Will County Health Department explains latent TB

Will County Health Department Medical Director Dr. Dan Garganera said latent tuberculosis is one of the major challenges in the world today.

"Latent" means the virus is in someone's body, but the virus is not producing symptoms, and the person is not contagious.

Latent TB is perhaps best described as an M&M candy with the hard shell around it. The chocolate is the TB bacteria, and the shell is keeping it latent.

But Sunny Hill TB Clinic Administrator Joyce Reliford-Parker says there are various factors that can take that “protective shell” away, and cause the bacteria to wake up and become Active TB.

“It can be awakened by advanced age, or numerous diseases such as diabetes, HIV/AIDS, cancer, or even sometimes smoking or exposure to pollution,” Reliford-Parker said in a news release. “In rare cases, even pregnancy can sometimes wake up the germ. And more and more today, new medications taken for common ailments can awaken TB as well.”

Garganera agreed. “We’ve had so many situations where someone with autoimmune diseases like rheumatoid arthritis awakens the TB in their system with medication. It can also happen when treating things like lupus or psoriasis.”

Once TB becomes active, symptoms mostly affecting the lungs. These can include coughing that lasts up to three or more weeks, coughing up blood, chest pain, difficulty with breathing, weight loss, fatigue, fever, night sweats, chills and loss of appetite.

A TB skin test (PPD) only shows a person has the bacteria. A blood test (such as a T-spot or TB-Quantification Gold test), is done along with a chest X-ray. If both are positive, sputum specimens are collected to determine active infection.

Garganera said active TB, an airborne disease, is extremely contagious.

“It’s really the flu on steroids," Garganera said in a news release. “While the flu is spread by the inhaling of droplets, often to someone up to about two meters from you; TB droplets actually become part of the air and can infect someone, say up to 20 yards away. Not only that, but the bacteria can remain in the air for a couple of hours.”

Garganera said health care workers in the United States – and worldwide – are highly affected.

“Sometimes a health care worker may inhale the bacteria from someone they are treating, but that patient may have undiagnosed active TB," he said in a news release. The bacteria may then be suppressed by the health care worker’s immune system, becoming Latent TB. This is why it is important that health care workers be screened for tuberculosis.”

In fact, the CDC recommends TB screening for health care workers, as well as for all immigrants; especially those from high incidence TB countries. They also recommend screening for prison inmates, as well as patients with weakened immune systems; including those with cancer, HIV/AIDS, diabetes, and renal failure patients. Pregnant women also need testing to avoid infecting their babies if they are actively infected.

Garganera and Reliford-Parker both emphasize that anyone diagnosed with latent TB should begin treatment immediately.

“Getting it before you are actively contagious is just one reason to treat Latent TB,” stated Gargenara said in a news release. “Another is that it is easier to kill it while it’s asleep. Once the TB wakes up, it will fight back.”

Reliford-Parker agreed. “While it takes two medications to treat latent TB, it takes up to four to treat active TB. It’s a completely different battle.”

In a news release, Garganera said TB is the now the top infectious disease killer worldwide."

"It used to be malaria," he said in a news release. "But the lack of testing and catching latent TB before it becomes active has been the main problem.”

Garganera said those new to the U.S. should definitely be tested, especially when coming from high TB areas such as Africa and South Asia. Specific countries he mentioned included China, Pakistan, India, and the Philippines.

Reliford-Parker says that in Will County there were 17 cases of Active TB in 2016, and 13 cases in 2017. And when local cases happen, it is often discovered how misinformed the public can be about TB.

“We had this one public forum,” Dr. Garganera recalled, “where a student had been in the same class with another student with active TB. Her father asked if this meant his mother with cancer, living in another city, was at risk for TB and would need treatment But she, of course, had nothing to do with the situation, since she had not been exposed by the infected student.”

Due to state statute, the Sunny Hill Tuberculosis Clinic at 503 Ella Ave. in Joliet provides medication free of charge for patients with active TB. Regardless of income or insurance, the TB clinic is responsible to case manage all Will County residents with infectious Tuberculosis.

Also by state statute, the Sunny Hill TB Clinic operates as part of the entire county rather than as part of the Will County Health Department, although it's next to the health department building; which ironically was first built as a TB sanatorium back in the 1930’s.

For more information on the TB clinic, visit www.willcountyillinois.com. For more information on TB, visit www.idph.state.il.us.