1. TB Disease and Latent TB Infection
Karen Galanowsky RN, MPH
Nurse Consultant, TB Program
New Jersey Department of Health & Senior Services

2. Transmission of M. tuberculosis
Spread by droplet nuclei
Expelled when person with infectious TB coughs,
sneezes, speaks, or sings
Close contacts at highest risk of becoming
infected
Transmission occurs from person with infectious
TB disease (not latent TB infection)

4. Latent TB Infection (LTBI)
LTBI is the presence of M. tuberculosis
organisms (tubercle bacilli) without
symptoms or radiographic evidence of TB
disease
With LTBI, the person is healthy and cannot spread TB to anyone

5. Testing for M. tuberculosis Infection
Mantoux tuberculin skin test (TST)
Skin test that produces delayed-type hypersensitivity reaction in persons with M. tuberculosis infection
Use a cut point of 5mm or 10 mm depending upon the reason for testing
QuantiFERON® -TB Gold Test
Blood test that measures and compares amount of interferon-gamma (IFN-) released by blood cells in response to TB antigens

6. Persons at Risk for Developing TB Disease
Persons at high risk for developing TB disease fall into 2 categories
Those who have been recently infected
Those with clinical conditions that increase their risk of progressing from LTBI to TB disease
HIV
Uncontrolled diabetes
Cancer of the head or neck
TNF-alpha blockers

7. Targeted Tuberculin Testing
Detects persons with LTBI who would benefit from treatment
De-emphasizes testing of groups that are not at high risk for TB
Can help reduce the waste of resources and prevent inappropriate treatment :

8. When TB Disease Develops Symptoms
Prolonged cough
Night sweats
Loss of appetite
Weight loss
Fatigue
Fever
Chills
Coughing up blood
Chest pain

9. Evaluation for TB Medical history Physical examination
Mantoux tuberculin skin test or Quantiferon-TB Gold
Chest radiograph
Bacteriology testing for smear and culture identification

10. Common Sites of TB Disease
Lungs
Pleura
Central nervous system
Lymphatic system
Genitourinary systems
Bones and joints
Disseminated (miliary TB)

11. Principles of Treatment for TB Disease
Treatment for TB disease is usually 6 – 9 months
The four first-line drugs should be used initially until drug susceptibility studies are determined.
Dosages should be calculated based on weight (mg/kg)
All TB medications should be ingested together the approximately at the same time daily
TB medications may be given intermittently (twice or thrice weekly by directly observed therapy after the initial phase of treatment.

12. MDR and XDR-TB
MDR-TB - Mycobacterium TB that is resistant to at least Isoniazid and Rifampin
XDR TB is defined as resistance to the four first-line drugs, an injectable, and one of the quinolones
Individuals with XDR TB are more likely to die during treatment or have treatment failure
XDR TB has emerged worldwide as a threat to public health and TB control raising concerns for a future epidemic of virtually untreatable TB
Second-line anti-TB medications are used in the treatment of MDR and XDR-TB. These are costly, difficult to administer, and cause serious side effects

13. Factors that Affect TB Transmission
Infectiousness of person with TB
Environment in which exposure occurred
Duration of exposure
Proximity to the infectious person