Tuberculosis

[MichelleP_3811]

My boyfriend's mother may have TB.  She came home from Mexico and about 4 or so days later started to feel sick.  She did not seek medical help for almost 2 weeks.  While in the hospital they ran a skin test and a first sputum test that came back negative for TB.  They sent her home diagnosed as viral pneumonia but then called and said the 2nd sputum test was positive.  They are awaiting a 3rd sputum test to definitively diagnose it as TB. She is in her 80s and I have read that the skin test for older folks can come back negative but was a bit surprised the first sputum test was negative so it makes me question if she does indeed have it but. this said, I do have some questions just in case.

I have done some initial research online about how it is caught and that it is mainly transmitted via breathing it in but how easy is it to catch?  My boyfriend wore a mask around her in the hospital but when they sent her home he spent a few hours at her house without a mask.  Should he be tested?  

If a person were to wear a mask around an infected person is that a pretty reliable safe guard for catching it?  If she stays home alone in isolation she may still need someone to bring her food and medicine so just want to be sure what the safe practice would be.  

How long is a person contagious if they do have it and how long is their environment contaminated?  I read that the bacteria can persist in dusk particles for months.  She is a very clean person so she likely doesn't have a lot of dust to begin with but should a healthy person avoid her residence for an extended period of time even after she is cured?  

[mkh9]

Yes the diabetes and age would contribute to it if she got exposed. But age alone wouldn't probably do it necessarily. I think if the doctors are taking good care of her then they will check on this.
take care,
mkh9

[MichelleP_3811]

I know she has type 2 diabetes that I believe she is on medication for but not sure how well she practices her diet for it.  She also had a husband that chained smoked and worked as a waitress when smoking was everywhere so her lungs may be a bit compromised from that.  As well as being in her 80s so a whole lot against her.  Going to Mexico a day or so after the hurricane probably didn't help either but I will let my boyfriend know she should be checked for underlying problems.  I suspect her doctors are on it as well.  Thanks for all your advice.  I appreciate it.

[mkh9]

Yes that is good to hear. But usually you don't get M. avium unless your immune system is low. If she is pretty old that my be the reason. She could have some underlying problem. You may want to ask about that. Good luck.
mkh9

[MichelleP_3811]

So it appears she doesn't have tb but has Mycobacterium avium strain. Just found out that another person she knows who was in Mexico was flown home with a lung infection though from what it sounds this strain is usually only contracted by older folks and those with weakened immune systems but I will say she has complained of feeling tired for quite a while before she even got really sick so maybe she was developing in for some time now.  It also sounds like she will have to be on medicine for at least a year same as TB.  Good news is she did stop coughing so that is improvement but she still complains of being not just tired now but super weak.  Not great news but at least it isn't TB.    

[MichelleP_3811]

Out of curiosity, does having any type of mycobacterium strain make a person contagious or is it only the TB strain that is worrisome?  

[mkh9]

Most of the other strains of Mycobacteria other than tuberculosis people with normal immune systems don't get them. So if his immunity is normal he shouldn't get it. They are infectious but usually your immune system will fight off the non tuberculosis strains off.
That is my understanding of it.
mkh9

[MichelleP_3811]

Yes, that is what they are testing for the type of mycobacteria. Her and her boyfriend appear to have the same lung doctor and are both seeing them on Tuesday so hopefully her boyfriend starts to get tested because his cough has not cleared up for supposed bronchitis.  I will keep you posted.  Thanks again for your help.

[MichelleP_3811]

So the last test was inconclusive which means she has had mixed results for her tests and now has to wait for 6-8 weeks for a definitive diagnosis though there is some sort of bacteria present they just don't know if it is TB.  She is starting to feel better but we have cautioned her that she needs to follow the doctors orders and use safe practices just in case.  Thanks for all your advice.  

[mkh9]

Okay yes she definitely should follow the drug course. It could be another type of Mycobacteria other than tuberculosis (TB is caused by Mycobacterium tuberculosis but there are other strains of Mycobacteria that may or may not cause disease). But I doubt it. It depends on her usual state of health. But as for him taking something ahead of time I meant he can take something after he was exposed to her if it was TB. Usually Isoniazid (INH). Sometimes when you have TB early on you can have some days where you "cough up" bacteria and other days where you don't. So they will treat her until she becomes negative for three straight days. It depends on the what they see under the microscope and also what they culture. If the culture grows TB or not. They now can use molecular tests too. Sometimes the molecular tests don't come up positive so they have to wait for the culture. Let me know how it goes or if you have any other questions.
mkh9.

[MichelleP_3811]

Thanks so much for your help.  Wow, almost a whole year.  How long does it usually take for a person to not be contagious?  If my boyfriend was around her only a couple of hours would he be less likely to have caught it?  He doesn't think he was near her when she coughed.  Obviously one can't say for sure but just a little concerned.  I am more worried about her boyfriend.  I didn't know that he could take something ahead of it.  I will let him know.  

[MichelleP_3811]

They did a chest xray and saw something so that is why they started to test the sputum for TB.  She does have diabetes but I thought it was pretty contagious regardless.  I hope not because her boyfriend has been pretty close to her and he has bronchitis at the moment so his immune system is compromised as well.  He drove her to the hospital initially when she just kept getting worse.  He is staying away now so as not to catch it or give her his illness though I implored him to be mindful and be tested as well since he was likely in close quarters with her in the car when she was coughing.    I did not know it was slow to grow and that if she stops treatment she can complicate things.  I will make sure she is fully aware.  She is not improving after being sick for over two weeks so that is a bit concerning but she is also not likely on proper antibiotics.  At this point she is at home but hope she goes back into the hospital if it does come back positive.  She is feeling very weak though she has been able to get up and make herself something to eat.  Good to know about the dust.  She is very clean anyways but good to know it isn't a huge concern.   Is a person contagious before they show symptoms or only after they start to cough?

[mkh9]

Her boyfriend is at risk if he was in contact with her for a while and she was coughing. So even if he doesn't have symptoms he may have been exposed. They can give him prophylactic drugs like Isoniazid to prevent him from getting a future infection. For her she should be on a combination of drugs.     isoniazid (INH)
               rifampin (RIF)
               ethambutol (EMB)
               pyrazinamide (PZA)

The treatment is initially 2 months with a combination of these drugs (not all of them), then 6-9 months with a different combination. But her doctor may choose a some what different combination. But it will be long term.
Regards

[mkh9]

Hi and sorry your Boyfriend's mother has possibly contracted TB. It is possible that her immune system is low at that age and she didn't have a positive skin test. Didn't they do a chest Xray? Usually, that is another diagnostic tool they can use. The second sputum should help. It may have been early in the disease to get a positive culture and that may be why one was positive the other negative. These bacteria grow very slowly.

I wouldn't worry about dust as a way to get TB. This is more for factory workers that work with silica and other harmful particles. Is she diabetic? Sometimes that makes them even more susceptible to getting TB.

Usually, a mask can help when being around her for a long time and good hand washing. Also you can change clothes or buy some disposable gowns if caring for her. Don't drink after her. They say if she is spitting up or coughing up sputum to cough it into a disposable cup or paper towel or napkin and ask the doctor how to disgard these. They may give you some infectious material bags or something like that. Once they start treatment if she is positive, then you can ask the doctor how long until it is safe to not wear the mask. Usually, they do several cultures in a row and when 3 in a row are negative after treatment they are clear to be released. She has to take the multiple antibiotics even if it makes her sick if she has it. If she stops she can get a resistant strain of TB and of course not cure the TB as it will come back.

Let me know if you have any other questions. I hope she is negative. But I would get the Xray done and probalby follow up again if her Xray is positive I would follow up with another culture in about a month or so.