Transcript Tuberculosis Screening and Treatment Process

Why do we test?
 1.
We want to prevent an outbreak of Tuberculosis in
our campus community
 2. We want to find those that are affected and get
them treated so you are able to continue to participate
in your schooling.
 3. Countries of Africa, Asia, Eastern Europe, South
and Central America have a high incidence of
tuberculosis.
Tuberculosis
 What is it?
 Tuberculosis (TB) is a disease caused by germs that are
spread from person to person through the air. TB usually
affects the lungs, but it can also affect other parts of the
body, such as the brain, the kidneys, or the spine. A
person with TB can die if they do not get treatment.
 About 10-20% of the international students that we
screen each semester will be positive for a tuberculosis
infection and will need further work up!
Tuberculosis Continued
 How is it spread?
 TB germs are put into the air when a person with TB
disease of the lungs or throat coughs, sneezes, speaks, or
sings. These germs can stay in the air for several hours,
depending on the environment. Persons who breathe in
the air containing these TB germs can become infected;
this is called latent TB infection.
 http://www.cdc.gov/tb/
Active versus Latent Disease
The Difference between Latent TB Infection and TB Disease
A Person with Latent TB Infection
A Person with TB Disease
• Has no symptoms
• Has symptoms that may include:
- a bad cough that lasts 3
weeks or longer
- pain in the chest
- coughing up blood or sputum
- weakness or fatigue
- weight loss
- no appetite
- chills
- fever
- sweating at night
• Does not feel sick
• Usually feels sick
• Cannot spread TB bacteria to others
• May spread TB bacteria to others
• Usually has a skin test or blood test
result indicating TB infection
• Usually has a skin test or blood test result indicating TB
infection
• Has a normal chest x-ray and a negative
sputum smear
• May have an abnormal chest x-ray, or positive sputum
smear or culture
• Needs treatment for latent TB infection to
prevent active TB disease
• Needs treatment to treat active TB disease
Tuberculosis
 How do you get tested?
 There are two tests that can be used to help detect TB
infection: a skin test or a special TB blood test. The
Mantoux tuberculin skin test is performed by injecting a
small amount of fluid (called tuberculin) into the skin
in the lower part of the arm. A person given the
tuberculin skin test must return within 48 to 72 hours to
have a trained health care worker look for a reaction on
the arm. The special TB blood test measures how the
patient’s immune system reacts to the germs that cause
TB.
Tuberculosis
 What does a positive test mean?
 A positive test for TB infection only tells that a person
has been infected with TB germs. It does not tell
whether or not the person has progressed to TB disease.
Other tests, such as a chest x-ray and a sample of
sputum, are needed to see whether the person has TB
disease.
Tuberculosis
 What is BCG?
 BCG is a vaccine for TB disease. BCG is used in many
countries to prevent TB infections in infants and young
children. BCG vaccination does not completely prevent
people from getting TB. It may also cause a false positive
tuberculin skin test. However, persons who have been
vaccinated with BCG can be given a tuberculin skin test
or specific TB blood test.
QFT
 What is it?
 The QuantiFERON®-TB Gold test (QFT-G) is a whole-blood test for use as an
aid in diagnosing Mycobacterium tuberculosis infection, including latent
tuberculosis infection (LTBI) and tuberculosis (TB) disease. This test was
approved by the U.S. Food and Drug Administration (FDA) in 2005.
 How does it work?
 Blood samples are mixed with antigens (substances that can produce an
immune response) and controls. For QFT-G, the antigens include mixtures of
synthetic peptides representing two M. tuberculosis proteins, ESAT-6 and CFP10. After incubation of the blood with antigens for 16 to 24 hours, the amount
of interferon-gamma (IFN-gamma) is measured.
 If the patient is infected with M. tuberculosis, their white blood cells will
release IFN-gamma in response to contact with the TB antigens. The QFT-G
results are based on the amount of IFN-gamma that is released in response to
the antigens.
 Clinical evaluation and additional tests (such as a chest radiograph, sputum
smear, and culture) are needed to confirm the diagnosis of LTBI or TB disease.
QFT
 A positive result suggests that M. tuberculosis
infection is likely; a negative result suggests that
infection is unlikely; and indeterminate result suggests
QFT-G results cannot be interpreted as a result of low
mitogen response or high background response.
Positive Test Results
 You will see the TB specialist at Student Health
 Sent to the hospital to have a Chest x-ray
 You will then come back to Student Health for results
 The provider will determine if you have the Latent
(inactive) form or the Active form of Tuberculosis
Treatment Options
 Active TB cases will be sent to Columbia for an
infectious disease physician to manage
 Latent TB cases (the majority):
 Take the treatment
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Isoniazid daily treatment for 9 months with Vitamin B-6
 Medication will be provided free of charge
You will have blood taken again after the 1st, 2nd, 3rd and 6th
month of treatment
You will come into student health for monthly visits to make
sure you are not having any side effects and for medication
refills.
INH Treatment
 Take medication daily along with Vitamin B-6
 Baseline and routine laboratory monitoring during
treatment of LTBI are indicated only when there is a history
of liver disease, HIV infection, pregnancy (or within 3
months post delivery), or regular alcohol use. Baseline liver
measurements of serum AST, ALT, and bilirubin are used in
the situations mentioned above and to evaluate symptoms
of liver toxicity.
 Clinical monitoring, including a brief physical
examination, should occur at monthly visits to assess
adherence and identify signs or symptoms of adverse drug
reactions.
INH Treatment
 Drug-Drug Interactions
 Obtain a list of patient’s current medications to avoid drug
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interactions. Some interactions to note:
INH increases blood levels of phenytoin (Dilantin) and
disulfiram (Antabuse)
Side Effects
Patients on treatment for LTBI should be instructed to report
any potential medication side effects to their health care
provider, including
Unexplained anorexia, nausea or vomiting, dark urine
Persistent numbness/tingling of hands or feet
Persistent weakness, fatigue, fever, or abdominal tenderness
Easy bruising or bleeding
Treatment Options
 You have to decide the risk and benefits of treatment
versus the latent infection becoming active.
 You may decide not to take treatment

If so, you will be asked to come in every 6 months and review
signs and symptoms of active disease with the TB specialist at
Student Health.
 You should be aware of your chances of getting active
tuberculosis
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The following website will interpret the likely hood of going
from latent to active disease: www.tstin3d.com
Adherence
 Important that once you start treatment that you
adhere to the medication regime.
 If we need to stop the treatment because of side effects
we will discuss options from there.
 Drug resistant Tuberculosis has been associated with
the incomplete treatment of Latent Tuberculosis.
We are here for you
 We want to keep you healthy and also keep the campus
community healthy.
 The goal is to keep you in class so that you are able to
complete your degree and move on to your
professional life.
 It is important that you review this information and
then we can answer questions as they arise.
References
• Center for Disease Control and Prevention, Tuberculosis,
http://www.cdc.gov/tb/
 ACHA guidelines: Tuberculosis screening and targeted
testing of college and university students (2008).
http://www.acha.org/Publications/docs/Tuberculosis
%20Screening%20and%20Targeted%20Testing_Jul200
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