Tuberculosis (TB) can attack many different parts of the
body, but in developed countries, it is usually found in the lungs. For that
reason only the lung, or pulmonary, form of the disease will be discussed
As always, this information is provided for educational
purposes only. See your health care provider for your personal medical needs.
Tuberculosis or TB was very common in this country
before antibiotics were developed. At that time, it was called Consumption
and was a major cause of death. It is still a common cause of death in
developing countries. It is caused by the tiny, slow growing bacteria
Mycobacterium tuberculosis. The bacteria lodges in
the lungs and can become active immediately or wait months or years to emerge
as an active infection. It is terminal if left untreated.
TB is one of the few diseases that are spread in the air
from the sick person coughing or breathing. The bacteria ride in the air as
tiny droplets that may stay airborne for hours. It is spread by inhaling
these droplets. Because of this, patients with known TB must have special
Active infections of TB can come from a new exposure to
the bacteria or from reactivation of the disease from an old exposure. People
with weak immune systems are more likely to have active TB. This would
include the elderly, children, people with HIV/AIDS, people with diabetes, or
anyone who has been “worn down” from lack of sleep or lack of
TB will be difficult, if not impossible, to treat in TEOTWAWKI situation. The best course is prevention.
Encourage everyone in your party to be screened annually for TB. The test is
cheap and easy. If someone in your group has been exposed, REQUIRE them to go
through the full course of treatment, which can take up to 9 months. Put
refugees through a period of quarantine to make sure you’re not
infecting the group.
Diagnosis of TB is next to impossible without labs and
x-rays. It shares symptoms with many other respiratory infections. Since TB
is not extremely common in this country at this time, suspect other problems
before you suspect TB.
1) Presence of signs and
2) Treatment for other respiratory infections has not cleared the problem.
3) The following would increase your suspicion of TB:
___a) History of exposure to someone with active TB.
___b) History of previous active TB.
___c) History of a positive TB test (also called a PPD
test or a Mantoux test) in the past.
___d) History of travel to a country where TB is common (most third world
___e) History of working/living in a high-risk area: hospital, nursing home,
prison, group home, drug treatment center, refugee camp, etc.
Signs and Symptoms
Pulmonary TB is often so nearly asymptomatic (showing no
signs or symptoms) that the patient may deny all symptoms except "not
Cough that does not go away is
the most common symptom. The patient often ignores it and attributes it to
smoking or a cold. The sputum (the junk that’s coughed up) is yellow or
green. At first, this is just a small amount first thing in the morning, but
becomes more productive as the disease progresses.
Dyspnea (shortness of breath) may result from
damage to the lung by the bacteria.
Hemoptysis (coughing up blood) usually does not
occur until the later stage of TB
Unexplained weight loss
Night sweats from a fever that spikes up at night and is down during the day.
The drugs used to treat TB are expensive, specialized,
and very hard to get. They also must be given daily for a period of 6 to 9
months. Chances are they’ll only be available in the unlikely event
that your retreat is a pharmacy. Use supportive, non-drug treatment until
advanced medical help is available. If not available, use of supportive and
eventually palliative care will be your most likely option.
Treatment can be complicated by the presence of strains
(particular “families” of the bacteria) that have grown resistant
to the antibiotics used to treat TB.
If not drug resistant:
300mg one by mouth once a day for 9 months
[and] rifampin 600mg one by mouth once a day for 9
[WITH] pyridoxine (Vitamin B6) 25mg by mouth once a day for 9 months
(a combination drug with Isoniazid 150mg and rifampin 300mg) two by mouth once a day for 9 months.
Take on an empty stomach.
[WITH] pyridoxine (Vitamin B6) 25mg one by mouth once a day for 9 months.
For known drug resistant strains of TB:
(INH) 300mg one by mouth once a day for 6 months
[and] Rifampin 600mg one by mouth once a day for 6
[and] ethambutol 15mg/kg one by mouth once a day
for 2 months
[and] pyrazinamide 25mg/kg one by mouth once a day
for 2 months (max 2.5g/d)
[WITH] pyridoxine (Vitamin B6) 25mg by mouth once a day for 6 months.
isolation as listed below.
2)Supplemental oxygen (if available) to treat
shortness of breath.
3)Keep head of bed raised to treat shortness of
4)Maintain nutritional intake to support the body's
fight with the infection.
5)Acetaminophen/Tylenol, ibuprofen/Advil, or aspirin
for fever control.
6)Encourage rest. The body needs energy to fight the
Patients with active TB require respiratory isolation in
addition to standard infection control precautions to prevent spread of the disease.
1) Patient remains in a room
alone or only with others with active TB.
2) Patient is taught to cover mouth and nose at all times when coughing or
3) Room should have negative pressure (pulls air FROM the rest of the
building, exhausts it outside where others won’t be breathing) if
available, or a separate building or shelter,
4) Caregivers wear properly fitted HEPA masks when
entering patient room.
5) Caregivers use good hand washing after care.
6) Patient should wear a HEPA mask WITH NO
EXHALATION VALVE when in common areas.
If antibiotic treatment is available, the patient can
usually be taken off respiratory isolation after 2 weeks of treatment.
ePocrates qID database http://www.epocrates.com/
ePocrates qRx database http://www.epocrates.com/
The Merck Manual http://www.merck.com/
Infection Prevention and Safe Practice; Schaffer,
Garzon, Heroux, and Korniewicz. 1996, Mosby