When H was a med student, he caught TB at work, which turned into an active case. He was on four medications. Family had to be tested–D was positive. S and I were on isoniaizid for a few months, D for nine. Same thing; she will always have to get an Xray if she needs a TB test for any reason, since the test will always come back positive. Which is a pain; we had to educate the school about that when she was in middle school.
A member of my family always has a positive tine test and has to have chest x-rays to prove negativity. Probably exposed as a child, but didn’t progress to full-blown TB.
The history of TB is quite interesting. Before the days of antibiotics, there were TB sanitariums in high, dry climates. Patients were sent to live at these sanitariums, often for years, while trying to become TB-free. The ‘great outdoors’ was deemed the best medicine for TB in the late 1800’s and early 1900’s. Many of Denver’s hospitals began as sanitariums because of its its ideal climate and location. Thank Goodness antibiotics were developed!
TB really shouldn’t be taken lightly. Some strains are becoming resistant to antibiotics, making treatment quite difficult–even in developed countries like ours. It’s really quite easy to transmit the disease via droplet infection. I’ve read that as much as one-third of the world’s population has tuberculosis.
“First of all, TB is MUCH easier to get than either Hep or HIV for what should be obvious reasons.”
^I would not make blanket statements like this. The route of transmission is different, for sure, if that’s what you meant by “easier.”
“I’ve read that as much as one-third of the world’s population has tuberculosis.”
It is because that the abovementioned 1/3 of the world population has other medical conditions that weaken the immune system and make the population vulnerable to TB. Not all of them have active TB though. I am not trying to diminish the severity of the threat to the Western population, but if you are not immune-compromised, to actually catch TB you need to be constantly exposed to it (e.g., a household member is infectious).
Yes that’s what I meant by easier.
Just some popular culture trivia, Vivien Leigh (Scarlett O’Hara) died of TB.
National Institutes of Health…
https://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=31
"TB remains one of the leading causes of death and illness in the world. "
“It is estimated that one-third of the world’s population is infected with the TB bacterium, and that 16.2 million people currently have TB.”
One of my kids was required to get one before going to college (scramble right before she left, as results take a while). D2’s school only required it if you had traveled to certain places, I think. It is not a big deal, tiny needles. 
HI has a lot of immigrants and a LOT of cases of active TB. Two of my sisters were exposed and had to take medications over a period of time. I have equivocal skin tests, so have had to have X-rays and recently had a blood test for latent TB (fortunately the level in my blood is NOT worthy of treatment).
Many jobs in HI require annual/periodic TB testing, e.g. Working with kids or commercial food like restaurants. Students also need TB testing when they start any new school, including going between public and private and from grade to middle to HS. Most pediatrician so include it in the annual physical. Am not positive if it is REQUIRED each year, but my kids had it because the pediatrician had them get it each year. Fortunately, it was always negative. He would allow my SisIL (dermatologist) to read the TB test instead of going in to see him witchin the 48 hour time window.
Excuse my ignorance re: TB.
Romani, I mentioned “consumption” because that’s the kind of thing folks died of in Victorian novels–no one would write a novel today and have a character die of TB–they would choose something else . Living in the northeast for almost 60 yrs, I’ve NEVER been aware of anyone contracting TB. I don’t work in an urban ER. A third-world disease?
I feel like your tone is belittling my ignorance. Play nice, please
One of my aunts, who just died this past summer, was an army nurse and contracted TB. She was sent to a sanitarium in Oklahoma (she was living in the Rio Grande Valley in Texas at the time) for a couple of years. But I guess I don’t consider Oklahoma as a high, dry climate! I’ll bet she would have preferred Colorado (decades later she and her H built a vacation home in Ruidoso, New Mexico). One of her sisters had to take care of the one child she had since her husband was in the army. She lived to the ripe old age of 93 and was in great health for all except maybe a year or two in the end when she contracted cancer.
National Jewish Health in Denver CO is the #1 respiratory hospital in the US (according to US News & World Reports). It was built there because it was for TB and up at altitude (5000 feet). It has expanded and now treats most lung problems, with patients from all over the world and does a lot of cutting edge medical research on lung health. Many folks need supplemental O2 there, even though they don’t need it for where they live at sea level. It is an amazing institution and I have been there many times and have received excellent care there.
I feel like I have read in recent years that drug resistant TB is becoming a big problem in places like Russia. I think it has been an area of focus for PIH & Paul Farmer, too, as an emerging world health threat.
In HI, there have been some cases of drug resistant TB as well. It happens especially where people don’t take all the TB meds are prescribed for whatever reason–didn’t understand, forgot, wanted to share drug with others, decided enough taken, couldn’t afford, transportation problems or trouble getting drug, etc.
Some people born in other countries may have received a TB vaccination as children that can result in a positive skin test.
Yes, the BCG vaccine produces the same antibodies that the infection causes.
^^But there is now a blood test that can distinguish between BCG and TB.
^^Quantiferon Gold, to be precise.
http://usa.quantiferon.com/irm/content/quantiferon-tb-gold1.aspx?RID=300
Quantiferon Gold test - yes. Is increasingly covered by insurance and may be the test of choice for some employers. Institution that requires testing is usually very specific about what tests they will accept.
How timely! Didn’t know the name of the test until last evening.
A patient presented today to me in Triage at my Peds ER with a note from PMD: + Quantiferon Gold. Please Xray.
No time wasted with Google, just arranged for a mask and reverse isolation room.
If your child plans to do medical research some day, they may be required to do annual TB testing. Some mammals catch it more easily than humans, so anyone who has to go in the vicinity of the labs or where those animals are housed must be tested for the animals’ protection.