Pulmonary Tuberculosis with Concomitant Aspergillus Fungal Ball in a Diabetic Indian Male: A Rare Case Report

County Confirms Active Pulmonary Tuberculosis Case At Lane Middle School

A person at Lane Middle School may have been contagious with tuberculosis for almost eight months, Multnomah County announced Thursday afternoon.

The county confirmed the one active case of pulmonary tuberculosis at the Woodstock neighborhood school, and said the person was recently diagnosed. At this time, officials are "optimistic" that spread won't occur from this specific case, though the person could have been contagious for eight months—from Sept. 3, 2024, to May 1, 2025.

Tuberculosis, a bacterial infection that primarily affects the lungs, can, if left untreated, progress into more serious symptoms or even death. The disease can be active, like the one at Lane, meaning it is contagious and presents symptoms, or latent, meaning the bacteria are present but the carrier is not contagious and presents no symptoms.

The disease hard to catch and usually spreads only through close face-to-face contact for several hours over a period of weeks or months, according to the county's announcement. That means casual encounters—like walking by an infected individual in the hallway, or even sharing drinking glasses—are not ways the infection traditionally spreads. The bacteria also do not live on surfaces.

"Most people who have had casual contact with a person diagnosed with tuberculosis will not become infected," Dr. Richard Bruno, the county's health officer, said in a statement. "While tuberculosis can be spread in school settings, we expect that anyone infected would not yet be ill and could be effectively treated with medication."

Tuberculosis is hard to detect, which could explain why the individual may have been contagious for such a long period before being diagnosed with TB. Active tuberculosis usually develops months or years after initial infection. When treated properly, almost all patients are cured.

Symptoms of tuberculosis include a cough, chest pain, and coughing up blood or phlegm. The county has contacted via email people who might have been exposed. The health department will provide free blood tests to the Lane school community in the coming weeks, and families or staff can call the county's tuberculosis clinic at 503-988-3406.

After Sachem East High Schooler's Infection, What To Know About Tuberculosis

The Suffolk County Department of Health Services said a Sachem High School East student was treated for tuberculosis. Credit: John Roca

A student at Sachem East High School was treated for tuberculosis, district officials said, sparking questions about the disease, which can be fatal if left untreated. Here are some answers to common questions about tuberculosis.

What is tuberculosis (TB)?

Tuberculosis is an infectious disease spread through the air that can impact the lungs, lymph nodes, bones, joints, brain and spine, according to the New York State Department of Health. It is caused by a germ called Mycobacterium tuberculosis.

People who are infected can have either latent TB, meaning they are not currently sick but could develop the illness, or active TB. People who are sick can infect others. Not everyone with active TB has symptoms, experts said.

Both conditions require treatment. TB can be fatal if left untreated.

What are the symptoms of TB?

Coughing, with blood-tinged sputum (phlegm that comes from deep inside the lungs); fever, weight loss and night sweats are the four major symptoms, according to Dr. Jonathan Garellek, chief of infectious diseases at Long Island Jewish Valley Stream hospital.

How common is TB in the United States?

There were 9,633 cases of TB disease reported in the U.S. in 2023, according to the Centers for Disease Control and Prevention, up from 8,332 in 2022.

In New York State, there were 714 cases in 2022, 894 in 2023 and 1,089 in 2024. The majority of cases were in the five boroughs of New York City. In 2024, there were 48 cases in Nassau County and 52 in Suffolk County, according to state figures.

Cases locally and nationally dropped during the COVID-9 pandemic and are rising to pre-pandemic levels.

Who is at risk for TB?

"Tuberculosis is not endemic in the United States, which means children will not randomly pick it up because they go to the park every day," Garellek said.

For example, if someone with active TB disease coughs out particles, a person nearby can contract the infection but usually after they have been exposed for a prolonged period of time, generally around eight hours, he said.

"Someone living in the same home with a child with pulmonary tuberculosis would be at a high risk," Garellek said.

Cases in the U.S. Generally involve people who come from countries where TB is more prevalent, he said.

The CDC said TB is common in some countries in Asia, Africa and Latin America. Other people at risk include those who live in homeless shelters and prisons; those who recently spent time with someone who has active TB and people whose immune systems are compromised because of health conditions such as diabetes, cancer and HIV, and the medications they take to treat these conditions.

How do you test for TB?

There are two tests used to detect TB. A blood test checks to see how a person's immune system reacts to the germs that cause TB, according to the CDC.

Another test monitors how a person reacts after a small solution is placed under the skin, usually on the forearm. It takes about 48 to 72 hours to see if a reaction occurs on the skin.

Lisa joined Newsday as a staff writer in 2019. She previously worked at amNewYork, the New York Daily News and the Asbury Park Press covering politics, government and general assignment.

Danger Zones Where Tuberculosis Spreads Most Easily

Comprehensive guide to the primary transmission routes of tuberculosis and effective prevention measures

Tuberculosis (TB) remains one of the world's deadliest infectious diseases, affecting millions annually despite being preventable and curable. Understanding how TB spreads is crucial for both prevention efforts and identifying those at highest risk. This article examines the transmission mechanisms of tuberculosis and provides evidence-based prevention strategies.

The airborne nature of tuberculosis transmission

Tuberculosis is primarily transmitted through the air when people with active pulmonary or laryngeal TB cough, speak, sing, sneeze, or otherwise expel tiny droplets containing Mycobacterium tuberculosis bacteria. These microscopic droplet nuclei can remain suspended in the air for hours, especially in enclosed spaces with poor ventilation.

Unlike many other infectious diseases, TB isn't typically spread through casual physical contact like handshakes or hugs, sharing food, drinks, or utensils, touching surfaces or objects used by someone with TB, sexual contact, or blood transmission.

This airborne transmission route makes TB distinctly different from other common infections and explains why certain environments and situations create higher risk scenarios for transmission.

Factors that increase transmission risk

While anyone can potentially contract tuberculosis through airborne exposure, several key factors significantly increase transmission probability:

Proximity and duration of exposure: Close, prolonged contact with someone who has untreated active TB disease dramatically increases risk. Household members of TB patients have approximately 15% risk of developing active TB themselves.

Enclosed, poorly ventilated spaces: The bacteria concentrate in confined areas with limited air exchange. Research shows that improving ventilation can reduce transmission risk by 70-80%.

Bacterial load of the infected person: Individuals with cavitary lesions in their lungs or positive sputum smears typically release more bacteria when coughing, making them more infectious.

Absence of treatment: People with active TB who haven't started appropriate antibiotic therapy remain highly contagious. After approximately two weeks of proper treatment, most patients' infectiousness decreases significantly.

Immunocompromised status of exposed individuals: Those with weakened immune systems, particularly HIV-positive individuals, face substantially higher risks both of becoming infected after exposure and of developing active disease if infected.

High-risk settings for tuberculosis transmission

Certain environments create particularly favorable conditions for TB transmission due to their combination of crowding, poor ventilation, and concentration of vulnerable individuals:

Healthcare facilities: TB transmission in hospitals and clinics occurs primarily when patients with undiagnosed TB are not properly isolated. Healthcare workers have 2-3 times higher TB rates than the general population in many regions.

Correctional facilities: Prison populations worldwide experience TB rates 10-100 times higher than general populations due to overcrowding, inadequate ventilation, and higher rates of risk factors.

Homeless shelters: Studies show TB outbreaks occur frequently in shelters, with transmission facilitated by overcrowding, transient populations, and limited healthcare access.

Long-term care facilities: Nursing homes and other residential facilities can experience rapid TB spread due to the concentration of older adults with weakened immunity in close quarters.

Refugee camps and immigration centers: Overcrowding combined with populations from high-burden TB countries creates transmission hotspots.

Congregate settings in high-burden regions: Schools, workplaces, and public transportation in countries with high TB prevalence can serve as transmission sites, especially when TB screening is inadequate.

Special transmission considerations

Several TB transmission scenarios deserve special attention:

Extrapulmonary TB: Most forms of extrapulmonary tuberculosis (affecting areas outside the lungs) are minimally contagious or non-contagious. The exception is laryngeal TB, which can be highly infectious.

Children with TB: Young children with primary TB disease rarely transmit the infection because they typically have fewer bacteria in their lungs, produce weaker coughs, and often have non-cavitary disease.

Silent transmission: Research increasingly shows that TB can spread through normal breathing and speaking, not just coughing, contributing to what epidemiologists call "silent transmission" from people with minimal symptoms.

MDR/XDR TB: Multi-drug resistant and extensively drug-resistant tuberculosis strains transmit through the same mechanisms as drug-susceptible TB but present greater public health concerns due to treatment challenges.

Prevention strategies for tuberculosis transmission

Preventing TB transmission requires multi-level approaches:

Rapid identification and treatment: Finding and properly treating active TB cases remains the cornerstone of prevention. Studies show each untreated TB patient may infect 10-15 others annually.

Airborne infection control measures: Proper ventilation (natural or mechanical), HEPA filtration systems in high-risk settings, ultraviolet germicidal irradiation (UVGI) in appropriate facilities, and proper patient isolation in healthcare settings all contribute to reducing airborne transmission.

Personal protective equipment: N95 respirators (not regular surgical masks) can protect healthcare workers and visitors when worn properly around infectious TB patients.

Preventive treatment: Treating latent TB infection with isoniazid, rifampin, or newer shorter regimens reduces the risk of developing active disease by 60-90%.

BCG vaccination: Though imperfect, the Bacille Calmette-Guérin vaccine offers partial protection, particularly against severe forms of TB in children.

Cough hygiene education: Teaching TB patients to cover coughs with tissues or elbows and proper disposal of potentially contaminated materials reduces transmission risk.

Addressing systemic factors: Reducing overcrowding, improving nutrition, treating HIV, and addressing other social determinants significantly impacts TB transmission.

What to do if exposed to tuberculosis

For those who have been exposed to someone with infectious TB, consult with healthcare providers about TB testing (either skin test or blood test). If recently infected, discuss preventive treatment options. Monitor for TB symptoms, including persistent cough, night sweats, weight loss, and fatigue. Understand that most healthy adults who become infected with TB bacteria initially develop latent TB infection, where the bacteria remain inactive and non-contagious.

The role of public health programs

Public health departments play crucial roles in breaking TB transmission chains through contact investigation to identify and test people exposed to TB, Directly Observed Therapy (DOT) to ensure treatment completion, TB screening programs for high-risk populations, education and awareness campaigns, and outbreak investigation and management.

Global challenges in TB transmission control

Despite decades of efforts, TB transmission continues globally due to delayed diagnosis, particularly in resource-limited settings, incomplete treatment leading to continued transmission and drug resistance, HIV co-infection facilitating both TB transmission and progression, limited healthcare infrastructure in high-burden regions, and socioeconomic factors including poverty, malnutrition, and overcrowded housing.

Understanding the science behind tuberculosis transmission underscores the importance of comprehensive public health approaches. While TB remains a serious global health threat, its airborne transmission route is well understood, and effective prevention measures exist. Continued investment in TB control programs, research, and addressing underlying social determinants remains essential to reducing the global burden of this preventable disease.

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