Tuberculosis (TB): Practice Essentials, Background, Pathophysiology

Tuberculosis Has Overtaken COVID As World's Deadliest Infectious Disease

Tuberculosis (TB) is once again the infectious disease responsible for the most deaths worldwide, according to a Tuesday announcement from the World Health Organization (WHO).

The contagious disease was responsible for 1.25 million global deaths in 2023, WHO reported, including 161,000 people with HIV.

COVID-19 had overtaken TB as the world's leading infectious killer for the previous three years.

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What to know about tuberculosis

TB is a preventable and curable disease caused by bacteria that typically impacts the lungs, according to WHO.

This 2006 electron microscope image provided by the Centers for Disease Control and Prevention shows Mycobacterium tuberculosis bacteria, which causes the disease tuberculosis.  (Janice Carr/CDC/AP)

It is an airborne contagion that can be spread through coughing, sneezing or saliva.

While around 25% of people have likely been infected with the bacteria, only 5% to 10% will experience symptoms and develop the disease, the same source stated.

Only people with symptoms can spread the disease.

Who is at risk?

"If you breathe, you can catch TB — so all people are at risk," Masae Kawamura, M.D., a former TB control director in San Francisco and a tuberculosis clinician, told Fox News Digital. 

Kawamura calls TB a "social disease of crowding and mobility." 

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"Since TB is airborne, congregate settings like hospitals, nursing homes, prisons, jails, classrooms and homeless shelters are places TB is more easily spread, especially if multiple risks are involved," she said.

Those at the highest risk of developing TB disease after exposure include people who have diabetes, have weakened immunity, are malnourished, use tobacco and/or drink excess amounts of alcohol.

Babies and children are also at higher risk.

"If a person has latent TB infection, TB disease activation varies from 5% to 15% over a lifetime, but can be higher if a person has multiple risks, such as being an elderly person and/or being malnourished, having diabetes and/or having other diseases that weaken the immune system," said Kawamura.

Symptoms, diagnosis and treatment

Those who get sick with TB may experience mild symptoms, including coughing, chest pain, fatigue, weight loss, weakness, fever and night sweats, according to WHO.

Symptoms will vary depending on which organs are affected. 

"If you breathe, you can catch TB — so all people are at risk."

In addition to the lungs, the disease can also affect the kidneys, spine, skin and brain.

"TB can affect any organ of the body, but it causes disease in the lung in over 80% of cases," said Kawamura.

"This is dangerous because it causes cough, the mechanism of airborne spread."

TB is an airborne contagion that can be spread through coughing, sneezing or saliva. (iStock)

In more severe cases, patients may cough up blood, noted Kawamura, who serves on the board of directors of Vital Strategies, a global public health organization. 

"Often there are minimal symptoms for a long time and people mistake their occasional cough with allergies, smoking or a cold they can't shake off," she added.

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TB can be identified with rapid diagnostic tests, WHO noted.

The disease is treated with antibiotics that are taken every day for four to six months, the same source stated. Some of the most common include isoniazid, rifampicin, pyrazinamide and ethambutol.

"TB can affect any organ of the body, but it causes disease in the lung in over 80% of cases," an expert said. "This is dangerous because it causes cough, the mechanism of airborne spread." (iStock)

Failing to take the complete course of medications can cause the bacteria to become drug-resistant.

Cases of drug-resistant TB need to be treated with different medications.

When TB becomes deadly

If TB goes untreated, it is fatal in about half of its victims, according to Kawamura. 

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"About 25% recover on their own and another 25% persist as chronic active TB cases," she said.  

 In the U.S., most active TB cases are detected at an earlier stage, the expert noted, but the death rate is still "shockingly high" at 10%, and much higher if the patient is over 65 years old.  

Prevention of the disease

There is a childhood vaccine called Bacille-Calmette-Guerin (BCG) that is given in most of the world to infants, Kawamura noted.

"It reduces death, meningitis and organ dissemination by 75% in children under 5 — however, it does not prevent TB infection and is ineffective in adults," the doctor told Fox News Digital. 

The best means of prevention is testing those at risk and treating latent tuberculosis infection (LTBI), a doctor advised. (iStock)

"Overall, BCG is considered ineffective, hence, TB's title as the greatest infectious disease killer of all time."

BCG was never used in the U.S. Because of the country's lower rates of TB, its ineffectiveness and its interference with TB tests, she added.

"Our best chance to end the TB epidemic is to kill TB while it sleeps."

The best means of prevention is testing those at risk and treating latent tuberculosis infection (LTBI), according to the doctor.

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"Our best chance to end the TB epidemic is to kill TB while it sleeps," Marc Destito, head of global health for QIAGEN, a Netherlands-based company that provides tuberculosis testing solutions, told Fox News Digital. 

"To do that, we need to identify, test and treat the estimated millions of Americans — and many more around the world — who are infected with the bacteria that causes TB disease. More aggressive testing, contact tracing and education are the keys to ending TB." 

Melissa Rudy is senior health editor and a member of the lifestyle team at Fox News Digital. Story tips can be sent to melissa.Rudy@fox.Com.

Is Tuberculosis A Sexually Transmitted Disease (STD)?

A person usually contracts tuberculosis (TB) when they breathe in TB bacteria. In rare cases, the bacteria may travel to the genitourinary tract and transmit between people during sexual activity.

If the TB spreads to a person's urinary tract or genital organs, medical professionals may refer to it as genitourinary TB.

If a person contracts a TB infection, it may develop into the disease TB. However, people can contract a TB infection, but not the disease. This article refers to genitourinary TB as a sexually transmitted infection (STI), not a sexually transmitted disease (STD).

This article discusses how TB can spread from one person to another and provides other information about TB infection.

TB typically transmits through the air. If a person has TB, the bacteria can enter the air when they:

If another person breathes in the bacteria, they may contract a TB infection.

Sometimes, TB bacteria may remain in the air for several hours. The bacteria is more likely to spread in indoor areas with poor circulation than outdoors.

Rarely, the TB infection can spread to other parts of the body. These include the:

If a TB infection spreads to the urinary tract or genital organs, medical professionals may refer to the condition as genitourinary TB.

If a person with genitourinary TB has sexual contact with another person, the TB may transmit to them.

Genitourinary TB may not cause noticeable symptoms in the early stages of the disease.

symptoms similar to recurrent urinary tract infection, such as:

pain or burning during urination

increased urination

blood in the urine

low back pain or pain in the side of the back

fever

chills

symptoms of end stage kidney failure, such as:

difficulty urinating

chest pain

dry skin

increased urination

headaches

fatigue

nausea and vomiting

muscle cramps

unexplained weight loss

needing to get up in the night frequently to urinate

If the TB spreads to a person's penis or scrotum, it may cause them to develop swellings or ulcers on the genitals. They may also develop papules or nodules.

If TB spreads to a person's vulva, vagina, or cervix, they may develop the following symptoms:

bleeding after sexual intercourse

pain during sexual intercourse

pelvic pain

persistent coughing that may also produce blood

fever

unexplained weight loss

night sweats

chest pain

weakness

fatigue

Additionally, people should speak with a healthcare professional if they experience any symptoms of genitourinary tuberculosis. These may include increased urination, blood in the urine, and difficulty urinating.

TB is an infectious disease that most commonly affects the lungs. TB bacteria can transmit through the air when a person with TB coughs, sneezes, speaks, or sings.

The TB infection can also spread to other areas of the body, including the brain, spine, kidneys, urinary tract, and genital organs. If a person's TB does spread to their urinary tract or genital organs, then medical professionals may refer to it as genitourinary TB.

Genitourinary TB can spread from person to person via sexual contact. This means that medical professionals may classify it as an STI.

Tuberculosis Surpasses COVID-19 As Top-killing Infectious Disease In The World

The world health organization released information this week saying that tuberculosis is now the top killing infectious disease in the world… surpassing COVID-19.

San Luis Obispo County Public Health says so far there have been less than 5 cases of Active Tuberculosis in the county this year.

While the numbers are low for Active TB, I spoke to doctors who say there is another form of it to be aware of... Latent Tuberculosis, or LTBI.

"The bug does get into your lungs." said Dr. Roberts from Med Stop Urgent Care. "You have TB, but your immune system walls it off and your immune system keeps basically it hibernates it doesn't make you sick and you can't give it to other people, but you are infected with LTBI, Latent Tuberculosis. That's the one that's much more common, and the one we really need to make efforts to find those people."

Dr. Roberts says Latent TB can develop into Active TB, which will make you begin to show symptoms, and make you contagious.

"Tuberculosis is transmitted from person to person by droplets." said Dr. Vendegna from French Hospital. "So coughing, sneezing. So that's how you would get tuberculosis. And the symptoms of TB would be you would develop a cough, Sputum productions, fevers, weight loss. It's a slow progressing disease, if left untreated is very serious."

Both doctors say the treatment for active TB is a long process, but if followed strictly, you wont have any lingering impacts.

"It takes like 3 or 4 drugs to kill Tuberculosis over an extended period. So most treatments of tuberculosis are up to six months." said Dr. Vendegna.

Dr. Roberts says that if you have Latent TB, the treatment is easier and takes less time. If you suspect you could have Latent TB,he recommends getting tested with a skin test, or a blood test by your doctor.

"The benefit is not reactivating later. So, we said that more than 85% of the active cases are from LTBI. If you treat LTBI, it becomes extremely unlikely that it will activate." said Dr. Roberts.

While around the whole world TB is dangerous, both doctors agree that the likelihood of getting it here are low, and even if you do, there are treatments to kill it.

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