Tuberculosis (TB)

Overview

Tuberculosis, often called TB, is an infection caused by bacteria. It most often affects the lungs, but can also affect other parts of the body like the kidneys, spine, or brain. TB is spread through the air when a person with active TB in their lungs coughs, sneezes, or talks. Not everyone infected with TB bacteria becomes sick — many people have 'latent' TB, which means the bacteria are in their body but not causing symptoms and they cannot spread it to others.

TB is not very common in the UK, but it is still a serious health problem worldwide. The UK sees around 4,000 to 5,000 cases each year, mostly in large cities and among certain groups of people.

TB can affect anyone of any age. You are at higher risk if you have a weakened immune system (for example, due to HIV, diabetes, or some medications), if you live with or spend a lot of time with someone who has active TB, if you were born or lived in a country with high rates of TB, or if you live or work in crowded or poorly ventilated spaces.

Symptoms

Common symptoms

• A cough that lasts for more than three weeks
• Coughing up blood or phlegm
• Chest pain or pain when breathing or coughing
• Unexplained weight loss
• Fever or chills
• Night sweats
• Feeling very tired or weak
• Loss of appetite

Symptoms in children

• Coughing that doesn’t go away
• Weight loss or poor growth
• Fever
• Swollen glands
• Feeling unusually tired

Symptoms in older adults

• Symptoms may be less noticeable, such as a mild cough, tiredness, or lack of appetite.
• Weight loss often stands out.
• Confusion or changes in mental state can sometimes happen.
• Fever and night sweats may be less common than in younger people.

Causes

Main causes

• TB is caused by bacteria called Mycobacterium tuberculosis.
• It spreads through the air when a person with active TB of the lungs coughs, sneezes, laughs, or talks.
• The bacteria are inhaled into the lungs of another person, where they can start an infection.
• In most people, the immune system fights the bacteria and stops them from multiplying, leading to latent TB. In others, the bacteria become active and cause symptoms.

Risk factors

• Having a close contact with active TB, such as a family member or colleague
• Weakened immune system due to HIV, diabetes, kidney disease, cancer treatment, or long-term use of steroids
• Living or working in crowded, poorly ventilated places
• Being from a country where TB is common (parts of Africa, Asia, Eastern Europe, and Latin America)
• Being a health care worker who treats people with TB
• Smoking or heavy alcohol use
• Homelessness, shelter living, or incarceration

When to see a doctor

See a doctor urgently if:

• If you have a cough that lasts more than three weeks
• If you cough up blood or blood-stained phlegm
• If you have a fever, night sweats, and unexplained weight loss
• If you have been close to someone with active TB and develop any symptoms

Book a routine appointment if:

• If you have been in close contact with someone diagnosed with active TB (even without symptoms)
• If you have a health condition that weakens your immune system and you are worried about TB
• If you are going to live or work in a country with high TB rates and want to know about prevention

Diagnosis

To diagnose TB, your doctor will ask about your symptoms, travel history, and any contact with people who have TB. They will also do tests to check if TB bacteria are in your body and whether the infection is latent or active.

Tests that may be done

• Mantoux test (TB skin test) — a small amount of fluid is injected into the skin of your arm to see if your immune system reacts
• Blood test (IGRA) — a blood sample is tested for TB infection
• Chest X-ray — looks for signs of TB in the lungs
• Sputum test — a sample of phlegm (mucus coughed up from the lungs) is checked for TB bacteria
• CT scan or other imaging if TB might be in other parts of the body

What to expect at your appointment

If your doctor thinks you have active TB, you may be asked to stay at home or in a hospital room until you are no longer contagious (usually two weeks after starting effective treatment). The tests themselves are not painful, though the skin test may cause a small bump. Results can take a few days to a few weeks. Your doctor will explain everything clearly and support you through the process.

Treatment

TB is treated with a combination of antibiotic medicines taken every day for several months. It is important to take all the medicine exactly as prescribed and for the full duration — even if you start to feel better. Stopping early can make the bacteria resistant to the drugs, which makes TB much harder to treat. With proper treatment, most people are cured.

Self-care at home

• Take all medicines exactly as prescribed, at the same time each day.
• Get plenty of rest to help your body fight the infection.
• Eat a balanced diet with enough calories to prevent or reverse weight loss.
• Cover your mouth and nose when you cough or sneeze, and avoid close contact with others until you are no longer contagious.
• Avoid alcohol and smoking, as these can make treatment less effective and harm your lungs.

Medical treatments

Treatment for TB involves a course of antibiotic tablets taken daily. The standard regimen typically lasts six months, with a combination of medicines for the first two months and a smaller combination for the remaining four months. A healthcare worker may watch you take your medicine to make sure you complete the treatment (this is called directly observed therapy, or DOT). For drug-resistant TB, treatment may take longer and involve different medicines. Your doctor will decide the best plan for you.

When is surgery considered?

Surgery is rarely needed for TB. In very rare cases, it may be used to remove damaged areas of the lung or to drain fluid from around the lungs that does not respond to medicines.

Living with this condition

Life during TB treatment requires some adjustments. You may need to stay away from work or school for the first two to four weeks to avoid spreading the infection. After that, while you are no longer contagious, you still need to take your medicine every day and see your doctor regularly. It can be tiring, but most people return to their normal routine gradually.

Lifestyle tips

• Take your medicines at the same time each day — set alarms or use a pillbox.
• Avoid alcohol and recreational drugs, as they can interfere with treatment.
• Do not smoke — smoking worsens lung damage and slows recovery.
• Get enough sleep and listen to your body; rest when you feel tired.
• Keep follow-up appointments with your TB clinic or doctor.

Diet and exercise

Eat a healthy, balanced diet with plenty of protein, fruits, vegetables, and whole grains to help your body repair and regain strength. You may need extra calories if you have lost weight. Light exercise like walking can help you regain energy, but avoid pushing yourself too hard. Talk to your doctor about what level of activity is safe for you.

Mental health and emotional wellbeing

Being diagnosed with TB can feel overwhelming. The long treatment, need to isolate, and possible stigma may cause anxiety or depression. It is normal to have these feelings. Talk to your doctor or a mental health professional if you are struggling. You are not alone, and support is available.

Prevention

Yes, TB can often be prevented. The most important step is avoiding exposure to people with active TB. If you have latent TB, treatment can prevent it from becoming active. Good ventilation, covering coughs, and wearing masks in high-risk settings also help. Strengthening your immune system with a healthy lifestyle can reduce your risk.

Vaccines

There is a vaccine for TB called BCG. In the UK, it is given to babies and children at high risk of TB, and sometimes to older children and adults who have not been vaccinated and are at risk. The vaccine does not completely prevent TB, but it helps protect against severe forms of the disease, especially in children.

Screening programmes

Screening is available for people who have been in close contact with someone with active TB. This involves a test to check for latent infection. If found, treatment can be given to stop it from becoming active. Some workplaces and people traveling to high-risk areas may also be offered screening.

Complications

If left untreated

• TB can spread within the lungs, causing more damage and making breathing harder.
• The infection can spread to other parts of the body, such as the kidneys, spine, brain, or lymph nodes.
• TB in the brain (meningitis) can cause severe headaches, neck stiffness, confusion, and can be life-threatening.
• Drug-resistant TB can develop if treatment is not completed, making it much harder to treat.
• Untreated active TB can be fatal.

Long-term outlook

The outlook for TB is very good with proper treatment. Most people with active TB are cured within six months. Even drug-resistant TB can often be treated successfully with longer, more complex treatment. Early diagnosis and completing the full course of medicine are the keys to a full recovery. With today’s treatments, TB is no longer the deadly disease it once was. Help is available, and people do get better.

Find support

International organisations

• World Health Organization (WHO) — TB ↗
• Stop TB Partnership ↗

Local organisations

• TB Alert (UK) ↗ · United Kingdom

Helplines

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