TB Unmasked

Clinic keeps a steady watch to check spread of tuberculosis in county

Of all the diseases to worry about, tuberculosis probably ranks low on the Top-10 list for most folks. Right now, West Nile Virus is the lead story in newspapers and television broadcasts. During winter months, Swine Flu will grab a few headlines, too.

But local health care professionals pay close attention when someone is identified with TB: one person with active TB can easily infect 10-15 others in the span of a year, according to health authorities.

“Active tuberculosis is contagious and, without treatment, can be deadly,” says Collin County immunization nurse Rayola Leggett, whose office is monitoring 17 active TB patients and more than 100 latent TB cases here. “But TB is curable, so we get to see very sick patients at first, and by the time they are done with treatment, most are leading healthy, active lives.”

Once the leading cause of death in the U.S., effective vaccines and treatment programs dealt TB a serious blow in the last half-century. And when the bacteria that causes TB began resisting some drugs, a second generation of medications proved to do the job. Yet TB has continued to claim more than a million lives each year across the globe, especially in developing countries.

Nurse Rayola Leggett makes a contact call with one of her TB patients.
The Centers for Disease Control and Prevention tracked more than 11,000 reported cases in the U.S. during 2010, less than half of those reported during a spike in TB cases in 1993. In the most recent data available on deaths from TB, some 547 people in the U. S. died from the disease in 2009.

That’s hundreds more than those who have died from West Nile Virus in the past year.

So Rayola dons her mask and fires up the air purifier in her exam room for active TB patient exams, just a part of their  long-term treatment regimen.

TB patients are required to undergo treatment for anywhere from six to 24 months, depending on where the bacteria resides in their bodies or how resistant it is to drugs. Regular testing and chest X-rays help determine how a patient progresses, but the first months can be trying for everyone involved.
“When patients first come to see us, fear is the number one obstacle,” Rayola explains. “Once we educate the patient and they see we are here to help, they become more at ease.”

Active patients are generally put in isolation, required by law to stay at home. Things we take for granted, such as taking a bus to school, shopping on Saturday morning or going to the movies on a Friday night aren’t possible until they’re no longer contagious, which can take one or two months of treatment. When they do venture out of the house, it’s normally only for doctor appointments or medical emergencies, and patients are still required to wear a mask. Simply talking, singing or coughing can pass on the disease.

While they remain contagious, field workers come to their homes to watch them take their medications and collect specimens for testing.

The entire treatment process for active and latent cases calls for close monitoring, since even people who have a latent TB can develop serious medical problems as they age or if their immune systems weaken considerably.

Unlike many healthcare workers, Rayola and her counterparts stay in close touch with their patients throughout the treatment program and get a firsthand view of their progress.

“It’s a nice transformation to see,” she says. “We get to develop a different type of relationship with our patients with the amount of time we spend with them, and no two cases are the same. TB doesn’t discriminate, so I get to meet people from all walks of life, and I feel that I am doing some good as a nurse. Really, there is nothing better.”

So You Know

TB is caused by the bacteria Mycobacterium tuberculosis and is spread through the air. Most TB disease occurs in the lungs but TB can affect any part of the body. There are two kinds: latent TB, where people who breathe in the TB germs may not show any symptoms for years. Some never develop active TB, while others with a weakened immune system or older folks may become active later in life. People with latent TB infections do not look or feel sick and are not contagious.

For those with active TB, symptoms include:

  • Feeling of sickness, weakness
  • Fever
  • Weight loss
  • Night sweats
  • Coughing, persistent
  • Coughing up blood
  • Chills

A person with active TB can pass the germs to others usually through coughing. Individuals with the following risk factors are more likely to develop TB through a weakened immune system, such as persons with HIV/AIDS, leukemia, cancer and other serious illnesses. They are also vulnerable if they’ve been infected with TB in the last two years, or didn’t receive complete or proper treatment in the past.

For information on screening or testing for TB, go here.



View Past Features