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Tuberculosis (TB) is a bacterial infection. It is spread through inhaling tiny droplets of saliva from the coughs or sneezes of an infected person.
TB mainly affects the lungs. However, the infection can spread to many parts of the body, including the bones and nervous system.
Typical symptoms of TB include:
See Tuberculosis - symptoms for more information.
The bacteria responsible for TB are very slow moving, so TB develops slowly in the body. You may not experience any symptoms for many months or even years after being infected.
What happens if you are infected?
Three things can happen if you are infected with TB:
Latent TB could develop into an active TB infection at a later date, particularly if your immune system becomes weakened.
If it is not treated, an active TB infection can be fatal. It can damage the lungs to such an extent that a person cannot breathe properly.
With treatment, a TB infection can usually be cured. Most people will need to take a long-term course of antibiotics, which usually lasts for at least six months. See Tuberculosis - treatment for more information.
However, TB can sometimes be fatal even with treatment.
The Bacillus Calmette-Guérin vaccine, also known as the BCG vaccine, can protect against TB. The BCG vaccine provides effective protection against TB in up to 8 out of 10 of people who are given it.
BCG vaccinations are not routinely given as part of the childhood vaccination schedule, unless a baby is thought to have a higher than normal risk of coming into contact with TB.
For example, babies born in areas of inner-city London, where TB rates are higher than in the rest of the country, will probably be given the BCG vaccination.
Vaccinations may also be recommended for people who have an increased risk of developing a TB infection. This includes health workers who may be exposed to TB and children who have recently arrived in the UK from countries that have high levels of TB.
See Tuberculosis - prevention for more information about the BCG vaccination.
How common is TB?
Before antibiotics were introduced, TB was a major health problem in the UK. Nowadays, the condition is much less common. However, in the last 20 years TB cases have gradually increased, particularly among ethnic minority communities originally from places where TB is widespread.
In 2009, 9,040 cases of TB were reported in the UK. Most of these occurred in urban centres, with over one-third of cases in London. Globally, TB remains a major public health problem. There were 9.4 million new cases of TB in 2009, and 1.7 million deaths from the condition.
Countries with high numbers of HIV cases also often have high numbers of TB cases. This is because HIV weakens a person’s immune system, which means they are more likely to develop a TB infection.
It is also estimated that one-third of the world’s population is infected with latent TB. Up to 1 in 10 of people with a latent TB infection (but who do not have HIV) will develop active TB at some point.
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Tuberculosis (TB) will not cause any symptoms until the infection has reached the lungs. As the bacteria are very slow moving, the condition develops very slowly. Your symptoms might not begin until many years after you were initially exposed to the bacteria.
Pulmonary tuberculosis (TB)
A TB infection of the lungs is known as pulmonary TB. In the UK, just over half of the TB cases in 2009 were pulmonary TB.
Symptoms of pulmonary TB include:
When to get medical help
Always see your GP if you have a cough that lasts for more than three weeks or if you cough up blood.
Extrapulmonary tuberculosis (TB)
In some cases, a TB infection can spread from the lungs to other parts of the body. TB infections that occur outside the lungs are known as extrapulmonary TB.
Extrapulmonary TB is more common in people with weakened immune systems (the body’s natural defence against infection and illness), particularly people with an HIV infection.
A TB infection can spread to:
These types of extrapulmonary TB can cause additional symptoms, which are described below.
Lymph node TB
Lymph nodes are small, oval glands that are part of the immune system. They remove unwanted bacteria and particles from the body. Symptoms of lymph node TB include:
Symptoms of skeletal TB include:
Symptoms of gastrointestinal TB include:
Symptoms of genitourinary TB include:
Central nervous system TB
Your central nervous system consists of your brain and spinal cord. Symptoms of central nervous system TB include:
Tuberculosis (TB) is caused by a type of bacterium called mycobacterium tuberculosis.
TB is spread when a person with an active TB infection in their lungs coughs or sneezes and someone else inhales a droplet of contaminated saliva.
However, although it is spread in the same way as a cold or the flu, TB is not as contagious. You would usually have to spend around eight hours in close contact with an infected person before you developed a TB infection yourself.
For example, TB infections usually spread between family members who live in the same house. It would be highly unlikely to become infected by sitting next to an infected person on a bus or train.
Risk factors for TB
Anyone can catch TB, but people who are particularly at risk include:
The known risk factors for an active TB infection include:
Several tests are used to diagnose tuberculosis (TB). The test you have will depend on the type of TB that is suspected. Your GP may refer you to a TB specialist if they think that you have TB.
A diagnosis of pulmonary TB (TB that affects the lungs) can usually be confirmed with a chest X-ray. This uses high-energy radiation to create an image of your lungs. If you have a TB infection, changes to the appearance of your lungs, such as scarring, should be visible on the X-ray.
Samples of mucus and phlegm will also be taken and checked under a microscope for the presence of TB bacteria.
If you have suspected extrapulmonary TB (TB that occurs outside the lungs), several tests can be used to confirm a diagnosis. These include:
You may also have a lumbar puncture. This involves taking a small sample of cerebrospinal fluid from the base of your spine. Cerebrospinal fluid is a clear fluid that surrounds and supports the brain. The cerebrospinal fluid will be checked to see whether TB has infected your central nervous system.
Screening for latent TB
In some circumstances, you may need to be screened to check for a latent TB infection. This is when you have been infected with the TB bacteria but you do not have any symptoms.
For example, you may need to be screened if you have been in close contact with someone who is known to have an active TB infection, or if you have recently spent time in a country where TB levels are high.
If you have just moved to the UK from a country where TB is common, you may be screened when you arrive or your GP may suggest screening when you register as a patient.
If you need to be screened for TB, you may be referred to Public Health Wales. Public Health Wales helps protect health in Wales by providing support and advice to organisations such as the NHS. They have offices across Wales and may be your point of contact if you are involved in an outbreak of TB or need to be screened. See the Public Health Wales website for more information about how they are involved in cases of TB.
The Mantoux test is a widely used test for latent TB. It involves injecting a substance called PPD tuberculin into the skin of your forearm.
If you have a latent TB infection, your skin will be sensitive to PPD tuberculin and a hard red bump will develop at the site of the injection, usually within 48 to 72 hours of having the test. If you have a very strong skin reaction, you may need to have a chest X-ray to confirm whether you have an active TB infection.
If you do not have a latent infection, your skin will not react to the Mantoux test. However, as TB can take some time to develop, you may need to be screened again within a year.
If you have had the Bacillus Calmette-Guérin (BCG) vaccination, you may have a mild skin reaction to the Mantoux test. This does not mean that you have latent TB, but that your immune system (the body’s natural defence against infection and illness) recognises the TB.
Interferon gamma release assay (IGRA)
The interferon gamma release assay (IGRA) is a newer type of blood test for TB that is becoming more widely available.
The IGRA may be used to help diagnose latent TB:
Several medicines are used to treat tuberculosis (TB). Treatment usually lasts at least six months.
If you are diagnosed with active pulmonary TB (TB that affects your lungs), you will probably be referred to a TB treatment team. This is a team of healthcare professionals with experience in treating TB.
Your TB treatment team may include:
It is also likely that you will be assigned a key worker. This is usually a nurse or a health visitor who will be the point of contact between you and the rest of the team and will help co-ordinate your care.
Pulmonary TB is treated using a six-month course of a combination of antibiotics. The usual course of treatment is:
After taking the medicine for two weeks, most people are no longer infectious. However, it is very important to take your medicine exactly as prescribed and to complete the whole course of antibiotics.
It may be several weeks or months before you start to feel better. The exact length of time will depend on your overall health and the severity of your TB.
Taking medication for six months is the most effective method of ensuring that both the active and dormant TB bacteria are killed. The active bacteria are responsible for causing your current TB infection, but the dormant bacteria could become active in the future, so must also be killed.
If you stop taking your antibiotics before you complete the course, or if you skip a dose, the TB infection may become resistant to the antibiotics. This is potentially serious and can be difficult to treat. See Tuberculosis - complications for more information about drug-resistant tuberculosis.
Extrapulmonary TB (TB that occurs outside the lungs) can be treated using the same combination of antibiotics as those used to treat pulmonary TB. However, you may need to take a 12-month course, rather than a six-month course.
If you have TB that affects your brain or heart, you may also be prescribed a corticosteroid, such as prednisolone, to take at the same time as your antibiotics. You will need to take the corticosteroid for several weeks.
As with pulmonary TB, it is very important to take your medicines exactly as prescribed and to finish the course.
Latent TB is where you have been infected with the TB bacteria but you do not have any symptoms. Treatment for latent TB is usually recommended for:
Treatment is not recommended for people who have latent tuberculosis and are over 35 years of age (and do not have HIV and are not healthcare workers). This is because the risk of liver damage increases with age and the risks of treatment outweigh the benefits for some people.
In some cases, treatment for latent TB may be recommended for people taking immunosuppressant medication. This medication suppresses the immune system (the body’s natural defence against illness and infection) and can make active TB more likely. This could include people taking long-term corticosteroids or people receiving chemotherapy.
Treatment for latent TB involves either taking a combination of rifampicin and isoniazid for three months, or isoniazid on its own for six months.
Side effects of treatment
Rifampicin can reduce the effectiveness of some types of contraception, such as the combined contraceptive pill. Use an alternative method of contraception, such as condoms, while taking rifampicin.
In rare cases, these antibiotics can cause damage to the liver or the eyes, which can be serious. Therefore, your liver function may be tested before you begin treatment. If you are going to be treated with ethambutol, your vision may also be tested.
Contact your TB treatment team immediately if you have any of the following symptoms:
See Medicines information to find out more about the side effects of your medication.
Sometimes people find it difficult to take their medication every day. If this affects you, your treatment team can work with you to find a solution.
This can include supervised treatment, which will involve regular contact with your treatment team (daily or three times a week) to support you taking your medication. This can take place in your home, the treatment clinic or somewhere else more convenient.^^ Back to top
Antibiotic-resistant tuberculosis (TB)
Like most bacteria, mycobacterium tuberculosis can develop a resistance to antibiotics. Antibiotic resistance means that the medicines can no longer kill the bacteria they are meant to fight.
Tuberculosis (TB) that develops a resistance to one type of antibiotic is not usually a concern because alternative antibiotics are available. In 2009, about 8 out of 100 cases of TB were resistant to at least one type of antibiotic normally used to treat the condition.
However, in an increasing number of cases:
In 2009, just over 1 out of every 100 cases of TB was resistant to at least two antibiotics.
Both MDR-TB and XDR-TB will usually require treatment for around 18 months using a combination of different antibiotics. As these conditions are difficult to treat, you may be referred to a specialist TB clinic for treatment and monitoring.
Preventing the spread of infection
If you are diagnosed with pulmonary tuberculosis (TB), which affects the lungs, you will be contagious until you have received treatment for two to three weeks.
You will not need to be isolated during this time, but it is important to take some basic precautions to stop TB spreading to your family and friends. These precautions are:
For most people, the Bacillus Calmette-Guérin (BCG) vaccination provides protection against TB. However, the BCG vaccine is not usually offered to people over 35 years of age. This is because there is little evidence that it provides protection for these people.
Before you have a vaccination, you will be given a Mantoux skin test (see Tuberculosis - diagnosis) to check whether you have latent TB. Latent TB is where you have been infected with the TB bacteria but do not have any symptoms. Vaccination is not recommended for people with latent TB because it will have no benefit and could cause unpleasant side effects.
The BCG vaccination is recommended for all babies up to one year old who:
The BCG vaccination is also recommended for children under 16 years of age who:
The BCG vaccination is recommended for people under 35 years of age whose occupation puts them at increased risk of exposure to TB. These people include:
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