Community and Health

TB (Tuberculosis)
TB (Tuberculosis) is a disease caused by a bacterium called
Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB
bacteria can attack any part of the body such as the kidney, spine, and
brain. If not treated properly, TB disease can be fatal .

Active TB

Active TB, sometimes called TB disease, causes symptoms and is

contagious. The symptoms of active TB vary depending on whether it’s
pulmonary or extrapulmonary.

But general symptoms of active TB include:

 Fever
 Weakness or fatigue
 Unexpected weight loss (i.e. not from dieting)
 Loss of appetite
 Night sweats
 Persistent coughing
 Coughing up blood (if disease in lungs or throat)
 Chest pain (if disease in lungs)
 Shortness of breath (if disease in lungs)
 Other symptoms based on the site of disease

Active TB can be life-threatening if not properly treated.

 Latent TB

The bacteria can cause two types of illness, latent or active. TB is latent when the
body's immune system forms a wall around the TB bacteria so they cannot multiple or
spread. A person with latent TB has no symptoms. People can have latent TB for long
periods of time. If a person with latent TB does not get treatment, the TB bacteria can
"activate" and cause disease, often if the person's health declines due to sickness,
stress, or aging

Infectious agents
TB is caused by the M. tuberculosis complex. M. tuberculosis is responsible for most
cases. Mycobacterium bovis (M. bovis)*, M. africanum. M. canetii and M. capraealso
cause a small number of TB cases in Australia.

Reservoir
Humans are the primary reservoir for M. tuberculosis complex, although it is also found
in other animals, predominantly primates.1 M. bovis particularly is found in cattle and
other mammals.

Mode of transmission
 TB is transmitted mainly by inhalation of infectious droplets produced by persons
with pulmonary or laryngeal tuberculosis during coughing, laughing, shouting, singing or
sneezing.

 Transmission can occur from potentially high risk procedures including sputum
induction, treatment using a nebuliser, bronchoscopy, drainage of an open abscess,
autopsy or any procedure in which an aerosol containing M. tuberculosis is generated.

 Rarely, invasion of M. tuberculosis may occur through mucous membranes or

damaged skin.
 Extra-pulmonary tuberculosis, other than laryngeal, is generally not
communicable, although can be associated with pulmonary tuberculosis.

 M. bovis tuberculosis results mainly from ingestion of unpasteurised milk and

dairy products.

 Aerosol transmission of M. bovis has been reported among abattoir and dairy
workers and other workers butchering or cutting infected animals (e.g. cattlemen,
veterinarians).

Prevention

Testing & Diagnosis

If you have been around someone who has TB disease, you should get a skin test.
Individuals with a positive TB skin test should also get additional tests as recommended
by their healthcare provider. You should ask your healthcare provider about being
tested for TB if you:

 Live or work closely with someone who has active TB disease

 Were born outside the US (except Canada, Europe and some other
areas with low TB incidence)

 Live or work in a prison, residential institution or nursing home

 Inject recreational drugs

 Are immunocompromised

 Are a healthcare worker that cares for people in any of the above
groups

Treatment
If you have active active TB in your lungs, you should be treated and kept away from
other people until you are no longer at-risk of spreading it. Treatment, as with latent TB
may take several months.

If you have latent TB you should be evaluated to see which specific treatment is right for
you - usually one medication for several months.

Latent Tuberculosis Infection Treatment

Treatment of latent Tuberculosis Infection (LTBI) greatly reduces the risk that TB
infection will progress to disease. Certain groups are at very high risk of developing TB
disease once infected. Every effort should be made to begin appropriate treatment and
to ensure those persons complete the entire course of treatment for LTBI.

Referring Patients to Special Services

Persons suspected of having TB disease should be referred to the RISE Clinic.

RISE Clinic

The RISE Clinic is the state-funded TB clinic in Rhode Island. Patients with suspect or
confirmed TB disease or LTBI can be referred to the RISE Clinic for specialty care. The RISE
Clinic is a referral only clinic; walk-ins and patient self-referrals are not accepted.

To refer a patient to the RISE Clinic, the provider must complete the referral form, confirm the
appointment time with the patient, and fax the form to the RISE Clinic. Contact the RISE Clinic
to obtain available appointments and facilitate appropriate triage.

The RISE Clinic will triage the patient. If you suspect that the patient has active TB and/or an
abnormal chest x-ray, you must speak with the RISE Clinic physician to discuss the case. The
RISE staff will then collect any pertinent information so that the patient can be seen as soon as
possible.

Directly Observed Therapy (DOT) Program

Directly observed therapy (DOT) is the standard of care for all TB disease cases in the state.
Upon receiving a report of a new TB disease case and a prescription from the TB clinician for
the case, the TB Program will match the case with a DOT outreach worker based on culture and
language needs. Every treatment dose will be administered to the patient under direct
observation by the DOT outreach worker.