Tuberculosis is real threat in Contra Costa County

Posted on Wed., March 18, 2009
By Charles M. Crane

Marianne, a preschool teacher, recently went to her doctor to get a TB skin test (TST) required by her job. She had always tested negative in the past. This time, however, the spot on her arm became red and swollen, and slightly tender. Her test was positive.

Shocked, she called her doctor to learn what this meant. Her mind was buzzing with questions: What had happened? Did she have tuberculosis? Was she contagious to the children in her class?

Fortunately, like most people with a positive TST (also called a PPD, short for purified protein derivative), Marianne did not have any symptoms of "active" TB — a persistent cough, fever, night sweats and weight loss — but she still needed a chest X-ray.

Her X-ray was normal, meaning her TB was in the dormant ("inactive") stage. Inactive TB means the germ is alive inside the body, waiting for the opportunity to grow, make the person sick and spread to others. We call that TB infection.

Getting the TST had enabled Marianne to find out early that she´d been infected with TB before it harmed her or became contagious. There is also a new blood test called "Quantiferon," which is more accurate than the TST.

To cure her TB infection, and to prevent it from growing and causing her to become ill, Marianne was given an antibiotic called isoniazid. Taking the pill once daily for nine months should cure Marianne, so her TB will never become active.

Since World TB Day is March 24, now is an appropriate time to increase our awareness of this devastating disease. Each year worldwide, 9.3 million people become ill with active TB, leading to 1.8 million deaths. TB is the biggest killer of people with AIDS.

The threat of TB in Contra Costa County is real. Last year, active TB cases increased by 55 percent, up from 51 cases in 2007 to 79 cases in 2008.

Anyone can become infected with TB because all you have to do is breathe air with TB germs in it. This can happen when someone with active TB coughs near you.

Certain people are at higher risk of getting TB, however. Recent immigrants to this country had the most cases of TB in Contra Costa County in 2008. People with illnesses that affect their immune systems, such as HIV, diabetes or cancer, and people who are homeless, who use street drugs, or who have been in jail are at higher risk.

People who interact with these high risk groups, such as doctors, nurses, teachers, firefighters and law enforcement officers are also at increased risk.

Unfortunately, some people with TB don´t seek care until they are really quite sick, perhaps because the cough has worsened so gradually, or they fear the cost of medical care. And the longer the diagnosis is delayed, the more people are likely to become infected.

Active TB is generally treatable with two-to-four special antibiotics, taken for six-to-nine months. TB treatment requires multiple antibiotics taken for many months because the germs can easily develop resistance to one antibiotic. Once treatment is started, TB patients rapidly become noncontagious.

For more information, call the county TB program at 925-313-6740, or visit www.cchealth.org/topics/tb.

Crane is the medical director for the TB program.