Events

Web chat: Discuss tuberculosis with our TB specialists

In advance of World Tuberculosis (TB) Day on 24 March, we’re hosting a web chat with Professor Onn Min Kon, a consultant respiratory physician and chief of service for the TB service, along with Marie O’Donoghue, lead TB clinical nurse specialist at our Trust.

Join us at 12.30 on Monday 21 March to spend an hour discussing tuberculosis. Patients, GPs, other health workers and members of the public are all invited to submit questions about tuberculosis. We’ll cover topics such as:

• What are the symptoms of tuberculosis?
• How does tuberculosis spread?
• How is tuberculosis treated?

We’ll open the web chat for questions at noon, then Professor Kon and Marie will join us to start the discussion at 12.30. You can join the chat right here on this page, or follow along via Twitter @ImperialNHS. You are also welcome to email your questions to web@imperial.nhs.uk. If you can’t make it to the live chat, check our website later to see the chat in full.

Prof Kon & Nurse Marie: 
Tuberculosis (TB) is an illness caused by bacteria. Most people have the latent, inactive form of TB, but some people develop active TB disease. Active TB most commonly affects the lungs, but you can get TB in almost any part of your body. TB in the lungs or throat is the only type of TB that can be infectious, which means it can be passed on to other people. TB is curable with a course of antibiotics, usually lasting six months.

It is estimated that a third of the world’s population has latent TB. This means you have breathed in the TB germ but your body is keeping them under control and stopping you from becoming unwell. People with latent TB do not have any symptoms and cannot pass the infection to other people. There is a risk that you will become unwell with active TB later on, especially if your immune system becomes weak due to another illness or certain medication.

People with latent TB do not have any symptoms and cannot pass the infection to other people. Without treatment, there is a risk that around 5-10% of those with latent TB with develop active TB at some time during their lives. Therefore around 90% of those with latent TB will never develop the disease.

Not everyone who has latent TB infection needs to take preventative treatment, as risks of developing active TB differs and is dependent on individual risk factors – for example, those with a weakened immune system due to another illness or medicine, recent contact with a person with infectious TB. 
 
Comment From Guest 
Hi I am constantly working with TB patients but I am on methotrexate for a long term condition. Am I at a greater risk? 

Prof Kon & Nurse Marie: 
Prof Kon says: Methotrexate is associated with a small but measurable risk of increased reactivation of TB. This is likely in the order of being two-fold the normal risk. We would not normally regard methotrexate use itself as a contraindication to working in these situations but clearly if there is inadvertent exposure to an infectious patient, then you should seek medical advice. I would also consider ensuring that you know your baseline status to help inform yourself in the future (e.g. tuberculin skin test/ IGRA/ CXR results).
 
Comment From Alan 
Just a General enquiry ; what is the current patient volume on cases ; has there been a significant increase .
 
Prof Kon & Nurse Marie: 
In line with the rest of the United Kingdom there’s been a decrease in the last three years of active TB cases. But activity is still high given that we are now screening more people for TB.
 
Comment From Beth 
How can we protect our staff with active TB in the clinic?
 
Prof Kon & Nurse Marie: 
You are most likely to get TB yourself if you have spent a lot of time with a person with infectious TB, for example living in the same household. It is unlikely that you could catch TB from casual contact with patients with active TB in a clinical setting, since close contact for a number of hours is usually necessary to pass on the infection. 

NHS practice is to also offer the BCG vaccination to all healthcare workers, which will also offer some additional protection. 

If you think you have been exposed inadvertently, you should ask your physician for advice.
 
Comment From K 
Does TB leave you with any permanent damages or conditions?
 
Prof Kon & Nurse Marie: 
The overwhelming majority of TB can be treated and leaves no permanent damage. 

In a very small number of patients, particularly those who present very late or have infection in the brain or spinal cord, some can have residual scarring, which affects their function. If patients present with very advanced lung infection, they may be left with residual scarring in the lungs that causes long-term cough and other infections. In patients with infection affecting the spinal cord, this could include pain or difficulties performing normal tasks. 

Prof Kon & Nurse Marie: 
It is worth noting that a significant proportion of patients with TB have a TB infection that affects other parts of the body beyond the lungs. TB will only cause a cough if it is affecting your lungs. If TB is in another part of the body it can also cause pain and swelling. All of these symptoms may also be signs of problems other than TB, so if you are worried you should talk to a doctor or nurse at your local clinic or GP practice at your local surgery.

If you have any of the following symptoms, you should seek medical advice: 
• A cough that lasts for more than three weeks
• Fever (high temperature)
• Heavy night sweats
• Unexplained weight loss
• Fatigue (extreme tiredness)
• No appetite

TB that does not affect the lungs may still present with some of the above symptoms, but will not present with a cough. 

Prof Kon & Nurse Marie: 
We received several questions via email in advance of our web chat, many of which concerned latent TB. We will answer those questions now.
 
Prof Kon & Nurse Marie: 
Question via email: 'What is latent TB and how do you catch it?'
 
Prof Kon & Nurse Marie: 
This means you have breathed in the TB germ but your body is keeping them under control and stopping you from becoming unwell. People with latent TB do not have any symptoms and cannot pass the infection to other people. There is a risk that you will become unwell with active TB later on, especially if your immune system becomes weak due to another illness or certain medication.

It is estimated that a third of the world’s population has latent TB. People with latent TB do not have any symptoms and cannot pass the infection to other people. Without treatment, there is a risk that around 5-10% of those with latent TB with develop active TB at some time during their lives. Therefore around 90% of those with latent TB will never develop the disease.

You are at risk of latent TB if you spent a lot of time with someone with infectious TB e.g. living in the same house or if you have lived in or travelled to a country with high numbers of TB e.g. Africa, Asia, South America and eastern Europe.

How do I find out if I have it?
If you are at risk of latent TB you may be offered one or more tests such as:
• a skin test called a Mantoux Test. 
• a blood test
• a chest x-ray.
The results of these tests will help determine the advice or treatment which is best for you.

It is important to remember that without treatment, there is a risk that around 5-10% of those with latent TB with develop active TB at some time during their lives. Therefore around 90% of those with latent TB will never develop the disease. Therefore treatment for latent TB is recommended for those at risk of becoming unwell with active TB e.g. those with recent contact with an infectious case, those who have lived or travelled to a country with high numbers of TB, those with a weakened immune system due to another illness or medication.

Prof Kon & Nurse Marie: 
Question via email: ‘Does having a diagnosis of latent TB affect fertility?’

Prof Kon & Nurse Marie: 
Having a diagnosis of latent TB does not affect fertility, as it is an inactive form of the disease. However, if you do have latent TB and pregnant then there is a slightly higher chance of developing active TB so it is worthwhile flagging this up with any of the team looking after you.
 
Prof Kon & Nurse Marie: 
Another question we received via email: ‘I’ve been told I’ve got latent TB and need to have a course of antibiotics – I don’t know how long I’ve had it for. What effect will having this have had on my body?’
 
Prof Kon & Nurse Marie: 
There is no easy way of defining how long someone has had latent TB unless there is a clear exposure history – you will not feel unwell nor will it have any actual effect on your body as such. The issue is whether you have a higher risk of developing the active form of the disease later as the TB bug ‘reactivates’ (for example if you are a recent contact or are going to be on other treatment that greatly increases the risk of you developing active TB). If you have been offered the preventative treatment then it implies that you are felt to be of sufficient risk so you should then at least be offered the chance of eradicating it at this stage. We do not offer this treatment to everyone with latent TB if they are low risk as there are some potential side-effects such as a rash, nausea and potentially some inflammation in the liver. However your physician will have balanced all these issues up and any potential small risks will be explained to you by the doctor and the TB nurses.
 
Prof Kon & Nurse Marie: 
‘I wasn’t given a BCG when I was a child because the pinprick test came up positive so I was told I had the antibodies – does this mean I have latent TB?’
 
Prof Kon & Nurse Marie: 
The currently available skin test (the mantoux test) can indicate past infection or a prior BCG vaccination and if you have not had a BCG, this is more likely to indicate latent TB infection.

It is important to remember that it is estimated that a third of the world’s population has latent TB. People with latent TB do not have any symptoms and cannot pass the infection to other people. Without treatment, there is a risk that around 5-10% of those with latent TB with develop active TB at some time during their lives. Therefore around 90% of those with latent TB will never develop the disease.

Not everyone who has latent TB infection needs to take preventative treatment, as risks of developing active TB differs and is dependent on individual risk factors – for example, those with a weakened immune system due to another illness or medicine, recent contact with a person with infectious TB. 

Prof Kon & Nurse Marie: 
‘I’m taking antibiotics for TB and they make my stomach hurt. What can I take to stop this? I’ve heard homeopathic remedies are good – can you suggest any?’
 
Prof Kon & Nurse Marie: 
We don’t normally recommend any homeopathic treatments, however, we suggest you speak to your TB specialist for suggestions. You may also consider taking your medication with a light snack, perhaps at a different time of day – for example, before going to bed. If you are experiencing pain or discomfort in your stomach, then your team can prescribe some anti-acid medication. We suggest you talk to your physician about this.
 
Prof Kon & Nurse Marie: 
Symptoms of TB are common to other illnesses. When symptoms such as a persistent cough or fever are unexplained and progressive – they persist and continue to get worse after several weeks – you should seek medical attention. 

Some ‘red flag’ symptoms of TB include a cough with phlegm or spit (also called sputum) that is blood-stained, swelling in your neck, and pain in your chest. 
 
Prof Kon & Nurse Marie: 
The BCG (Bacille Calmette-Guérin) is a strain of the TB germ that has been specially weakened so it can protect against TB. It will not cause TB but encourages the body to build up immunity to the disease.

The BCG programme was changed in 2005, BCG is no longer offered to children in secondary schools in the UK. It has been replaced with a targeted programme for babies, children and young adults at higher risk of TB.
 
Prof Kon & Nurse Marie: 
BCG vaccination is recommended for:

Neonates: All babies under 12 months either born or living in areas where there is a high number of cases (i.e. more than 40 cases of TB a year in every 100,000 people), or who have a parent or grandparent who was born in a country with a high number of TB cases, have a family history of TB in the past 5 years.

Older children: Routine BCG vaccination is not recommended for children aged 10–14 years. Older children who have not had BCG may be screened for TB risk factors, and tested and vaccinated if appropriate. Risk factors are usually either coming from a country where there are a high number of cases or having a parent or grandparent who was born in such a country.

Children under 16 going to live in a country with a high number of TB cases for more than three months and who have not had a BCG are advised to get a skin test to see if vaccination is needed. Usually, BCG for travel will need to be carried out privately, and many travel clinics offer this service.

There are certain other groups of people who may also be at increased risk of TB:

• Close contacts of people diagnosed with TB in the lungs or throat if they are aged 35 years or younger or are aged 36 years and older and a healthcare or laboratory worker who has contact with patients or clinical materials.

• New entrants from high-incidence countries aged younger than 16 years or 16–35 years from sub-Saharan Africa or a country with a TB incidence of 500 per 100,000 or more

• Occupational groups - healthcare workers and other NHS employees who have contact with patients or clinical specimens, irrespective of age.  

Prof Kon & Nurse Marie: 
The BCG programme was changed in 2005, BCG is no longer offered to children in secondary schools in the UK. It has been replaced with a targeted programme for babies, children and young adults at higher risk of TB. BCG is thought to be effective for only around 15 years and research suggests it has little effect on those aged over 35. As the risk of catching TB is still very low for most people, it wouldn’t really be useful to have the BCG after age 35. The only people we would give the BCG vaccine to over age 35 are healthcare workers.

Prof Kon & Nurse Marie: 
Although you get infected by breathing in the TB bug, we believe that in some cases, the TB bug can spread by the blood or lymph glands to other parts of the body. That is why it may present in the spinal cord rather than in the lungs, even though it is transmitted through the lungs.  It is possible to have TB in your lungs and also have it spread to other parts of your body. The treatment is generally the same wherever it is in the body, though if it affects the nervous system or the brain, it may be treated for a longer period of time.    

Prof Kon & Nurse Marie: 
Thanks so much for participating! If you have any additional questions, please feel free to email them to web@imperial.nhs.uk or Tweet them to @ImperialNHS.