Outbreak 2025: Tuberculosis

Outbreak 2025: Tuberculosis

By: Lisa Mathis FNP-BC

The outbreak of Tuberculosis (TB) in Kansas has been a cause for concern. Sixty-seven people are being treated for active TB and another 79 are diagnosed with latent TB. “We would expect to see a handful of cases every year, “said Dr Dana Hawkinson, an infectious disease doctor at the University of Kansas Health System, but the high case counts in this outbreak were a “stark warning.” (1) There are two recorded deaths since onset of outbreak.   TB is highly contagious with droplet spread when an infected person speaks, coughs, laughs, or even sings.  TB is a leading cause of infectious disease death worldwide and with a noted recent increase in cases. (1) 

In 2023, TB was responsible for the deaths of 1.25 million people globally and infected 8 million, the highest count since the World Health Organization (WHO) began disease surveillance. (1) TB numbers are rising in the U.S. due to a variety of factors. For example, increase immigrants from TB endemic countries and multi-drug-resistant TB. 

A person can have inactive or active TB. Not everyone infected with TB germs becomes ill. However, even if a patient is not ill, they should be treated due to the fact inactive TB can ultimately become active TB with symptoms.   Currently the Bacillus Calmette-Guérin (BCG) vaccine is available for TB but is not offered in the US due to the low numbers and the low risk of infection to US citizens.    

Providers can sometimes become complacent over a cough or a mild pneumonia, but an accurate history and physical is imperative when an outbreak such as TB is on the rise. Ask about any recent travel, immigration, exposure to someone who has traveled or immigrated, illness in family members, and night sweats in patients presenting with cough.  

An active TB patient must be kept in isolation for the first few weeks of illness and reported to the local health department. Treatment for active TB can take four, six, or nine months depending on the treatment plan, which will be determined by Infectious disease and pulmonary medicine. TB may be treated with different combinations of Ethambutol, Isoniazid, Moxifloxin, Rifampin and Rifapentine. (2) The most effective treatment plan is Directly Observed Therapy (DOT) or observing the patient taking medications to ensure compliance. This can result in a prolonged hospital stay for some patients. Financial and emotional support is imperative in this patient population.   

Patients are considered no longer infectious after 3 negative sputum samples and completion of 2-3 weeks of DOT therapy. Symptoms should quickly begin improving after the start of treatment. (3) 

Do not discount cough and fever as just CAP or bronchitis in the patient with recent travel. We can make a difference through preventing misdiagnosis. 

 Sometimes it is ok to look for that ZEBRA! 

“ To live is to suffer, to survive is to find some meaning in the suffering.” Nietzsche 

1-The Tuberculosis outbreak in Kansas is alarming. It is not the biggest in US history though, the CDC says. https://apnews.com/article/tuberculosis-tb-outbreak-kansas-largest-b6b58f4f5461abb430745e3a8e7dc758 

2-Treatment of TB. https://www.cdc.gov/tb/topic/treatment/tbdisease.htm 

3-Infection- TB https://globaltb.njms.rutgers.edu/abouttb/infection.php#:~:text=Patients%20who%20have%20been%20receiving,such%20as%20homes%20or%20worksites.