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TB - info for health services

What is Tuberculosis?

Tuberculosis, or TB, is an illness caused by a germ called “Mycobacterium tuberculosis”. TB affects the lungs most commonly.  However, the TB germ may occasionally spread from the lung to infect the lymph glands, bones and joints, kidneys and many other parts of the body.

What are the types of TB?

‘Latent’ (sleeping) TB

  • In sleeping TB, the TB germ can stay in the body and rest. A sleeping TB-affected person is not sick while having the germ in their body, but they may get sick later on.
  • The person with sleeping TB is not infectious, so cannot pass these TB germs to others.
  • Sleeping TB can be treated with special antibiotics to stop TB germs from waking up and causing sickness.

Active TB

  • In a person affected by active TB, the TB germs wake up and the person can get sick with active TB disease.
  • Someone affected with active TB disease will have symptoms.
  • The person affected by active TB disease can spread TB to others when they have not been treated with the right antibiotic medications yet.

How do you catch TB?

TB is caught by breathing in the tiny drops coughed up or sneezed by a person who has TB. These drops are invisible and may contain TB germs. Once inhaled, the germs invade the lungs and slowly multiply.

CDC Video on how TB spreads: https://youtu.be/UKV8Zn7x0wM

How can I protect myself and keep the clients of the service safe?

TB is not as easy to catch as some other respiratory infections. However, it can spread through the air when the person with the active infection coughs, spits, sings, talks and sneezes.

  • Everyone needs to follow the health service’s infection prevention measures for physical distancing, hand hygiene and mask wearing.
  • Follow airborne precautions when caring for a person with suspected active TB: Staff member wears a P2/N95 mask.
  • Client wears a surgical mask.

If a healthcare worker is there when the person is coughing up a specimen, they must wear a P2/N95 mask. However, in most circumstances the client should be advised to collect a specimen outside, away from others.

What are signs of active TB infection?

The most common symptom of TB is a persistent cough, lasting for more than two weeks. Other symptoms of TB include cough with mucus or blood, chest pain, fever, loss of energy, sweats (particularly at night), swollen lymph glands and weight loss. The TB cough may produce phlegm/mucus and sometimes blood. The symptoms are often mild at first and develop slowly.

Most people who are exposed to tuberculosis germs will never get sick with active TB. Wwhen the TB germs stay in the body and rest, this is called latent TB infection (LTBI). In this case, they can't pass on the infection. However, the person usually needs treatment, so they don't get sick in the future.

High risk groups

 It is especially important to consider TB in people with higher risk of getting very unwell with active TB such as:

  • Young children
  • Older people
  • People with severe malnutrition
  • People with weakened immune systems, like people with chronic health conditions such as diabetes, kidney disease, cancer, HIV
  • People who are taking medications that lower the immune system

Testing for active TB

Seek specialist advice if there is high suspicion of TB, you can call SA TB Services on 7117 2967 during business hours.

For active TB testing, please submit 3 sputum specimens collected on consecutive days, ideally early morning. If this is not possible, preferably specimens should be collected at least eight hours apart.

Specimens need to be sent to SA Pathology. Testing for tuberculosis includes TB culture and acid-fast bacilli smear, as well as GeneXpert test in certain circumstances. It is helpful to provide as much information as possible on the request form to guide laboratory processing- please indicate “? Outbreak-associated" so that all the requested tests (including GeneXpert) are performed.

Please also arrange a chest X-ray as part of the TB testing. If the result is normal, sometimes a CT scan is needed. Make sure the person taking the chest x-ray knows that you suspect TB.

Seek urgent advice from SA TB services if the smear test result is positive. Note that a negative smear test result does not exclude TB, as the full culture test can take three to six weeks to get a result.

Notify SA TB services of suspected and confirmed cases of TB on 7117 2967.

Seek advice from SA Health TB Services about the need for isolation and measures the person should take to prevent exposure to others.

Bacille Calmette–Guérin (BCG) vaccine

The Bacille Calmette-Guerin (BCG) vaccine is a live vaccine with weakened germs which helps protect against tuberculosis (TB) disease. The vaccine reduces the risk of getting severe forms of TB in children under 5 years of age. There is a limited role of this vaccine in preventing TB.

Further information on the BCG vaccine is available at the SA Health website at this link: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/services/hospitals/outpatient+services/outpatient+clinics/central+adelaide+lhn+specialist+and+outpatient+clinics/sa+tuberculosis+services+in+calhn

Resources and useful links

Useful links from SA Health website:

Tuberculosis (TB) - including symptoms, treatment and prevention

Tuberculosis (TB) cases in Aboriginal communities

Be Alert for Tuberculosis

Webinar on Tuberculosis facilitated by NACCHO Tuberculosis in Aboriginal and Torres Strait Islander communities.mp4