Tuberculosis (TB) was a leading cause of death in the United States until the 1940s, when antibiotics were developed that could effectively kill the bacteria that cause the disease (Mycobacterium tuberculosis). However, since the early 1980s, strains of the bacteria that are resistant to available drugs have developed, and tuberculosis has again become a major public health problem.

Mycobacterium tuberculosis (or M tuberculosis) is easily spread by coughing, sneezing, laughing, or singing but generally does not cause disease without repeated exposure. However, you can be infected with tuberculosis without having the active disease. This type of infection produces no symptoms and is known as a latent infection. Infection, with or without the active disease, results in a positive TB (or tuberculin) skin test.

Although anyone can contract tuberculosis, certain groups of people are at higher risk. This includes homeless people, poor and medically underserved people, prisoners, nursing home residents, intravenous drug users, people with alcoholism, people with HIV infection, people with AIDS, and people with any disease that reduces the effectiveness of their immune system. People who are in regular contact with at-risk populations are also more likely to become infected. People from countries with high rates of tuberculosis may bring the infection with them when they emigrate.

Active tuberculosis disease may produce no signs or symptoms other than a vague feeling of being ill. Sometimes the infection causes a cough that persists for more than 2 weeks and may produce bloody mucus. Other symptoms may include chest pain, difficulty breathing, fever, night sweats, fatigue, loss of 253

appetite, and weight loss. Lungs

Because a latent infection with tuberculosis produces no symptoms, a person may be infected for years without realizing it. The infection may be discovered only after the person is examined or treated for another disease or through a routine screening with the tuberculin skin test.

Active tuberculosis is diagnosed with a chest X ray and microscopic examination and cultures of sputum samples expelled from the lungs. The tuberculin skin test is used both to screen people at risk for active tuberculosis and to identify people with a latent infection.

Treatment depends on factors such as whether the TB is active or inactive, whether it has spread to other tissues, or whether the person has been treated for TB previously. Two or more antibiotics (such as isoniazid and rifampin) are given together daily for at least 6 to 9 months; some drug combinations can be given daily for the first month and then twice a week for an additional 8 months, although in some cases, treatment must continue for years. Warning: If the drug therapy is not strictly followed, the bacteria may mutate and become resistant to the drugs being used. If you do not take the drugs exactly as prescribed, you could have very serious problems.

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