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Thursday, April 17, 2014
MY friend was tested positive for TB. She said she carries the virus but she is not contagious but she refused to take the medication. Now I am concerned because she wants to visit me and my famliy and I have a 4 year old and 9 month old.
Should I worry about them getting infected?
What your friend told you is a little confusing, but the same scenario is commonly heard in TB clinics. A person has a TB skin test done for some reason (usually because the person is a health-care worker, for whom TB screening is required), and sometimes the test is positive. Last year, about 9% of the people who had TB skin testing done at our clinic had positive results. A person with a positive TB skin test is probably infected with Mycobacterium tuberculosis, and that person needs to have a medical evaluation done to see if the person is already sick with TB (by taking a chest x-ray and asking about cough and other symptoms), to assess risk factors for becoming sick with TB in the future, and to talk about taking medication to prevent becoming sick from TB in the future (more about that later). The vast majority of people with positive TB skin tests found by screening have LATENT (quiet, inactive) TB infection and are not contagious to others at that point in time.
But, the TB germ can reactivate and make people sick in the future, even in people with perfectly normal immune systems, but more often in people with other illnesses or on medications that weaken their immune systems. Once a person is sick with TB, he or she is often contagious to others until the TB disease is treated. But, unless your friend is sick with TB, chances are she is not contagious to others.
Getting back to the medication issue, if a person has active, contagious tuberculosis, that person MUST isolate themselves and take several antituberculous medications until they are no longer contagious. Someone with latent TB, however, has the choice of taking a medication to kill off the TB germs before they can make the person sick, but they are not REQUIRED to take the medication. It sounds like your friend had a chance to talk with a medical provider about the risks and benefits of taking a medication and decided not to take it. While I don’t know the particulars of your friend’s health, I do know that in general, for people newly infected with TB, the benefits of taking the medication (which almost eliminates the risk of becoming sick with TB in the future) far outweighs the risk of side effects from the medication. Also, most health departments will pay for the medication and monitoring, so that money (or lack thereof) shouldn’t be a barrier to getting treatment of latent TB.
Lisa A Haglund, MD
Associate Professor of Clinical Medicine
College of Medicine
University of Cincinnati