Tuberculosis Testing: Risks and Precautions for Family Members

Q: Tuberculosis Testing: Risks and Precautions for Family Members

Hello： 1. <br>For tuberculosis contact screening, a chest X-ray is typically performed first. <br>According to the information provided, this was conducted at Hospital A. <br>Initially, there were concerns regarding your mother's X-ray results, but upon re-examination, no lesions

If tuberculosis tests yield inconsistent results, could this lead to an unnoticed infection?

Hello, Doctor.
I would like to ask a question.
Previously, a family member was diagnosed with tuberculosis, so both my mother and I received a notice from the health department to undergo chest X-ray examinations.
We first went to Hospital A for the check-up.
Fortunately, I did not have any issues, but my mother's X-ray showed some shadows in her lungs.
The doctor said it was uncertain and that we needed to follow up.
Later, the health department sent us another notice to have blood tests done.
We went to Hospital B (since Hospital A could not perform this type of test).
After a week, the results from Hospital B came back: my mother tested positive, while I tested negative.
The health department informed us to return to any hospital (either A or B) for a follow-up and to start treatment.

It was later discovered that during the first X-ray at Hospital A, the doctor assisted my mother in scheduling a follow-up appointment.
Therefore, we plan to return to Hospital A this Saturday.
We had another X-ray done, but this time no lesions were found, so the doctor determined there was no problem and did not prescribe any medication (I informed the doctor about the results from Hospital B, but they still did not prescribe any medication).
However, I am very worried about this outcome because my immune system has always been weaker than my mother's.
Since my mother is infected, am I at risk of contracting the disease? Although I have been tested, my mother is currently not on medication and could potentially become symptomatic at any time, which concerns me greatly.

I have been urging her to return to Hospital B or another hospital on Monday to get medication and start treatment, but she insists on not going because a relative recently passed away, and she needs to handle the funeral arrangements (such as paying respects and helping with preparations) before returning for a follow-up.
If, unfortunately, her health deteriorates and she becomes symptomatic, could this lead to a cluster outbreak of tuberculosis? I am also worried because we live together, and being in the same enclosed space for an extended period certainly increases the risk of transmission.
Is there any way to prevent this? Should I go back to the health department to obtain another examination notice and get checked again for safety?
Additionally, I would like to ask whether the results from Hospital A or Hospital B should be considered for determining if there is an infection with tuberculosis.
Since there was no sputum test conducted, only blood tests and X-rays were performed, the results seem quite different.
I hope to receive a prompt response from the doctor to ease my anxiety regarding tuberculosis.

Jeff, 10~19 year old female. Ask Date: 2020/05/10

Dr. Zhou Ziguang reply Pulmonology

Hello: 1.
For tuberculosis contact screening, a chest X-ray is typically performed first.
According to the information provided, this was conducted at Hospital A.
Initially, there were concerns regarding your mother's X-ray results, but upon re-examination, no lesions were found.
Therefore, based on the X-ray findings, the final conclusion from Hospital A is that neither you nor your mother has tuberculosis.
2.
Regarding the blood test conducted at Hospital B, it was likely to determine if there was any infection.
Your result was negative (indicating no evidence of infection), while your mother's result was positive (indicating she has been infected, but according to the report from Hospital A, she currently does not have active tuberculosis and is therefore not contagious).
If medication is to be prescribed for your mother, it would be for preventive purposes to reduce the risk of developing the disease in the future.
3.
Whether to use preventive medication should be discussed with your physician.

Reply Date: 2020/05/10

More Info

Understanding tuberculosis (TB) testing and the associated risks for family members is crucial, especially when a loved one has been diagnosed with an active form of the disease. Tuberculosis is primarily an airborne infection caused by the bacterium Mycobacterium tuberculosis, and it can be transmitted through the air when an infected person coughs, sneezes, or talks. Here’s a comprehensive overview based on your concerns.

Transmission and Risk of Infection
1. Transmission Dynamics: It is important to note that not everyone who is exposed to TB will become infected. The risk of transmission increases with prolonged exposure to an infected individual, particularly in enclosed spaces. If your mother has been diagnosed with active TB, there is a risk that you could have been exposed, especially if you live together and share close quarters.

2. Infection vs. Disease: There is a distinction between being infected with TB bacteria and having active TB disease. Many people can be infected (latent TB) without showing symptoms or being contagious. In your case, your negative test results suggest that you may not have contracted the infection, but the presence of your mother’s active TB does warrant ongoing monitoring and precautionary measures.

Testing and Diagnosis
1. Testing Methods: The standard methods for diagnosing TB include chest X-rays, sputum tests, and tuberculin skin tests (TST). Blood tests, such as the interferon-gamma release assays (IGRAs), are also available and can provide additional information. The discrepancy in results between hospitals can be concerning; however, it’s essential to consider the context of each test. X-rays can sometimes miss early or mild cases of TB, while blood tests can indicate exposure but not necessarily active disease.

2. Follow-Up Testing: Given your mother’s positive blood test and the shadow on her X-ray, it is critical for her to follow up with a healthcare provider for further evaluation and treatment. If she is reluctant to seek treatment immediately, it is advisable to encourage her to do so, as untreated active TB can lead to serious health complications and increase the risk of transmission.

Precautions and Preventive Measures
1. Preventive Treatment: If you have been in close contact with someone who has active TB, your healthcare provider may recommend preventive treatment, especially if you have a weakened immune system or other risk factors. This is typically done with a course of antibiotics to prevent the development of active TB.

2. Monitoring Symptoms: Keep an eye on any symptoms that may arise, such as persistent cough, fever, night sweats, or unexplained weight loss. If you experience any of these, it’s crucial to seek medical attention promptly.

3. Environmental Controls: Improving ventilation in your living space can help reduce the risk of transmission. If possible, ensure that your mother is in a separate room, especially if she has not yet started treatment.

Conclusion
In summary, while your negative test results are reassuring, the situation remains complex due to your mother’s active TB diagnosis. It is essential to maintain open communication with healthcare providers, follow their recommendations for testing and treatment, and take preventive measures to protect yourself and others in your household. If there is any uncertainty about the results from different hospitals, consider discussing this with a healthcare professional who can provide clarity and guidance on the best course of action. Your health and peace of mind are paramount, and proactive steps can help mitigate the risks associated with TB exposure.

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