TB disease
TB is a disease caused by a bacteria that is spread through the air from person to person. Although TB most often affects the lungs, it can affect any part of the body including lymph nodes, bones, kidneys and the brain. TB can cause very severe illness, and it can be fatal. Fortunately, TB can be prevented, treated, and cured.
Symptoms
Symptoms of TB can include fever, weight loss, night sweats, and fatigue. When TB affects the lungs, airway or pleural space, symptoms can also include a cough that lasts more than 2 to 3 weeks, coughing up blood, and chest pain. If you have any of these symptoms you need to see a doctor.
Populations at risk
TB can infect anyone who lives, works, or breathes in close proximity to someone with infectious TB disease, regardless of their age, race, sex, or socioeconomic status. Over 90 percent of patients with TB disease in Santa Clara County were born outside of the U.S., though most have lived in the U.S. for more than 5 years. In Santa Clara County, the majority of cases occur among people born in Vietnam, the Philippines, India or China.
90 percent of people who breathe in the TB bacteria do not develop TB disease, but rather control the germs and have latent TB infection (LTBI). Since 5 to 10 percent of people develop TB disease (50 percent in the first two years, the rest over the patient’s lifetime), it is appropriate to treat LTBI for patients at risk of progressing to TB disease.
For more information on TB, download the 2024 Tuberculosis Fact Sheet.
Screening
The California Department of Public Health, US Preventive Services Task Force (USPSTF) and the American Academy of Pediatrics recommend serially screening people for risk of TB infection or disease. TB testing should only be performed for those who were born in or lived in countries with increased TB disease prevalence, who were exposed to an individual with TB disease, who have comorbidities which put them at risk for progression to TB disease and persons who have lived in high-risk congregate settings. These include homeless shelters or correctional facilities. See links to risk assessment tools below.
Short-course LTBI regimens (rifampin daily for 4 months, isoniazid (INH) and rifampin daily for three months and once weekly INH and rifapentine) have similar efficacy and higher treatment completion rates as compared with 9 months of daily INH and are recommended for most LTBI patients.
Treatment regimens for LTBI
1. 12- dose Weekly Isoniazid/Rifapentine Regimen (3HP) (3HP CDPH Fact Sheet)
- Isoniazid 2-11 years old: 25 mg/kg rounded up to nearest 50 or 100 mg (max. 900 mg) ≥ 12 years old: 15 mg/kg rounded up to nearest 50 or 100 mg (max. 900 mg)
- Rifapentine 10.0-14.0 kg: 300 mg 14.1-25.0 kg: 450 mg 25.1-32.0 kg: 600 mg 32.1-50.0 kg: 750 mg >50 kg: 900 mg
- Vitamin B6 50 mg weekly
This regimen is not recommended for pregnant women, children under 2 years-old, HIV-positive patients on antiretroviral medications, or individuals exposed to a person with INH or RIF-resistant TB.
2. Rifampin- Daily for 4 months. (Rifampin CDPH Fact Sheet)
Adults: 600 mg; Children: 15 - 20 mg/kg (max. 600 mg)
3. Isoniazid and Rifampin - Daily for 3 months. (CDC Fact Sheet)
Children: Isoniazid 10-20 mg/kg (300 mg maximum) Rifampin 15- 20 mg/kg; (600 mg maximum)
4. Isoniazid 10 mg/kg - Daily for 9 months. (Isoniazid CDPH Fact Sheet)
(range, 10-15 mg/kg; max. 300 mg) Recommended pyridoxine dosage is 25 mg for school-aged children (or 1-2 mg/kg/day)
For patients treated with an isoniazid-containing regimen, daily vitamin B6 (pyridoxine) supplementation (25 mg) recommended for patients with other conditions associated with neuropathy (diabetes, HIV, chronic renal failure, alcoholism) or who are pregnant or breastfeeding. For children receiving vitamin B6, the recommended dosage is 6.25 mg for infants, 12.5 mg for toddlers, and 25 mg for school-aged children (or 1-2 mg/kg/day).
For more information, please see the LTBI Clinical Guidelines and California Adult Tuberculosis Risk Assessment. For pediatrics, refer to the LTBI Guidelines 2018 Revision.
