis, in 2021 and has already had 70 reported cases just four months into 2022. In fact, according to a Washington State Department of Health announcement on April 28, the state has been having its largest TB outbreak in the last 20 years.
Last year’s TB total represented a 22% jump from the year prior. Reported TB cases had actually decreased in 2020 compared to 2019. However, before you say, “yay, 2020,” keep in mind that 2020 was when a little thing called the Covid-19 pandemic had gotten started. This meant that many TB prevention services and clinics may have been closed or understaffed. Plus, many folks may have avoided health care settings. As a result, those infected with the TB-causing bacteria Mycobacterium tuberculosis may have gone undiagnosed and thus have spread the bacteria without even knowing it. That, in turn, could have pushed the number of new cases up and up, in the words of Coldplay.
The announcement quoted Washington’s Chief Science Officer Tao Sheng Kwan-Gett, MD, MPH, as saying, “It’s been 20 years since we saw a cluster of TB cases like this. The pandemic has likely contributed to the rise in cases and the outbreak in at least one correctional facility.”
Also included in the announcement was a statement from Washington State Department of Corrections (DOC) Chief Medical Officer MaryAnn Curl, MD: “Testing of staff, and our incarcerated population at Stafford Creek Correction Center continues, which is how these cases were found. We’ll continue to communicate with staff, their incarcerated population and their families as appropriate.”
One key will be to not “air” on the side of Mycobacterium tuberculosis. You can catch the bacteria by inhaling air contaminated by an infectious person who is coughing or sneezing. TB is not as contagious as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). So prolonged close contact is typically required for transmission to occur. Nevertheless, someone with active TB needs to stay isolated, and people should wear N95 face masks when in the same room as the person.
TB most often becomes a lung story with the bacteria wreaking havoc in your lungs. However, Mycobacterium tuberculosis can also go to and damage other parts of your body such as your kidneys, spine, and brain. Usually, it takes about three to nine weeks from the initial infection to the appearance of a lesion in the lung or a person’s TB skin test to turn positive. Not everyone who gets infected will necessarily develop active TB and become ill right off the bat. Some people will have latent TB infections (LTBI) instead where the bacteria is hanging out in your body but you aren’t infectious and don’t display any symptoms. However, latent infections can eventually turn into active TB disease when not treated properly. When you don’t treat active TB appropriately, you can die from the disease. And death from TB would be not good
Common symptoms of active TB include a bad cough that lasts three weeks or longer, chest pain, and coughing up blood. You may also feel weak, lose your appetite and weight, or suffer night sweats. Symptoms alone are not enough to determine whether you have TB since such symptoms can have other causes. For example, bronchitis, lung cancer, bronchiectasis, other types of pneumonia, and chronic obstructive pulmonary disease (COPD) are some of the other things that can cause hemoptysis, which is the medical term for coughing up blood. Similarly, a variety of others issues can lead to excessive sweating at night such as alcohol use, anxiety, autoimmune disorders, other types of infections, lymphoma, hyperthyroidism, and wearing 14 sweaters to bed. Diagnosis of a TB infection requires either a skin or blood test. Diagnosis of a active TB lung infection involves checking your sputum or lung secretions for presence of Mycobacterium tuberculosis.
Treatment for LTBI entails some combination of isoniazid, rifapentine, and rifampin for somewhere between three months and nine months depending on which of these medications are used. Treatment of active TB can take four, six, or nine months depending on what regimen of medication are used. These medications aren’t like pizza. Once you start them, you shouldn’t leave leftovers. It’s important to finish any regimen that you begin. Otherwise, you may not get rid of all the Mycobacterium tuberculosis and even worse could drive the development of antibiotic resistant strains of TB.
The keys to controlling this outbreak will be testing all close contacts of people infected with TB as well as those who are at risk for exposure such as people who live or work at homeless shelters, correctional facilities, nursing homes, and parts of the world where TB is more common. And then quickly isolating those who may have active TB, and treating everyone who’s infected. That may be easier said than done since the words “public health” and “swimming with resources” aren’t often seen together. Instead, you’re probably a whole lot more likely to see words such as “public health” and “which decade is that FAX machine from” together.