TB Can be in Your Body, to be Awakened in Many Ways
This is called “latent tuberculosis,” which the clinic’s Medical Director Dr. Dan Garganera says is one of the major challenges in the world today when it comes to battling TB. If the TB is “latent,” it means you have been exposed to the bacteria, and it is currently in your body, but not causing any manifestations of active TB. This also means you are not contagious at this point.
Latent TB is perhaps best described as an M&M candy with the hard shell around it. The chocolate is the TB bacteria, and the shell is keeping it latent. But Sunny Hill TB Clinic Administrator Joyce Reliford-Parker says there are various factors that can take that “protective shell” away, and cause the bacteria to wake up and become Active TB.
“It can be awakened by advanced age, or numerous diseases such as diabetes, HIV/AIDS, cancer, or even sometimes smoking or exposure to pollution,” Reliford-Parker explained. “In rare cases, even pregnancy can sometimes wake up the germ. And more and more today, new medications taken for common ailments can awaken TB as well.”
Dr. Garganera agreed. “We’ve had so many situations where someone with autoimmune diseases like Rheumatoid Arthritis awakens the TB in their system with medication. It can also happen when treating things like Lupus or Psoriasis. These days, you see all those biological ‘cure all’ drugs advertised on TV, and you have to be careful. Some of them can certainly cause a situation in your body where the TB becomes active.”
And once it becomes active, there are a variety of symptoms, mostly affecting the lungs. These can include coughing that lasts up to three or more weeks, coughing up blood, chest pain, difficulty with breathing, weight loss, fatigue, fever, night sweats, chills, and loss of appetite.
When a TB skin test (PPD) shows that a person has the bacteria, the next step is to find out if they actually are active and contagious. A blood test (such as a T-spot or TB-Quantification Gold test), is done along with a chest X-ray. If both are positive, sputum specimens are collected to determine active infection.
As for how someone becomes infected with TB in the first place, Dr. Garganera says it must be remembered how extremely contagious Active TB, an airborne disease, actually is. “It’s really the flu on steroids, “Dr. Garganera explained. “While the flu is spread by the inhaling of droplets, often to someone up to about two meters from you; TB droplets actually become part of the air and can infect someone, say up to 20 yards away. Not only that, but the bacteria can remain in the air for a couple of hours.”
The CDC has classified many high-risk groups for TB. Dr. Garganera says that ironically, there is a certain demographic that is highly affected in the U.S. and worldwide: health care workers. “Sometimes a health care worker may inhale the bacteria from someone they are treating, but that patient may have undiagnosed active TB. The bacteria may then be suppressed by the health care worker’s immune system, becoming Latent TB. This is why it is important that health care workers be screened for tuberculosis.”
In fact, the CDC recommends TB screening for health care workers, as well as for all immigrants; especially those from high incidence TB countries. They also recommend screening for prison inmates, as well as patients with weakened immune systems; including those with cancer, HIV/AIDS, diabetes, and renal failure patients. Pregnant women also need testing to avoid infecting their babies if they are actively infected.
Dr. Garganera and Reliford-Parker both emphasize that once someone finds they have latent TB, it can indeed be treated and treatment should begin immediately. “Getting it before you are actively contagious is just one reason to treat Latent TB,” stated Dr. Gargenara. “Another is that it is easier to kill it while it’s asleep. Once the TB wakes up, it will fight back.”
Reliford-Parker agrees. “While it takes two medications to treat latent TB, it takes up to four to treat active TB. It’s a completely different battle.”
And while some people think TB is completely a thing of the past, such as polio, they are 100 percent wrong. “TB is now the number one infectious disease killer worldwide,” Garganera stated. “It used to be Malaria. But the lack of testing and catching latent TB before it becomes active has been the main problem.” Garganera says those new to the U.S. should definitely be tested, especially when coming from high TB areas such as Africa and South Asia. Specific countries he mentioned included China, Pakistan, India, and the Philippines.
Reliford-Parker says that in Will County there were 17 cases of Active TB in 2016, and 13 cases in 2017. And when local cases happen, it is often discovered how misinformed the public can be about TB.
“We had this one public forum,” Dr. Garganera recalled, “where a student had been in the same class with another student with active TB. Her father asked if this meant his mother with cancer, living in another city, was at risk for TB and would need treatment But she, of course, had nothing to do with the situation, since she had not been exposed by the infected student.”
Due to state statute, the Sunny Hill Tuberculosis Clinic provides medication free of charge for patients with Active TB. Regardless of income or insurance, the TB clinic is responsible to case manage all Will County residents with infectious Tuberculosis.
Also by state statute, the Sunny Hill TB Clinic operates as part of the entire county rather than as part of the Will County Health Department. The clinic’s location, however, is 503 Ella Avenue, right next to the Health Department building; which ironically was first built as a TB sanitorium back in the 1930’s.
The Sunny Hill TB Clinic can be reached at the Will County website, www.willcountyillinois.com. More information on TB can be found at the Illinois Department of Public Health’s website, www.idph.state.il.us.