Student Health Center

Tuberculosis Fact Sheet

What is tuberculosis (TB)?

TB is a disease that is caused by becoming infected with Tubercle bacilli germs.  These germs are transmitted through the air by a person with active TB.  A person with active TB is contagious to others and is required to undergo treatment with antibiotics.  A person with inactive latent TB infection is not contagious to others but has the TB infection.  Treatment is recommended to prevent the development of active TB and to cure the infection.

What is the difference between active TB disease and inactive latent TB infection (LTBI)?
Active TB disease:  A person with active TB disease is someone who has been infected with the TB bacteria.  The bacteria has reproduced and attacks the body, usually the lungs.  Active TB disease may develop soon after being exposed to a contagious person or after many years.
Inactive Latent TB Infection:  A person is likely to have inactive latent TB infection if they have a positive skin test, a normal chest x-ray, and no symptoms of active TB.  A positive skin test is the only way to determine if a person could have TB infection.  Persons with unrelated inactive TB may develop active TB even many years later.

How is TB spread?
The TB germ is spread only from a person with untreated active TB by tiny droplets from the nose, mouth, lung or lymph fluid.  Someone who shares close breathing space with the infected person over a period of time can then inhale these germs.  TB is usually spread between household contacts, close friends, and people who work together.

What are the Symptoms of TB?
The most common symptoms of TB are persistent cough, fatigue, loss of appetite, unintentional weight loss, fever, chills, night sweats, coughing up blood, shortness of breath, chest pain.

Who can get TB?
Anyone can get TB.  You have a greater chance of getting TB if you:

  • Are infected with HIV
  • Live or spend time in close contact with a person who has active TB
  • Have certain medical conditions (diabetes, silicosis, blood disorders, cancer, renal failure, and certain gastrointestinal disorders)
  • Have suppressed immune system (either from steroid medicine or from disease)
  • Use IV drugs
  • Are addicted to alcohol
  • Are 10 percent below ideal body weight
  • Are from a country with a high TB rate
  • Are or have been a resident or employee of a correctional facility, nursing home or mental institution
  • Are working or studying in the health care field
  • Are or have been migrant, homeless, medically under-served, or from a low income background
  • Have recently converted from a negative to a positive TB skin test
  • Have an abnormal chest x-ray


What is the TB skin test?
The TB skin test is the only way to find out if a person has TB infection.  Although there is more than one type of TB skin test, the most accurate method is the Mantoux test.  For this test, a small amount of testing solution (PPD) is placed on the forearm just beneath the skin.  A health care professional must check the skin test area for a reaction 48-72 hours later.  If you do not have the site checked during this time, the test must be reapplied.  Two-step testing (having the test repeated) may be medically indicated for some people.

What does a positive skin test mean?
If a skin test shows a certain amount of swelling 48-72 hours after placement, this is called a "positive" skin test.  This may indicate that TB infection has occurred and further tests need to be done to determine the status of the TB infection.  All persons with a positive skin test should have both a chest x-ray and an evaluation of possible symptoms of active TB.

Are there any reasons not  to be tested for TB?
Any person with a documented history of a positive skin test should not be tested.  TB skin testing can be done for persons who have been vaccinated with BCG.  Studies indicate that a positive TB skin test in a person with a history of BCG vaccination is more likely to be due to TB infection than as a result of the BCG.

Some conditions may necessitate a delay in testing or special testing.  Please tell the nurse if you have any of the following:  severe illness with a fever, certain viral infections, Hodgkin's disease, Sarcoidosis, vaccination within the past 6 weeks with a live virus vaccine (MMR, yellow fever, varicella).

What are the risks of TB testing?
In highly sensitized persons, strongly positive reactions may include blistering, redness, discomfort, itching, discoloration, swelling and/or scarring at the test site.

How often should I be tested?
Persons listed in the high-risk groups previously mentioned should undergo annual TB screening (with the exception of those from countries with high rates of TB).

What is the treatment for TB?
Certain specialized antibiotics are prescribed for the treatment of active TB disease and Latent TB Infection (LTBI).  The specific course of therapy and follow-up will be determined by a health-care professional.  Treatment for active TB is required by public health law due to the seriousness and contagiousness of the disease.  It is very important that any person deemed to have LTBI also consider treatment with antibiotics.  Taking this medication can prevent the person with LTBI from developing active TB.

CDC FAQs about Tuberculosis

Virginia Division of Tuberculosis Control      Virginia Division of Tuberculosis Disease
 

Health Department Referral for Positive PPD Skin Test


A positive PPD skin test requires further follow-up at the Health Department.  A chest x-ray will be done to make sure you don’t have active tuberculosis disease.  Also, a Health Department specialist will evaluate the likelihood of latent (inactive) tuberculosis infection and whether preventative treatment is appropriate for you.

Please call 646-6855 to set up your appointment at the Richmond City Department of Public Health.  Appointments are scheduled for Tuesday and Thursday mornings between 8:00 am and 10:30 am .

The Richmond City Department of Public Health is located at 500 N. 10th Street .  Go to room 114.  The Student Health Center can help you arrange transportation by cab, if needed.  Please give us 24 hours notice to schedule a ride. Alternatively, a friend may transport you or you may ride the bus.  Information about bus transportation is available at the Student Health Center .

Health Department fees are as follows:

  • Tuberculosis risk assessment (evaluation by Health Dept. specialist): $13.00
  • Chest x-ray, if needed: $33.00


Directions to Richmond Department of Public Health from UR Main Entrance:

  •       Turn RIGHT on Towana Road, go to stop sign.
  •       Turn RIGHT on Three Chopt Road.  Go to 2nd stoplight (Cary Street Road).
  •       Turn LEFT on Cary Street Road.  Go about 2 miles.
  •       Turn LEFT on Malvern.  Continue until you cross Broad Street, then
  •       Turn RIGHT on E. Leigh Street.
  •       Turn RIGHT on N. 10th Street. Large gray building is Dept. of Health, 500 N.10th Street, Room 114


You must schedule your appointment at the Health Department as soon as possible. A “hold” has been placed on your registration until you have obtained a screening and evaluation at the Health Department. If you have further questions, contact Sarah Fisher, Nurse Supervisor or Dr. Lynne Deane, Medical Director at the UR Student Health Center at 289-8064.  

INH Treatment Information


What is INH?
INH (isoniazid) is an antibiotic for the treatment of latent TB infection (LTBI).

What is latent TB infection?
Latent TB infection (LTBI) is not contagious or harmful as long as the infection remains inactive.  Frequently in LTBI, the bacteria remain inactive without causing tuberculosis.  Without treatment, approximately one out of ten people with LTBI will develop tuberculosis.  If a person with LTBI develops another serious health problem, the TB infection may become active because the immune system is no longer able to suppress the TB bacteria.  The active infection (TB disease/tuberculosis) is contagious and much more difficult  to treat.
 

How is latent TB infection treated?
The most current recommendation for LTBI is a 9-month course of the antibiotic Isoniazid (INH).  To ensure effective treatment, the medicine must be taken as prescribed.  Also, to avoid antibiotic resistance, INH treatment should not be initiated if the patient does not intend to complete the entire course of treatment.

What are the benefits and risks of INH treatment for LTBI?

Benefits:  INH treatment substantially reduces the chance that the TB infection (LTBI) will progress to tuberculosis--a serious, contagious illness which can be difficult to treat.
Risks:  Rarely, INH may be harmful to the liver, causing symptoms such as abdominal pain, nausea, loss of appetite, jaundice (yellowing of the skin and eyes), dark urine, rash, easy bruising or bleeding, extreme fatigue, numbness or tingling of hands or feet.

Important INH Treatment Recommendations

  • A blood test for baseline liver function will be checked on all patients before starting INH treatment.  The cost of the blood test is $75.
  • Monthly follow-up is required while taking INH.  The first 2 monthly follow-up appointments will be with the doctor.  Thereafter, monthly follow-up may be done by phone or by submitting the INH Treatment Monitoring form (available on our website).  call or email the Health Center before you finish your medicine each month.  (SHC dial-a-nurse: 804-289-8700 or ext. 8700 or email:  shcnurse@richmond.edu.)
  • INH is a prescription medicine available at local pharmacies for $4-$15/month.  It may be delivered to the SHC from Ukrop's Pharmacy.
  • Do not drink alcohol while taking this medicine.
  • Take a daily multivitamin (with 10-50 mg Pyridoxine Hydrochloride).
  • Take with food (if medicine causes stomach upset) one to two hours before bedtime.
  • Do not miss doses.  If you miss a dose, take it as soon as possible.  However, if it is almost time for your next dose, skip the missed dose.  Do not double-up on doses.
  • Contact a healthcare provider if you develop any of the symptoms listed above (potential side effects of INH).  You may need a blood test to check your liver function.
  • If symptoms of TB disease occur prior to finishing the full course of preventative treatment, see your healthcare provider as soon as possible.  The symptoms of TB are:
  1. Productive cough (yellow, green, or brown/blood-tinged) lasting longer than  3 weeks; shortness of breath
  2. Loss of appetite, unintentional weight loss over several months
  3. Fever during the day, night sweats, chills
  4. Excessive fatigue 


If you decide not to take the preventative medication for LTBI, you must contact a healthcare provider immediately if you develop any symptoms of TB disease.

The following form is intended for use only by students who are prescribed INH by the Student Health Center physicians.  Please print the form, complete it, and return it to the Student Health Center by campus mail or in person during our regular business hours.  If you have any questions about your treatment, please call the SHC Dial-A-Nurse at 289-8700 (or x 8700 on campus).

Print this form:   INH Treatment Monitoring

For more information, call 289-8700 for Dial-A-Nurse.