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TB CLINICS | ||||||||||||||||
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By appointment only, call Utica 798-5747. | For more information call: #798-5747 | |||||||||||||||
There are two types of TB, Latent
TB Infection (LTBI) and TB
Disease.
TB bacteria is spread through the air from one person to another,
usually when a person with active TB disease coughs or sneezes. People
nearby may breathe in these bacteria and develop latent
TB infection. Many
people who have latent TB infection never develop the TB disease.
A healthy body walls off the TB infection and remains
“asleep”. A person with
TB Infection feels well and is not contagious.
Other people, especially children and people with weakened immune
systems, are at higher risk of the bacteria becoming active (and coming
out of the protective “wall”) and cause TB disease. Active
TB disease
primarily affects the lungs but also can grow in the bones, spine,
kidneys, brain or disseminate throughout the body.
Only pulmonary TB is contagious when an actively diseased person
coughs or sneezes. Symptoms for active TB disease include one or more of
the following: Cough for greater than 3 weeks; chest pain; discolored or
bloody sputum; recurrent fever or night sweats; appetite and weight
loss; generalized weakness and fatigue. These symptoms may progress
quickly or extremely slowly. In non-pulmonary TB, unexplained pains in
the bones or spine, headaches, or blood in the urine may result. DIAGNOSIS AND TREATMENT OF
|
v HIV Infection |
v Substance Abuse |
v Recent Infection |
v History of TB |
v Diabetes |
v Silicosis |
v Prolonged corticosteroid therapy |
v Other immunosuppressive therapy |
v Cancer of the Head and Neck |
v Certain blood disorders |
v End Stage Renal Disease |
v Intestinal bypass or gastrectomy |
v Chronic malabsorption syndrome |
v Low body weigh (10% or more below the ideal) |
|
Treatment of Latent TB Infection (LTBI) is essential
to controlling and eliminating TB in the
TB testing is encouraged if a
person has any of these recognized risk factors. TB testing is done
using the Mantoux method. A small quantity (0.1 ml) of a solution
containing a small but precise amount of protein derived from the TB
bacteria is injected under the skin. You cannot get TB from the
solution. Between 48 - 72 hours a trained person inspects the
site for a firm lump (induration) just under the skin and carefully
measures it (in mm).
To determine a positive skin test
depends on your individual risk factors and the size of the reaction as
explained below.
A reaction of 5mm or more is
positive for:
HIV positive persons
Recent contact to a known Active TB case
Chest X-Ray with fibrotic changes consistent with old TB
Persons with organ transplants and other
immunosuppressing conditions or treatments (ie. high dose prednisone)
A reaction of 10mm or more is
positive for:
Immigrants from high-prevalence countries (link: TB Worldwide)
Injecting drug Users
Residents and employees of high-risk congregate settings (ie.
jails/prisons, nursing homes, homeless shelters, hospitals, and
other health care facilities)
Persons with clinical conditions that make them high-risk
Children under 4 years of age, or children and
adolescents exposed to adults in high-risk categories
A reaction of 15mm or more is
positive if:
No known risk factors.
If testing reveals you have a
positive PPD, you must have a complete evaluation to determine if you
have TB Disease or TB Infection. The
evaluation includes a complete medical history, physical exam, and chest
radiograph (also known as a chest x-ray).
Depending on the result of your chest x-ray some additional tests
may be ordered.
The Oneida County Health
Department conducts medical evaluations on Tuesday – 9-11am or 1-3pm
or Thursday – 9-11am. CXR
Clinic is Tuesday – 1-3pm. Evening
Clinics are held from 4-6pm the first and third Tuesday of each month.
Off-site evaluation and testing for certain high-risk groups is
also possible. Please call 315-798-5747 for more information. Russian
and Bosnian speaking staff is also available on site.
TB-related
information is available in different languages.
There are relatively few
antibiotics that are effective in killing the TB germ and it takes 6 -
12 months of treatment to ensure a cure for active TB disease. It is
much easier and safer to treat the latent TB infection. Active TB
disease is not only much harder to cure (requiring 4 different drugs)
but the scar tissue resulting from the disease remains after the germ is
killed which can lead to permanent disability. Also, active TB is
difficult to diagnose because it resembles other infective diseases of
the lungs. This allows the germ an opportunity to be spread to close
contacts, such as family, friends and co-workers.
There are several medicines
(antibiotics) that are recommended to kill the Latent TB Infection
before it has a chance to become active. The amount of medicines to
treat LTBI is much less than those for Active TB disease.
The best treatment option is Isoniazid (INH). The usual dose for adults is 1 pill (300mg) Daily for nine months (270 doses taken within 12 months).
Side effects
are uncommon and most don't
notice any effect whatsoever. However, as with any medicine, a small
number of people experience adverse reactions. We monitor our clients
monthly or more as needed by asking focused questions and, if any
problems are noted, getting the appropriate tests done with medical
follow-up.
If a person is at risk for
developing active TB and cannot tolerate INH, or if the person
contracted the infection from a strain of TB known to be INH-resistant,
then other medicines may be used.
Peripheral neuropathy
- a numbness or tingling most often felt in the fingertips. In most
cases, this is overcome by taking Vitamin B6 while on INH.
Liver Inflammation - a much rarer effect
(1-2%) primarily affecting those with a history of alcohol/drug abuse,
or chronic liver infections (Hepatitis B or C). Signs of this include:
extreme fatigue (tiredness), muscle weakness, loss of appetite,
coffee/tea-colored urine, pale stools, yellowing of whites of eyes and
skin. The liver is a strong organ and has the ability to regenerate very
quickly. There are blood tests that can give us a very accurate picture
of how the medicine is affecting it.
DIAGNOSIS
OF TUBERCULOSIS DISEASE
Pulmonary TB is the most common
form of TB in all persons, including HIV-infected persons. The symptoms
of extrapulmonary TB depend on the site affected. For extrapulmonary TB,
sometimes a biopsy is obtained to smear and culture for TB.
Active TB in Chest X-Ray & Lung
The presence of acid-fast bacilli
(AFB) on a sputum smear often indicates TB. Acid-fast microscopy is easy
and quick, but it does not confirm a diagnosis of TB because some
acid-fast bacilli are not M. tuberculosis. Acid-fast microscopy may also
be negative in some persons with M. tuberculosis.
Therefore, a culture is done on all specimens to confirm a
diagnosis of M. Tuberculosis. Laboratories
should report positive smears and positive cultures within 24 hours by
telephone or fax to the Oneida County Health Department.
For all patients, the initial M. tuberculosis isolate should be tested for drug resistance. It is crucial to identify drug resistance as early as possible in order to ensure appropriate treatment. Drug susceptibility patterns should be repeated for patients who do not respond adequately or who have positive culture results despite 2 months of therapy. Susceptibility results from laboratories should be promptly forwarded to the health department.
Active TB Disease must be treated
for a long time (at least 6 months for most clients) compared with many
other infectious diseases.
For most persons, the preferred
regimen for treating TB disease consists of an initial 2 month phase of
four drugs: isoniazid, rifampin, pyrazinamide, and ethambutol followed
by a 4 month continuation phase of isoniazid and rifampin.
Medication is usually given daily for 14 days and then changed to
2/wk. for the remainder of treatment unless other problems arise.
This regimen can be altered
depending on the response of the client, the drug susceptibility
patterns that emerge from the culture, the existence of other conditions
(ie. HIV infection), and the extent of the disease. Thus every client is
ensured close medical attention throughout the course of treatment. This
approach to treating TB disease was developed to rapidly kill the TB
germs as fast as possible and to prevent the emergence of drug-resistant
strains of the TB bacteria.
DIRECTLY
OBSERVED THERAPY (DOT)
Directly Observed Therapy
(DOT) is the standard of care for treatment of all active TB disease
clients in
DOT provides personal support to the sick client in order to cure the TB disease and to prevent drug resistant strains from developing. Primarily, we wish to enlist the client cooperation and goodwill to ensure a full and final cure of the disease and to stop the spread of this infection to our community. However, if a client is unwilling to cooperate then we can enlist the aid of the courts and law enforcement to force the client to comply because of the risk to the community as stated in public health law. Fortunately, this is rarely the situation.
If you have latent TB infection,
the risk of developing active TB for a person with a good immune system
is about 10% over the course of your life. Persons with HIV infection
and TB may have atypical (unusual) chest X-Rays, and they are more
likely to have extrapulmonary TB than are persons without HIV infection.
Again, any disease or condition that suppresses your immune system increases the chances of developing active TB. HIV/AIDS is a potent activator of latent TB infection. The risk of developing active TB disease is 10% for every year of your life.
It is recommended that if you have
HIV/AIDS, you should get tested for TB infection as soon as possible.
The treatment of the TB infection is the same as for anyone testing
positive for LTBI. Once you've completed the medicine, you've
dramatically decreased your chances of suffering from active TB disease.
Confidential:
Your name is used on your test and results.
You may get a copy of results for your own use whether personal
or for immigration purposes. The
testing, the results and the chart are all kept in a highly confidential
manner.
Anonymous:
Your test and results do not have your name on them.
You cannot get a copy. You
cannot use the anonymous testing for immigration purposes.
All identification is done with an individualized code number.
Special arrangements are required for this kind of testing
through New York State Department of Health.
If interested in getting tested,
Oneida County Health Department offers confidential HIV testing on
Mondays and Fridays from 9am-11am and on Wednesdays from 1pm-3pm.
If you are being followed in the tuberculosis clinic, you may
also get a HIV test when here for your TB visit.
In many areas of the world where
the incidence of TB is high, the use of the BCG vaccine is common.
It is not generally recommended in
the
BCG stands for Bacille
Calmette-Guerín, named after the 19th century French scientists who
developed it. It is a live bacillary vaccine from the form of TB that
infects cows (Mycobacterium bovis) that has been weakened so that it
causes only a minor infection but stimulates the body to produce an
immune (protective) response to human TB (Mycobacterium tuberculosis).
The proven effect of BCG is to
prevent the worse forms of TB disease in children (ie. disseminated TB
and TB of the brain or kidneys). The ability to prevent TB Infection is
uncertain and diminishes over time. Several studies have indicated that
BCG does not prevent infection or subsequent development of Pulmonary TB
in adolescents or adults.
The BCG vaccine can cause a
reaction though usually it is much smaller than what is usually called
"positive", especially if the vaccine was given many years
ago.
If you have a positive skin
reaction you probably have TB infection.
This is very likely if:
the reaction is large
you are born & raised in a region where TB is common
you are a recent contact of a person with infectious TB
your chest X-ray shows evidence of previous TB
disease
Because of persistent public
health efforts in the
Yet, worldwide, the disease is
reaching epidemic proportions. The
rates and numbers of new infections and causes of active disease are on
the rise.
About 2-3 million people die from TB every year.
More than 8 million develop active TB disease each year.
One-third of the world’s population is currently infected with TB
bacillus.
In
TB and HIV are increasing together – HIV activates
TB infection.
The Oneida County Health
Department conducts medical evaluations on Tuesday – 9-11am or 1-3pm or Thursday – 9-11am.
CXR Clinic is Tuesday – 1-3pm.
Evening Clinics are held from 4-6pm the first Tuesday
of each month. TB skin
testing is offered on Monday – 1-3pm.
Please call 315-798-5747 for more
information.
You will be asked about insurance coverage as required by
state law but, if your insurance does not reimburse us for our services,
you will not be billed. There are no co-payments or surcharges.
We are located on
From 90:
Take the thruway to exit 31 (
From
Centers
for Disease Control - Fact Sheet on BCG
http://www.cdc.gov/nchstp/tb/pubs/tbfactsheets/250120.htm
NYC
Department of Health & Mental Hygiene
Tuberculosis Control Program
http://www.ci.nyc.ny.us/html/doh/html/tb/tbbcg.html
BCG
discussion by Families with Children from
http://www.fwcc.org/TB_BCG.htm
15
Year study in
click on: Chingleput BCG Vaccine Trial Reports
http://www.trc-chennai.org/
LINKS TO SOURCES OF TB-RELATED INFORMATION
GENERAL
PUBLIC INFORMATION
http://www.cdc.gov/nchstp/tb/faqs/qa.htm
http://www.health.state.ny.us/nysdoh/communicable_diseases/en/tb.htm
http://www.ci.nyc.ny.us/html/doh/html/tb/tb.html
http://www.hopkins-tb.com/index.shtml
National
Institute of Allergy and Infectious Diseases
http://www.niaid.nih.gov/newsroom/focuson/tb02/tb.htm
American
Lung Association
http://www.lungusa.org/diseases/lungtb.html
Tuberculosis.net
http://www.tuberculosis.net/
INTERNATIONAL TB INFORMATION & TB
INFORMATION IN
LANGUAGES OTHER THAN ENGLISH
TB
information in many languages
http://www.healthlinknm.org/refugee/resources/foreign/tb.htm
http://ush1.ush.vcu.edu/tb/lang.htm
http://www.lung.ca/tb/notenglish/
http://www.dhs.vic.gov.au/phd/language.htm
EthnoMed
- TB information - many languages
http://ethnomed.org/ethnomed/clin_topics/tb/
Assc.
of Asian Pacific Community Health Organizations
TB & other health information - many languages
http://www.aapcho.org/display.pl?template=pp_topic#top
International
Union Against Tuberculosis & Lung Disease
http://www.iuatld.org/full_picture/en/frameset/frameset.phtml
Stop
TB world wide perspective
http://www.stoptb.org/
Stop
TB - Ukrainian language
http://www.tb.org.ua/
Centers
for Disease Control - Fact Sheet on BCG
http://www.cdc.gov/nchstp/tb/pubs/tbfactsheets/250120.htm
NYC
Department of Health & Mental Hygiene
Tuberculosis Control Program
http://www.ci.nyc.ny.us/html/doh/html/tb/tbbcg.html
BCG
discussion by Families with Children from
http://www.fwcc.org/TB_BCG.htm
15
Year study in
http://www.trc-chennai.org/
Centers
for Disease Control - TB Home
http://www.cdc.gov/nchstp/tb/
Centers
for Disease Control - Direct link to Core Curriculum on TB
http://www.cdc.gov/nchstp/tb/pubs/corecurr/default.htm
National
TB Center
http://www.nationaltbcenter.edu/
OSHA
TB page
http://www.osha-slc.gov/SLTC/tuberculosis/index.html
National
http://www.niaid.nih.gov/newsroom/focuson/tb02/tb.htm
http://www.state.nj.us/health/cd/tbhistry.htm
Centers
for Disease Control
http://www.cdc.gov/nchstp/tb/pubs/pamphlets/tbandhiv_eng.htm
Acid-fast bacilli (AFB)
- a class of bacterium of which TB is a member; they are recognized by
their unusual staining properties. Seeing these bacterium in a slide of
lung sputum is often called "smear positive".
Adverse Reaction - negative side effect resulting from the use
of a drug (for example, hepatitis, nausea, headache). Also called a side
effect.
Antibiotics - drugs that kill bacteria infecting the body. Not
completing the recommended course of antibiotics can create bacteria
that is resistant to these drugs.
BCG - bacille Calmette-Guerín; a vaccine to protect
against TB, only proven to protect children from the worst forms of TB
and it effectiveness decreases in time; may produce small (1-5 mm) skin
reactions.
Biopsy - a small amount of body tissue or fluid is removed
and then tested for signs of infection.
Cavity - a hole in the lung where TB bacteria have eaten
away the surrounding tissue. If a cavity shows up on your chest x-ray,
you are more likely to cough up bacteria and be infectious.
Chest x-ray - a picture of the inside of your chest. A chest
x-ray is made by exposing a film to x-rays that pass through your chest.
A doctor can look at this film to see whether TB bacteria have damaged
your lungs.
Contact - a person who has spent time with a person with
infectious TB.
Culture - a test to see whether there are TB bacteria in
your phlegm or other body fluids. The bacteria from the sputum is put
into a media to allow it to reproduce and test for vulnerability to
certain antibiotics. This test can take 2 to 4 weeks in most
laboratories.
Clinical Evaluation
- an evaluation done to find out whether a patient has symptoms of TB
disease or is responding to treatment; also done to check for adverse
reactions to TB medications.
Continuation Phase - the period after the first 8 weeks of
treatment, during which tubercle bacilli that remain after the initial
phase are killed.
Daily Regimen - a treatment schedule in which the patient takes a
dose of each prescribed medication every day.
DOT-Directly Observed Therapy
- health care workers or another designated person watches the TB
patient swallow each dose of the prescribed drug. The standard of care
for treating active TB disease includes DOT.
Ethambutol - a drug used to treat TB disease. May cause vision
problems. Ethambutol should not be given to children who are too young
to be monitored for changes in vision.
Extrapulmonary TB - TB disease in any part of the body other
than the lungs (for example, the kidney or lymph nodes).
Hepatitis - liver inflammation that can be caused by several
drugs used to treat TB infection or disease.
HIV infection - infection with the human immunodeficiency virus,
the virus that causes AIDS (acquired immunodeficiency syndrome). A
person with both TB infection and HIV infection is at very high risk for
TB disease.
Infectious TB - TB disease of the lungs or throat, which can be
spread to other people.
Infectious person - a person who can spread TB to others
because he or she is coughing TB bacteria into the air.
Initial Phase - the first 8 weeks of treatment, during which most
of the tubercle bacilli are killed.
Intermittent Regimen
- a treatment schedule in which the patient takes each prescribed
medication two or three times weekly at the appropriate dosage.
Isoniazid - the drug most often used for preventive therapy
and also used to treat TB disease. Sometimes referred to as INH.
Miliary TB - TB disease that has spread to the whole body
through the bloodstream. Also called disseminated TB.
Multi Drug-Resistant TB (MDR TB)
- TB that is resistant to isoniazid and rifampin and is more difficult
to treat than drug-susceptible TB.
Mycobacterium tuberculosis
- the species of bacteria that causes TB infection and TB disease.
PPD - purified protein derivative; see TB skin test.
Pulmonary TB - TB disease that occurs in the lungs, usually
producing a cough that lasts longer than 2 weeks. Most TB disease is
pulmonary.
Pyrazinamide - drug used to treat TB disease, usually during the
initial phase of treatment; should not be given to pregnant women.
Rifampin - drug used to treat TB disease; also used for
preventive therapy in people with a positive skin test reaction who have
been exposed to isoniazid resistant TB. Rifampin has several possible
side effects (for example, hepatitis, turning body fluids orange, drug
interactions).
Streptomycin - an injectable drug used to treat TB disease; may
cause hearing problems; should not be given to pregnant women.
TB skin test - a test that is often used to detect TB infection.
A liquid called tuberculin (PPD) is injected under the skin on the lower
part of your arm. It is inspected 2 - 3 days later for any reaction and,
if so, carefully measured. If you have a positive reaction to this test,
you probably have TB infection. Also called a Mantoux test or PPD.
Smear - a test to see whether there are TB bacteria in
your phlegm. To do this test, lab workers smear the phlegm on a glass
slide, stain the slide with a special stain, and look for any TB
bacteria on the slide. This test usually takes 1 day.
Sputum - phlegm (mucus) coughed up from deep inside the
lungs. Sputum is examined for TB bacteria using a smear; part of the
sputum can also be used to do a culture.
TB infection - a condition in which TB bacteria are alive but
inactive in the body. People with TB infection have no symptoms, don't
feel sick, can't spread TB to others, and usually have a positive skin
test reaction. But they may develop TB disease later in life if they do
not receive preventive therapy.
TB disease - an illness in which TB bacteria are multiplying
and attacking different parts of the body. The symptoms of TB disease
include weakness, weight loss, fever, no appetite, chills, and sweating
at night. Other symptoms of TB disease depend on where in the body the
bacteria are growing. If TB disease is in the lungs (pulmonary TB), the
symptoms may include a bad cough, pain in the chest, and coughing up
blood.
Tuberculin - a liquid (PPD) that is injected under the skin on
the lower part of your arm during a TB skin test. If you have TB
infection, you will probably have a positive reaction to the tuberculin.
See TB skin test.
Nicholas A. DeRosa
Director of Health
Oneida County Department of
Health
Adirondack Bank Building
5th Floor
185 Genesee Street
Utica, New York 13501
(315) 798-6400
Email: publichealth@ocgov.net
© 2002 Oneida County, New York, USA