Tuberculosis Transmission and Treatment Risks in Families

Q: Tuberculosis Transmission and Treatment Risks in Families

Dear Megan： Thank you for your inquiry. <br><br>1. <br>You had a nodular shadow in the past, which suggests that you may have had an infection that is currently in a dormant state as a granuloma. <br>Although preventive medication was administered, it may not have completely erad

Tuberculosis-related issues?

Hello, Doctor! My father was diagnosed with open pulmonary tuberculosis in 2020 and was hospitalized for nearly a year for treatment.
After that, both my mother and my daughter tested positive and received preventive medication.
I, myself, tested negative for tuberculosis through blood tests, chest X-rays, and sputum tests.
However, a shadow was detected in my lungs, so I subsequently paid for a CT scan.
At the end of last year, the shadow on the X-ray and the CT scan showed signs of possible enlargement, prompting my doctor to request another sputum test.
This time, the report indicated the presence of tuberculosis bacteria, classified as open and contagious, necessitating treatment.

I would like to ask, given the time that has passed since my father's diagnosis, was I infected during that period? I don't understand why nothing was detected during the follow-up, and now it has turned into an open case.
Additionally, I would like to know if my daughter is at risk of a second diagnosis, considering she has already been on medication for nine months.
If someone else in the household falls ill at different times, will young children continuously face the risk of needing medication? The medication is extremely unpleasant and harmful, and I am genuinely worried about the potential risks to my child.
Thank you, Doctor, for your answers!

Megan, 30~39 year old female. Ask Date: 2023/03/12

Dr. Huang Yiwen reply Pulmonology

Dear Megan: Thank you for your inquiry.

1.
You had a nodular shadow in the past, which suggests that you may have had an infection that is currently in a dormant state as a granuloma.
Although preventive medication was administered, it may not have completely eradicated the infection.
Therefore, the possibility of recurrence is present, and it is best to consider treatment for tuberculosis.
2.
If your daughter does not exhibit any of these symptoms, there is no need for concern, and she does not require continuous medication.
There are two approaches you can consider: for children under 5 years old, you can compare the size of two Tuberculin Skin Tests (TST) to determine if further medication is necessary (though medication is not mandatory), or you can perform an Interferon Gamma Release Assay (IGRA) to compare the values from two tests.
Changhua Hospital is here to support you.

Reply Date: 2023/03/12

More Info

Understanding tuberculosis (TB) transmission and treatment risks within families is crucial, especially in light of your family's history with the disease. Tuberculosis is primarily spread through the air when an infected person coughs, sneezes, or talks, releasing droplets containing the bacteria into the environment. Given that your father was diagnosed with open TB in 2020, it is indeed possible that you and other family members were exposed to the bacteria during that time.

In your case, the timeline is significant. You mentioned that both your mother and daughter tested positive for TB exposure and received preventive treatment. This indicates that they were likely infected but did not develop active TB disease at that time. It is important to note that the immune system can sometimes contain the bacteria, leading to latent TB infection (LTBI), where the person is infected but asymptomatic and not contagious. However, latent TB can reactivate, especially if the immune system is compromised or under stress.

Your situation, where you initially tested negative but later developed active TB, raises questions about the sensitivity of the tests used. Tuberculin skin tests and blood tests (like IGRA) can yield false negatives, particularly in cases of recent infection or in individuals with weakened immune systems. The presence of a shadow on your X-ray and subsequent CT scan indicating potential disease progression suggests that there may have been an underlying infection that was not detected earlier. The transition from latent to active TB can occur, and it is not uncommon for this to happen months or even years after initial exposure.

Regarding your daughter, since she has already undergone preventive treatment for nine months, her risk of developing active TB is significantly reduced, but it is not entirely eliminated. Continuous exposure to an infectious source, such as a family member with active TB, can increase her risk. If another family member were to develop TB, it would indeed pose a risk to her, especially if she has not completed her preventive treatment or if her immune system is compromised.

The concern about the medication's side effects is valid. TB treatment typically involves a combination of antibiotics taken over a long period (usually six months or more for drug-susceptible TB). While these medications can have side effects, they are essential for curing the infection and preventing further transmission. It is crucial to weigh the risks of untreated TB, which can lead to severe health complications, against the side effects of the medications.
For young children, the risk of developing TB can be serious, and preventive treatment is often recommended if they have been exposed to someone with active TB. The medications used for TB treatment are generally safe, but it is essential to monitor for side effects and maintain open communication with healthcare providers about any concerns.

In summary, the transmission of TB within families is a complex issue influenced by various factors, including the timing of exposure, the immune response, and the effectiveness of screening tests. Continuous monitoring and follow-up with healthcare providers are essential to manage risks effectively. If there are concerns about ongoing exposure or the health of family members, it may be beneficial to consult with a specialist in infectious diseases or a pulmonologist who can provide tailored advice and treatment options.

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