My Doctor Online The Permanente Medical Group

Risk Factors

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Many of us with healthy bodies have been exposed to TB bacteria without even knowing it. Many carriers of TB do not know they have it in their body and have no symptoms. These patients have a latent form of TB called latent tuberculosis infection (LTBI). People with LTBI do not have active TB and cannot spread it to others. In latent TB, the bacteria are alive but are trapped by the body's immune system so that they do not grow and cause illness.

Active TB is different than LTBI. Active TB causes symptoms and makes you feel sick. You are at higher risk of developing active TB if you:

• Have a weakened immune system from a disease, such as diabetes, cancer, or HIV/AIDS.
• Were infected with TB bacteria in the last 2 years.
• Are very old or very young (an infant).
• Have poor nutrition.
• Inject illegal drugs.
• Abuse alcohol or drugs.
• Smoke (smokers are 20 percent more likely to become infected with TB).
• Have diabetes.
• Have an autoimmune disease, such as lupus, and are being treated with strong medicines which weaken the immune system.
• Have traveled or lived in other countries where active TB is a common condition.

If you were exposed to TB bacteria in the past or have previously had active TB and were not properly treated, you are also at higher risk of developing or having recurring, active, or MDR-TB.

You are most likely to get TB through the air you share with someone you spend a lot of time with in your daily life. This could be at your work environment, or even from a close friend or relative. However, many people who are infected with TB do not recall being around someone with TB.

TB bacteria are only spread through the air and is most common when there is either exposure over a long time or intense exposure in an enclosed space. Because of this, the greatest risk of spreading TB comes from those we are closest to, such as our friends, families, and coworkers. It is important to know that TB is NOT spread through having sex, a toilet seat, kissing, shaking hands, or from sharing drinks, food, or toothbrushes.

Worldwide, about one third of the world's population is infected with TB, and most of these people have LTBI. Outside the United States, TB is found in many countries. It is especially common in Southeast Asia and sub-Saharan Africa but is found in many parts of Asia, Eastern Europe, and Central and South America. If you are from these countries or have traveled to these areas recently, please let us know.

Types

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The table below shows the differences between LTBI and active TB:

Source: Adapted from the Centers for Disease Control and Prevention

Multidrug-resistant (MDR)-TB is another, rarer type of TB. This type of TB is described as resistant because most common medications do not work. MDR-TB is more difficult to treat and causes more serious concerns about your health.

Testing

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Testing for LTBI (latent tuberculosis infection) consists of either a skin or blood test. The skin test is placed by injection under the skin.  The test is then checked 2 to 3 days later to see if a reaction is present that would indicate infection with TB. A blood test can also be done to look for the infection. Both tests are equally accurate, and your healthcare provider can help decide which is the best test for you. Testing for LTBI is often a requirement for people working in health care, schools, or services for the elderly or disabled.

For patients who might have active TB or pneumonia or lung infection from tuberculosis, we will obtain sputum samples to try and find the infection and to determine if the patient is contagious. Your doctor may get repeat sputum samples after treatment is started to make sure you are getting better and no longer contagious.

Additional testing of the blood, urine, or other organs depending on the suspected area of infection may be done to look for TB. The particular tests recommended will depend on the details of each patient's illness.

Symptoms

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A healthy person's body can usually keep LTBI in check, without spreading it to others or making you sick for many years. LTBI has no symptoms, and the only way to know if you have it is to have a TB test. However, at some point latent TB can become active in your body, and this happens in about 5 to 10 percent of people. This may happen simply as you age or if you have another illness that suppresses your immune system (like HIV or diabetes).

The most common place for TB to first settle in your body is in your throat or lungs. If TB is active in these areas, symptoms can include:

• Persistent cough lasting 2 weeks or longer
• Cough that produces blood or sputum (phlegm)
• Fever or chills
• Fatigue and weakness
• Weight loss
• Sweating at night
• Chest pain and wheezing
• Loss of appetite

Many of these symptoms are common to other diseases, which may make it more difficult to diagnose TB. If the TB is active or spreading in another area of the body, you might also have other symptoms:

• Swollen abdomen
• Joint pain
• Low blood iron (anemia) resulting in pale skin
• Swollen glands, such as lymph nodes in the neck, armpits, or groin that become tender to the touch

Please let us know about any of these or other symptoms you are experiencing. Some patients with active TB do not have symptoms, and it may be detected only by a chest X-ray. It is important to know that TB is treatable, but TB left untreated can be fatal.

Treatments

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Your treatment will vary depending upon the type and the severity of the TB. The most important thing you can do is to take all prescribed medications exactly as instructed. If you miss a dose or do not take the medicine as instructed, you may not get rid of the TB, or you can even develop multidrug-resistant TB (MDR-TB). Your treatment plan will depend on whether you are diagnosed with latent, active, or MDR-TB.

Medications 

Latent TB

The goal of treatment for latent TB infection (also known as LTBI) is to prevent the bacteria from becoming active. We usually treat latent TB with one antibiotic for 9 months, but sometimes shorter treatments can be used.

Active TB

For active TB, we usually prescribe a combination of several antibiotics. You must take all prescribed medications every day for 6 to 12 months. Other antibiotics may also be used, depending on your unique health history and tolerance for antibiotic side effects.

Most people begin to feel better and are not at risk of infecting others with the TB bacteria after a few weeks of treatment with antibiotics. However, you must continue taking all medications as prescribed for the entire 6 to 12 month period or you may become sick again or infect others.

The most likely antibiotics we will use to treat your TB are:

• Isoniazid (also known as INH)
• Rifampin
• Pyrazinamide
• Ethambutol

Other antibiotics may also be used.

Multidrug-resistant TB (MDR-TB)

MDR-TB occurs when the TB bacteria is resistant to at least 2 of the main drugs usually used to treat TB. You may need to take several alternate antibiotics, and the medications may have additional side effects that require close monitoring by your doctor. MDR-TB can cause significant illness and is more difficult to treat.

Directly observed therapy

Many public health departments will help Kaiser Permanente patients with taking their medications. Directly observed therapy (DOT) is done when your county's public health department visits with a TB patient and watches them take the medications. The decision to do directly observed therapy will be made by your healthcare provider and the public health department.

Isolation

If sputum testing shows you are potentially contagious, your healthcare provider and the public health department will recommend, and in some cases legally order, that you be isolated in your home until the bacteria are cleared from the sputum through effective treatment.

The public health department and your Kaiser Permanente provider will help determine when you are no longer contagious and when you no longer require isolation.

Hospital stay

Hospitalization is generally not required for most cases of TB.  However, if you have significant symptoms you may require hospitalization until you improve. If TB is diagnosed during the hospitalization, we will start medications to treat the illness. Most patients begin to feel better within the first few weeks of treatment. 

HIV/AIDS and TB

Some HIV/AIDS medications lessen the effectiveness of the antibiotics used to treat TB. If you have HIV/AIDS and are taking medications, be sure to let us know. You may need to take the TB antibiotics for a longer period of time, or you may not be able to take certain antibiotics (such as RIF) in order to avoid drug interactions.

You may also be enrolled to participate in directly observed therapy (see above).

Lifestyle Management

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If you have active TB and are receiving treatment, here are some things you can do in your home or hospital room to help prevent the spread of TB:

• Stay home or in the hospital until a medical professional tells you that you are no longer infectious to others. If you are at home, sleep in a separate room, away from other family members. We may recommend that visitors and caregivers wear masks.
• Take your TB antibiotics exactly as prescribed. This means for the full duration of the treatment.
• Keep all your medical care appointments. You may need regular chest X-rays or other tests to see how your treatment is progressing.
• Cover your mouth with a tissue when you cough, sneeze, or even laugh. If you cough up sputum or phlegm, throw out the tissue in a closed bag.
• If you smoke, this is a great time to quit. Your lungs will need to be as strong as possible to fight the TB.
• Avoid drinking alcohol while taking medications for TB.

When to Call Us

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When to contact us

The antibiotics used to treat TB may cause side effects, including:

• Loss of appetite
• Vomiting
• Abdominal pain
• Weakness
• Fever
• Fatigue
• Bruising
• Tingling in the hands or feet
• Changes in vision
• Rashes or hives

Contact your provider if any of these symptoms occur. 

For Caregivers

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If you live with or frequently visit someone who is diagnosed with active TB of the lung or throat, we recommend that you get tested for the disease. If you are found to have LTBI or active TB, then treatment would be recommended.

We might advise you to wear a mask while caring for the person during the first few weeks of their treatment.

General caregiver guidelines

Patients with TB involving their lungs should cover their mouth when coughing or sneezing and wash their hands.

Ensure that the person takes medication exactly as instructed and for the length of time prescribed. You might find it helpful to keep a record of when the person takes daily medications.

If the medications cause side effects, such as nausea, have the person take the medications with a small snack. If the side effects become more severe, such as a skin rash, changes to vision or hearing, or repeated vomiting, contact your health care provider.

Your Care with Me

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If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

For general medical advice, our Appointment and Advice line is available 24 hours per day, 7 days per week.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

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If surgery or a procedure is a treatment option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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