The TB skin test may be used to find out if you have TB infection. You can get a skin test at your Community Health Clinic or from your TB health worker. Please contact the TB Programme Coordinator to get an appointment for a home visit.
The health care worker will inject a small amount of testing fluid (called tuberculin or PPD) just under the skin on the under side of the forearm. After 2 or 3 days, you must return to have your skin test read by the health care worker. You may have a swelling where the tuberculin was injected. The health care worker will measure this swelling and tell you if your reaction to the test is positive or negative. A positive reaction usually means that you have been infected by someone with active TB disease.
If you have recently spent time with and been exposed to someone with active TB disease, your TB skin test reaction may not be positive yet. You may need a second skin test 10 to 12 weeks after the last time you spent time with the person. This is because it can take several weeks after infection for your immune system to react to the TB skin test. If your reaction to the second test is negative, you probably do not have latent TB infection.
What if I have a positive test for TB?
If you have a positive reaction to the TB skin test, the healthcare provider may do other tests to see if you have active TB disease. These tests usually include a chest X-ray and a test of the phlegm you cough up. Because the TB bacteria may be found somewhere other than your lungs, your doctor or nurse may check your blood or urine, or do other tests. If you have active TB disease, you will need to take medicine to cure the disease. Yes, TB can be cured!
What if I have been vaccinated with BCG?
BCG is a vaccine for TB. BCG vaccine can protect people from getting TB. If you were vaccinated with BCG, you may have a positive reaction to a TB skin test. This reaction may be due to the BCG vaccine itself or due to infection with the TB bacteria.
If I have latent TB infection, how can I keep from developing active TB disease?
Many people who have latent TB infection never develop active TB disease. But some people who have latent TB infection are more likely to develop active TB disease than others. These people are at high risk for active TB disease. They include:
- People with HIV infection.
- People who became infected with TB bacteria in the last 2 years.
- Babies and young children.
- People who abuse illegal drugs or alcohol.
- People who are sick with other diseases that weaken the immune system.
- Elderly people.
- People who were not treated correctly for TB in the past or have stopped taking the prescribed medication before advised to.
If you have latent TB infection (a positive TB skin test reaction) and you are in one of these high-risk groups, you need to take medicine to keep from developing active TB disease. This is called treatment for latent TB infection. There are several treatment options. You and your healthcare provider must decide which treatment is best for you.
The medicine usually taken for the treatment of latent TB infection is called isoniazid (INH). INH kills the TB bacteria that are in the body. If you take your medicine as instructed by your doctor or nurse, it can keep you from developing active TB disease. Children and people with HIV infection may need to take INH for a longer time.
Because there are less bacteria in a person with latent TB infection, treatment is much easier. Usually, only one drug is needed to treat latent TB infection. A person with active TB disease has a large amount of TB bacteria in the body. Several drugs are needed to treat active TB disease.
Sometimes people are given treatment for latent TB infection even if their skin test reaction is not positive. This is often done with infants, children, and HIV-infected people who have recently spent time with someone with active TB disease. This is because they are at very high risk of developing active TB disease soon after they become infected with TB bacteria.
It is important that you take all the pills as prescribed. If you start taking INH, you will need to see your doctor or nurse on a regular schedule.
Warning: Drinking alcoholic beverages (wine, beer, and liquor) while taking INH can be dangerous. Check with your doctor or nurse for more information.
People who have latent TB infection need to know the symptoms of active TB disease. If they develop symptoms of active TB disease, they should see a doctor right away.
What if I have HIV infection?
A person can have latent TB infection for years. However, if that person's immune system gets weak, the infection can quickly turn into active TB disease. Also, if a person who has a weak immune system spends time with someone with active TB disease, he or she may become infected with TB bacteria and quickly develop active TB disease.
Because HIV infection weakens the immune system, people with latent TB infection and HIV infection are at very high risk of developing active TB disease. All persons with HIV infection should be tested to find out if they have latent TB infection. If they have latent TB infection, they need to begin treatment as soon as possible to prevent them from developing active TB disease. If they have active TB disease, they must take medicine to cure the disease.
Active TB disease can be prevented and cured, even in people with HIV infection.
How is active TB disease treated?
There is good news for people with active TB disease! It can be cured. But the medicine must be taken as the doctor or nurse tells you.
If you have active TB disease, you will need to take several different medicines. This is because there are many bacteria to be killed. Taking several medicines will do a better job of killing all of the bacteria and preventing them from becoming resistant to the medicines.
The most common medicines used to cure TB are:
- Isoniazid (INH).
- Rifampin (RIF).
If you have active TB disease of the lungs or throat, you are probably infectious. You need to stay home from work, school or church so that you do not spread TB bacteria to other people. After taking your medicine for a few weeks, you will feel better and you may no longer be infectious to others. Your doctor or nurse will tell you when you can return to work, school or church, or visit with friends.
Having active TB disease should not stop you from leading a normal life. When you are no longer infectious or feeling sick, you can do the same things you did before you had active TB disease. The medicine that you are taking should not affect your strength, sexual function, or ability to work. If you take your medicine as your doctor or nurse tells you, the medicine will kill all the TB bacteria. This will keep you from becoming sick again.
What are the side effects of medicines for TB?
If you are taking medicine for TB, you should take it as directed by your doctor or nurse. Occasionally, the medicines may cause side effects. Some side effects are minor problems. Others are more serious. If you have a serious side effect, call your doctor or nurse immediately. You may be told to stop taking your medicine or to return to the clinic for further tests.
The side effects listed below are serious. If you have any of these symptoms, call your doctor or nurse immediately:
- no appetite.
- yellowish skin or eyes.
- fever for 3 or more days.
- abdominal pain.
- tingling fingers or toes.
- skin rash.
- easy bleeding.
- aching joints.
- tingling or numbness around the mouth.
- easy bruising.
- blurred or changed vision.
- ringing in the ears.
- hearing loss.
The side effects listed below are minor problems. If you have any of these side effects, you can continue taking your medicine:
- Rifampin can turn urine, saliva, or tears orange. The doctor or nurse may advise you not to wear soft contact lenses because they may get stained.
- Rifampin can make you more sensitive to the sun. This means you should use a good sunscreen and cover exposed areas so you do not burn.
- Rifampin makes birth control pills and implants less effective. Women who take rifampin should use another form of birth control, for example, condoms.
- If you are taking rifampin as well as methadone (used to treat drug addiction), you may have withdrawal symptoms. Your doctor or nurse may need to adjust your methadone dosage.
Why do I need to take TB medicine regularly?
TB bacteria die very slowly. Even though you will probably start feeling well after only a few weeks of treatment, it takes at least 6 months for the medicine to kill all the TB bacteria. You must continue to take your medicine until all the TB bacteria are dead. Only testing at the Community Health Clinic can let your care provider and you know when the bacteria are dead.
If you do not continue taking your medicine regularly, this can be very dangerous. The TB bacteria will grow again and you will remain sick for a longer time. As an additional complication, the bacteria may become resistant to the medicines you are taking. You may need new, different medicines to kill the TB bacteria if the old medicines no longer work. These new medicines must be taken for a longer time and usually have more serious side effects.
If you become infectious again, you could give TB bacteria to your family, friends, or anyone else who spends time with you. It is very important to take your medicine the way your doctor or nurse tells you.
How can I remember to take my medicine?
The only way to get well is to take your medicine exactly as your doctor or nurse tells you. This may not be easy! You will be taking your medicine for a long time (6 months or longer), so you should get into a routine. Here is one way to remember to take your medicine: Participate in the Directly Observed Therapy (DOT) programme.
How can I keep from spreading TB?
The most important way to keep from spreading TB is to take all your medicine, exactly as directed by your doctor or nurse. You also need to keep all of your clinic appointments! Your doctor or nurse needs to see how you are doing. You may need another chest X-ray or a test of the phlegm you may cough up. These tests will show whether the medicine is working. They will also show whether you can still give TB bacteria to others. Be sure to tell the doctor about anything you think is wrong.
If you are sick enough with active TB disease to go to a hospital, you may be put in a special room. These rooms use air vents that keep TB bacteria from spreading to other rooms. People who work in these special rooms must wear a special face mask to protect themselves from TB bacteria. You must stay in the room so that you will not spread TB bacteria to other people. Ask a nurse for anything you need that is not in your room.
If you are infectious while you are at home, there are certain things you can do to protect yourself and others near you. Your doctor may tell you to follow these guidelines to protect yourself and others:
- The most important thing is to take your medicine.
- Avoid using “soiled” tissue again. Always cover your mouth with a tissue when you cough, sneeze, or laugh. Put the tissue in a closed bag and throw it away immediately.
- Do not go to work or school. Separate yourself from others and avoid close contact with anyone. Sleep in a bedroom away from other family members.
- Air out your room often to the outside of the building (if it is not too cold outside). TB spreads in small closed spaces where air doesn't move. Put a fan in your window to blow out (exhaust) air that may be filled with TB bacteria. If you open other windows in the room, the fan also will pull in fresh air. This will reduce the chances that TB bacteria will stay in the room and infect someone who breathes the air.
Remember, TB is spread through the air. People cannot get infected with TB bacteria through handshakes, sitting on toilet seats, or sharing dishes and utensils with someone who has TB.
After you take medicine for about 2 or 3 weeks, you may no longer be able to spread TB bacteria to others. If your doctor or nurse agrees, you will be able to go back to your daily routine. Remember, you will get well only if you take your medicine exactly as your doctor or nurse tells you.
Think about people who may have spent time with you, such as family members, close friends, and co-workers. The local health department may need to test them for latent TB infection. TB is especially dangerous for children and people with HIV infection. If infected with TB bacteria, these people need medicine right away to keep from developing active TB disease.
Understand what your test results mean!
A negative or “not significant result” means that you probably do not have TB germs in your body. However, the skin test is not “fool proof”. In other words, the test does not always detect the TB germs in people who have HIV or who were just infected with TB. Your healthcare provider may recommend other tests if you are at risk for TB.
A positive or “significant result” means that you have TB infection. A positive test result does not necessarily mean that you have or will get TB disease or that you can infect others. Other tests may be needed.
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