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Tuberculosis

TB scars and cancer

07/10/2006

Question:

My mother developed TB a couple of years ago but had the treatment and later on was told she was ok. 1-Is TB cuarable? 2-What are the chances of her getting TB again? 3-Can she get cancer?

As I said, she was told that she was ok, she felt good for a while but has never been able to get rid of the cough. Right now she is still going to the doctor. She seams to get pneumonia very easily. Just about a mont ago, she had some lab work done for TB and was negative.  The only bacteria that was found was streptococus alpha h. She is going to a doctor that specializes on pneumonia cases, but I wish I had a better idea of what type of doctor she really needs to go to. Please help.

Answer:

Tuberculosis is caused by a bacteria called Mycobacterium tuberculosis. Like most bacteria, M. tuberculosis can be cured with specific antibiotics taken for an extended duration. The duration of treatment is typically 6 months, but it can be longer or shorter based on the specific strain of the organism, the parts of the body that it infected, the exact medications used in its treatment, and the underlying health status of the person who is infected.

While the organisms may not be completely eradicated for some time, persons generally feel markedly improved after a few weeks of treatment. If the illness is diagnosed and treated early in its development, an excellent prognosis may be achieved. However, if the diagnosis and treatment are not started early enough, severe scarring and fibrosis of the lung (and other organs if infected) may develop. These changes in the lung are irreversible, putting the patient at risk for recurrent problems (including pneumonia) over the remainder of their life.

While tuberculosis can be completely eradicated, it also can recur, and new infections can develop. The PPD skin test is currently the easiest way to determine if anyone has ever been infected with tuberculosis. However, those who have had tuberculosis in the past should not have a PPD placed to check for recurrence or a new infection as the test is likely to always be positive regardless of if they are currently infected or not. Instead, a chest x-ray compared to ones that have been taken in the past is the best initial test. If there is further concern than the patient's sputum should be tested for the presence of the Mycobacterium tuberculosis organism.

It has been reported for some time that those with prior tuberculosis were at risk for the development of lung cancer. However, these studies may be confounded by the fact that the destruction of the lung and the subsequent scarring that develops from a severe tuberculosis infection makes it difficult for physicians to determine if lung cancer is present on a chest x-ray or even a CT scan. The biggest risk factor for lung cancer remains tobacco exposure. Certainly patients with severe scarring from old tuberculosis and significant tobacco exposure should be seen regularly by a physician to ensure that any changes that develop on chest x-ray are promptly evaluated. Decreasing exposure to tobacco (both first- and second- hand) remains the best means to decrease the lung cancer risk.

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Response by:

J Daryl   Thornton, MD, MPH J Daryl Thornton, MD, MPH
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University