Tuberculosis (TB)

Key points

• Tuberculosis (TB) is a bacterial infection.
• There are two forms of tuberculosis: TB affecting the lungs; and TB causing infection elsewhere in the body, including the glands, bones and nervous system.
• Extrapulmonary tuberculosis (where pulmonary or laryngeal disease has been excluded) does not require transmission-based precautions, however, if undertaking a procedure(s) on a lesion while the patient is considered infectious, a risk assessment should be completed to determine appropriate patient placement and use of respiratory protective equipment (RPE).
• If the patient has symptoms, this is called active TB.
• If the patient does not have symptoms, this is called latent TB. In some cases, after infection the bacteria can remain latent in the body for a long time (even lifelong), causing no symptoms of disease. Individuals with latent TB infection are not infectious; however, under favourable conditions, for example, immunosuppressed, the bacteria can start multiplying (reactivate) and cause clinical disease.

Symptoms

• Typical symptoms can include extreme tiredness or fatigue, loss of appetite or weight, night sweating and fever.
• Additional symptoms for pulmonary TB include increasing breathlessness and a persistent productive cough lasting more than 3 weeks, which may be bloody.
• Additional symptoms of extrapulmonary TB vary but may include persistently swollen glands, abdominal pain, pain and loss of movement in an affected bone or joint, confusion, persistent headache and seizures.

Incubation period

• Between 14 and 70 days.
• Immunocompromised individuals may have a shorter incubation period.
• Those with Latent TB infections may never develop TB disease.

Period of infectivity

• While symptomatic and for 2 to 4 weeks after starting antibiotic treatment.
• While viable bacilli are discharged in sputum.

Treatment for TB

Standard anti, TB treatment consists of a combination of 4 different antibiotics, usually taken daily for a minimum 6-month period

Multidrug-resistant tuberculosis (MDR TB) and extensively drug resistant tuberculosis (XDR TB)

These are difficult to treat. Advice will be given by the TB nurse specialist or chest physician.

IPC precautions

• Single room isolation with door closed on suspected or confirmed smear positive pulmonary or laryngeal TB. Community patients will be encouraged to remain at home whilst infectious.
• Follow standard precautions for Extrapulmonary Tuberculosis (where pulmonary or laryngeal disease has been excluded).
• Follow transmission-based precautions for airborne spread if undertaking a procedure(s) on a lesion while the patient is considered infectious.
• FFP3 masks or Hoods for routine care and aerosol generating procedures (AGPs).
• Treat linen as contaminated (red alginate bag) and waste as infectious (orange waste bag).
• Decontamination of the environment in hospital, use a cleaning and disinfection product for example, chlor-clean (1,000 ppm) at least once a day.
• Decontamination of medical devices or equipment in hospital and community, use a high-performance disinfectant for example, Clinell peracetic acid wipes.
• The TB specialist nurse or chest physician can give specialist advice for the individual patient:
  • Email Doncaster: rdash.tb-nursing-service@nhs.net
  • Email Rotherham: rgh-tr.rotherhamtbnursingservice@nhs.net
  • Phone North Lincolnshire: 03033 302739
• Notify the IPC team of any confirmed inpatient cases:
  • Phone: 03000 214872
  • Email: rdash.ipcteam@nhs.net

Page last reviewed: August 27, 2024
Next review due: August 27, 2025