Tuberculosis (TB): Practice Essentials, Background, Pathophysiology

North Carolina High School Sees Case Of Tuberculosis: Here's Where, What To Know

A month after a Western North Carolina individual was diagnosed with tuberculosis, news outlets are reporting on another case in Wake County.

ABC reported Sept. 8 that a case of TB was present in Wake County's Leesville High School in the last week. The North Carolina Department of Health and Human Services is working to identify and inform any individuals who may have come in close contact with the infected person.

Here's what else to know about tuberculosis, its presence in North Carolina and more.

Is there a tuberculosis outbreak in NC?

While there have been over 100 cases of TB so far in 2025, the NCDHHS has not reported an outbreak of the disease.

In 2024, the U.S. Centers for Disease Control reported a total of 250 cases of tuberculosis throughout the state of NC, a 15% increase from 2023's 215 cases and the highest count reported since 2010. NC's rate of tuberculosis cases in 2024 was 2.3 cases per 100,000 residents.

Which U.S. State has the highest rate of tuberculosis?

In 2024, California had the highest number of tuberculosis cases, 2,100 in total. However, Alaska had the highest overall rate of TB cases, with 94 cases among its roughly 740,000 residents. The CDC places the TB rate at 12.7 in Alaska, compared to California's rate of 5.3.

What is tuberculosis?

Mayo Clinic explains that tuberculosis or "TB" is a serious illness caused by bacteria that mainly affects the lungs. The illness can spread when an infected person coughs or sneezes, expelling tiny droplets carrying the germs into the air where they can be breathed in by others.

There are three stages of a TB infection, each of which can cause different symptoms.

Primary TB infection is the first stage, during which immune system cells find and capture the germs. The immune system can completely destroy the germs, but in some cases, captured germs may still survive and multiply. Most people don't have symptoms during this phase, but some people may see flu-like symptoms such as low fever, tiredness and coughing.

Latent TB infection usually follows primary infection. During latent infection, immune system cells build a wall around lung tissue with TB germs. There are no symptoms during latent TB infection.

Active TB disease occurs when the immune system fails to control an infection, allowing germs to cause disease throughout lungs or other parts of the body. Active TB can happen right after primary infection, but usually happens after months or even years of latent TB infection.

What are the symptoms of tuberculosis?

Symptoms of active TB disease in the lungs usually begin gradually and worsen over a few weeks. They can include:

Coughing up blood or mucus

Pain with breathing or coughing

Not feeling well in general

If active TB infection occurs outside of the lungs, further symptoms can develop, varying based on the location of the infection. Common sites include the kidneys, liver, fluid surrounding the brain and spinal cord, heart muscles, genitals, lymph nodes, bones and joints, skin, walls of blood vessels and voice box.

Some possible symptoms listed by Mayo Clinic include:

Not feeling well in general

Pain near the site of infection

Symptoms of severe tuberculosis listed by the Mayo Clinic include:

A dose of dose of BCG vaccine used to prevent TB.

Is tuberculosis fatal? Life-threatening?

Tuberculosis is an illness with a deadly history.

The U.S. Centers for Disease Control states that in 1882, TB killed one in seven people in the U.S. And Europe. While still a serious illness, TB is now far from the death sentence that it historically represented due to the discovery of antibiotics, general improvements to public health and other factors.

Mayo Clinic does add, however, that some forms of TB bacteria have become drug resistant, meaning that medicines that once cured the disease no longer work. Most recent NC data showed that in 2023, 10 total cases of drug-resistant TB were recorded in the state.

Iris Seaton is the trending news reporter for the Asheville Citizen Times, part of the USA TODAY Network. Reach her at iseaton@citizentimes.Com.

This article originally appeared on Asheville Citizen Times: Is there a tuberculosis outbreak in NC? What people should know

Tuberculosis Case Reported In Indio

RIVERSIDE, Calif. (KESQ) - Riverside University Health System - Public Health (RUHS-PH) department reported Friday that an Indio High School student has tested positive for tuberculosis.

RUHS-PH officials say they are making efforts to notify anyone who may have been exposed to the disease, and add that the student is receiving treatment and is expected to make a full recovery.

RUHS-PH worked with Desert Sands Unified School District (DSUSD) officials to send exposure notification letters to guardians, faculty and staff members of students who may have had on-going contact with the individual in April through the end of May.

Riverside County Public Health Officer Jennifer Chevinsky says, "Our team is working closely with the school to identify anyone who may have had close contact with the student and ensure they receive appropriate testing and follow-up care. Given the rise in tuberculosis cases we've seen in our county, this is an important reminder that TB disease is both preventable and treatable."

TB testing will be offered for individuals who may have been exposed. If the test is positive, the individual will be sent for a chest X-ray and then follow up with Public Health. If the chest X-ray shows no disease in the lungs, treatment for latent TB infection is recommended to prevent progression to active TB illness.

Faculty, staff and parents or guardians of students who are not considered at-risk were notified of the potential TB exposure and informed that no further action was needed.

DSUSD Public Information Officer Tamara Wadkins says, "Desert Sands Unified School District is committed to the health and safety of our students and staff. Counseling services are available to assist any student or staff member who may feel unsettled during this time."

TB is a disease caused by bacteria that is spread through the air during prolonged, repeated and close contact with someone who has infectious TB disease.  In most cases, people infected with TB have a latent infection that has no symptoms, is not contagious, and does not progress to active TB disease, especially with the appropriate treatment. Symptoms of active TB can include a persistent cough, fever, night sweats and unexplained weight loss.

In Riverside County, 98 active TB cases were reported last year, an increase from 63 cases in 2023.

For more information, contact RUHS –PH Disease Control at 951-358-5107.

Even When You Don't Have TB Symptoms, This Century-old Test Can Still Detect The Disease.

Tuberculosis, or TB, is a disease that infects nearly 11 million people worldwide, killing some 1.25 million of them every year, per data from the World Health Organization.

A person infected with the disease may experience a range of symptoms such as a low-grade fever, coughing or fatigue on the mild end to a loss of appetite, difficulty breathing, night sweats, back and chest pain and a persistent cough (often with accompanying blood) on the more severe end.

TB is spread through airborne particles that are released when an infected person talks, sneezes or coughs and another person breathes in those particles. "It's a disease that is highly contagious," explains Amira Roess, a professor of global health and epidemiology at George Mason University in Virginia.

Detecting TB early, she adds, goes a long way toward avoiding some of the disease's worst outcomes and preventing its spread to others.

What is a TB test? What is a PPD test?

Forms of testing for TB vary depending on what stage of the disease a person is in. The three main stages of the disease are primary (exposure), latent (inactive) and active TB, each reflecting whether TB germs are still contained in the lungs or are actively wreaking havoc. Only someone with active TB has significant symptoms and can spread the disease to others, but it's still important to know if you have the less serious stages of the disease as primary and latent TB can develop into active TB at any time.

Symptoms aren't usually present in the primary or latent stage of TB, but there are still two ways to test whether TB germs are present in the body. The first of these is a blood test "which measures the body's immune response to tuberculosis proteins," explains Dr. Richard Doyle, a physician and clinical assistant professor of emergency medicine at Northwestern University.

The second diagnostic test option is known as a purified protein derivative (PPD) test, but it's commonly referred to as a TB skin test. "TB skin tests have been used in medicine for over a century," says Doyle. The skin test is administered by a healthcare professional using a small needle to inject testing materials under the skin, "typically in the forearm," says Doyle.

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How long do PPD test results take?

Results of a PPD test are not immediate because the test has to determine "if the immune system has been previously (affected) by TB exposure," says Doyle, which can take a couple of days. "If your immune system reacts to the injected protein," he explains, "it will cause a firm, raised area at the site of injection." This thickening and hardening of tissue is called an induration and the size of it is measured by your doctor in a return visit 48 to 72 hours after the initial injection took place.

If you're unable to return to the doctor within two or three days after the test is first administered, "you may be given instructions for how to read the test results yourself," says Roess.

When checked by a healthcare professional, "an induration on the skin of 15 millimeters or more is usually considered a positive TB result in healthy individuals," says Doyle. "But for people at higher risk, such as those with HIV, organ transplant recipients or people on immunosuppressive medications, an induration of just 5 millimeters may be considered positive due to their increased vulnerability to developing active TB."

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Who are PPD tests recommended for?

PPD tests are suggested for a number of reasons but "are most commonly recommended when a person has been in contact with a person infected with tuberculosis," says Dr. Cathy Hewison, a physician and tuberculosis advisor at the Paris-based humanitarian organization, Médecins Sans Frontières.

Education enrollment, new employment, traveling to or from certain countries or an immigration application can all be additional reasons a PPD test may be recommended. The U.S. Centers for Disease Control and Prevention (CDC) also suggests some groups of people be periodically tested under other circumstances. Such groups may include people who have a weakened immune system or conditions such as cancer, diabetes or HIV; if a person has been infected with TB in the past; if one is elderly; has done illegal intravenous drugs; or if one has not received proper treatment for a past TB infection.

PPD tests are also commonly recommend for people who work in homeless shelters, hospitals, prisons or nursing facilities. "Healthcare workers are routinely screened as part of occupational health protocols," says Doyle. "Patients who are about to start immunosuppressive therapies such as certain biologic agents or chemotherapy should also be screened for latent TB before treatment begins."

If exposure is detected or TB germs are found through PPD testing, Hewison says, "then preventive treatment can be offered to reduce your likelihood of developing active TB or spreading it to others."

This article originally appeared on USA TODAY: What is PPD?

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