Tag: latent tb

Tuberculosis in 2025: Kansas Outbreak, Vaccines, and Staying Safe

On By Dr. Scott RennieIn Infectious DiseaseLeave a comment

Tuberculosis is still very much with us. Kansas dealt with a large outbreak in 2025, a reminder of how persistent this disease can be. As of January 2025, more than 67 active cases had been confirmed, mostly in Wyandotte and Johnson counties. There were fatalities, and the number of latent infections was rising at the time. Public health teams worked hard to contain it. It’s a reminder that TB remains a threat in both high-risk groups and the general population.

What TB Is

TB is caused by Mycobacterium tuberculosis. It usually attacks the lungs, but it doesn’t stop there: it can affect the brain, kidneys, spine, and other organs. It spreads through the air when someone with active TB coughs, sneezes, or even talks, and people nearby can breathe in the bacteria without realizing it.

Symptoms and Progression

The first signs can be subtle. A cough that won’t go away, maybe three weeks or more. Some patients cough up blood or sputum. Chest pain, fatigue, fever, night sweats, loss of appetite, and unexplained weight loss are common. Left untreated, TB can destroy lung tissue and spread further, causing meningitis, bone infection, or failure of multiple organs.

Latent vs Active

It’s important to separate latent TB from active disease. Latent TB means the bacteria are present but not causing illness. The person has no symptoms and is not contagious. But the bacteria can “wake up,” especially if the immune system gets weaker, and turn into active TB.

Active TB means the bacteria are multiplying, symptoms are present, and the patient can spread it to others. That’s the form that requires urgent treatment.

How It’s Detected

Testing matters. The skin test (the PPD or tuberculin test) is still used. A small injection under the skin, and the site is checked in 48 to 72 hours. Blood tests like QuantiFERON-TB Gold or T-SPOT.TB are often preferred, especially for people who got the BCG vaccine, since it can interfere with skin test results.

If TB is suspected, chest imaging can show lung changes, and sputum culture confirms the presence of M. tuberculosis. That culture is the gold standard for diagnosis in someone with symptoms.

The Role of the BCG Vaccine

The only vaccine we have is BCG. It’s mostly given to infants in countries where TB is widespread. It helps protect children from the most severe forms of TB, like meningitis, but it’s less effective at preventing pulmonary TB in adults. In the United States, it’s not routinely used because of its limited impact on adult disease and the way it interferes with skin testing.

Some healthcare workers in high-risk settings or people with repeated exposure may still receive it.

Protecting Against TB

Vaccination isn’t the whole answer for TB. Early detection and treatment carry just as much weight, maybe more. People at higher risk should be screened regularly, and treating latent TB is critical, because it stops progression to active disease.

Simple steps help too: masks in healthcare settings, good airflow in crowded places, covering your mouth when you cough, washing your hands regularly. During outbreaks, N95 or P100 respirators are the masks that actually filter TB bacteria from the air. Surgical masks don’t provide the same protection.

Treatment and Why It Has to Be Completed

TB can be treated, but it takes time. Standard therapy is multiple antibiotics for six to nine months. Isoniazid, rifampin, ethambutol, and pyrazinamide are the most commonly used.

Stopping treatment too soon is dangerous, because that’s exactly how drug-resistant TB develops, and multidrug-resistant TB is much harder to treat, far more expensive, and comes with worse outcomes across the board. An incompletely treated patient is also still contagious. Public health departments often use directly observed therapy, or DOT, where someone watches patients take their medications. It might sound strict, but it works. It prevents resistance and saves lives.

Public Health and What’s Next

TB is a problem here at home, and the outbreak in Kansas proves it. It spreads any time we let our guard down. Healthcare providers need to push for routine testing in high-risk groups, make sure patients complete treatment, and support public health efforts.

Patients and communities have a role too: stay informed, recognize symptoms, seek evaluation early. And we need continued research into better vaccines and treatments.

—

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Sources

Clear glass culture tubes in a stainless steel rack on a laboratory bench

Tuberculosis: A Growing Problem in the Seattle Area

On By Dr. Scott RennieIn Infectious DiseaseLeave a comment

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Tuberculosis, or TB, is caused by the bacterium Mycobacterium tuberculosis. It remains a major public health problem worldwide and still shows up here in the Seattle area. I recently spoke with an infectious disease colleague who noted more documented cases on the eastside. TB most often attacks the lungs, but it can also spread to the brain, bones, or kidneys. Because so many people travel or move here from countries where TB is more common, we continue to see cases in our local community.

One of the challenges with TB is that it exists in two forms. Latent TB means the person is infected but has no symptoms. You only find it with a skin test or a blood test. Active TB, on the other hand, makes people sick. Symptoms can include fever, night sweats, a persistent cough that sometimes brings up blood, chest pain, weight loss, and fatigue. On a chest x-ray, we often see abnormalities in the upper part of the lungs, especially in the lymph nodes.

The disease spreads when someone with active TB coughs and another person inhales the airborne particles. That is why TB transmission in healthcare settings is such a concern. Doctors, nurses, and patients who share space with someone infected can be exposed. To reduce the spread, hospitals use protective masks, isolation rooms, and yearly testing of healthcare workers.

Treating TB depends on whether it is latent or active. With latent TB, the goal is to kill the bacteria before it has a chance to become active. This usually involves months of medication. Isoniazid is the most common, sometimes taken for six to nine months. Rifampin and rifapentine are other options, often used in shorter regimens. These medicines can stress the liver, so patients on therapy need regular monitoring for problems such as jaundice, nausea, or abdominal pain.

If the infection is active, treatment is more aggressive. Patients often start on four antibiotics while waiting for culture results. Those cultures, taken from sputum samples, can take up to two months to confirm the diagnosis. Using multiple drugs at once helps prevent the bacteria from becoming resistant. Multi-drug resistant TB, or MDR-TB, is already a serious global issue. Some strains no longer respond to the standard medications like isoniazid or rifampin, which makes treatment more complicated.

Public health reporting is central to TB control. Anyone diagnosed with active TB must be reported to the health department. They work closely with the patient and the medical team to track treatment and prevent spread. In many cases, directly observed therapy is used, where a nurse watches the patient take each dose. This ensures the full course is completed, since partial treatment can fuel resistance.

I’ve seen how confusing TB can be for patients. A person exposed to someone with active TB may test positive on a skin or blood test but feel completely fine. In that case, they have latent TB. They aren’t contagious, but they do carry the bacteria. About five to ten percent of these people will go on to develop active disease, especially in the first two years after infection or if their immune system becomes weakened by something like HIV, diabetes, chemotherapy, or long-term steroid use. This process is called reactivation.

There is a vaccine, BCG, which is given in many countries where TB is widespread. In the United States, it is not used because it provides little protection beyond early childhood. That leaves testing and treatment as the main tools for prevention here. The PPD skin test is the most widely used. It involves placing a small amount of inactive TB protein under the skin of the forearm. If someone has been infected, the area becomes red and swollen after 48 to 72 hours. Blood tests are also available in some areas. They are more expensive, but they don’t require a second visit to read the result and may be more accurate.

TB remains one of the leading infectious killers worldwide. Identifying people who carry the infection before it becomes active is one of the most effective ways to protect communities.

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

References:

  • Centers for Disease Control and Prevention. “Treatment of Latent Tuberculosis Infection.” CDC, 2011. http://www.cdc.gov/tb/topic/treatment/ltbi.htm

  • World Health Organization. “Global Tuberculosis Control.” WHO Report, 2010.

  • American Thoracic Society, CDC, and Infectious Diseases Society of America. “Treatment of Tuberculosis.” Am J Respir Crit Care Med, 2003.