Disability and Progress-April 24,2025-Tuberculosis

[00:00:00] Speaker A: KPI.org It. [00:00:59] Speaker B: Greetings and thank you for joining Disability and Progress, where we bring you insights into ideas about and discussions on disability topics. I'd like to remind you my name is Sam. I'm the producer of the show. Charlene Dahl is my research PR person. Hello, Charlene. [00:01:14] Speaker C: Good evening, everyone. I hope everybody's well. [00:01:18] Speaker B: I also want to remind you that if you have thoughts on what should be playing on the show or who should be on the show, you can contact us at disability and progressamjasmin.com that's disability and [email protected] we will also send out an emailer to let you know who's on each week. So that is another good reason to be on tonight or today, whichever you're looking at it. We will speak with Dr. Susan Klein. Dr. Klein is a professor of medicine in the infectious diseases and internal medicine at the University of Minnesota. Hello, Dr. Klein. [00:02:04] Speaker A: Hello. [00:02:05] Speaker B: Oops. Where are you? [00:02:07] Speaker A: I'm. There you are over here. [00:02:10] Speaker B: All right. Always good to have you on, and thank you for coming on again. Dr. Klein was with us for our measles discussion, and if you want to hear that, I'm pretty sure you can find that on our podcast. So, Dr. Klein, can you start out by talking a little bit about your history and how you got to where you are? So for those listeners who are just getting acquainted with you, sure. [00:02:38] Speaker A: So I'm a medical doctor. I actually trained at the University of Minnesota Medical School, and after I graduated, I went on to do further training in internal medicine. And then after that, I did a fellowship to train to be an infectious disease specialist. And so now I do specialize in treating patients who have infectious diseases. I also work at the University of Minnesota Hospital, and I'm the medical director for infection prevention there. [00:03:18] Speaker B: Excellent. Okay, I'm sure there's a lot of that going on right now. Can you talk a little bit? We're on to talk about tuberculosis tonight and what exactly it is, how it works, and who's at risk. So can you just start out by telling us, giving us a definition of what tuberculosis is? [00:03:41] Speaker A: Sure. Tuberculosis is an infection, and it is actually the disease that that is caused by the bacteria, which is known by the full name of Mycobacterium tuberculosis. [00:03:57] Speaker B: Ah. I guess we usually just hear it called tuberculosis or tb. As far as I know, there's like two different kinds of tuberculosis, sort of, I guess if you call it. There's that latent and than active. Would I be saying that correctly? Can you talk about what that is? Exactly. The differences between those two, certainly, yes. [00:04:25] Speaker A: That is an important distinction. So after a person has been exposed to tuberculosis, some people will become infected with tuberculosis, and usually that is through inhalation, that is breathing in the TB bacteria. It can be transmitted through the air when other people are coughing. But for most people who are exposed, their body's immune system contains it and it stays in the body, but it's in a latent state. That means it's resting. It's not actively making new bacteria, it's not actively making that person sick. So their body has kind of walled it off and it's no longer active. So that's what we call latent tuberculosis. Okay, but after someone has been infected at some point with latent tuberculosis, we know that over their lifespan, they have about a 10% risk of that progressing to what we call active tuberculosis. And active tuberculosis is the disease that we usually think about when we say someone has tb. And that means that bacteria is actually active and making new bacteria in the body, it's making the person feel sick, might be causing a chronic cough or fevers. And that's what we call active tuberculosis. [00:06:14] Speaker B: So who is more at risk for contracting tb and are people with disabilities more at risk? [00:06:26] Speaker A: Well, people with disabilities aren't necessarily more at risk. The people who are more at risk are those that, that are exposed to people who have active tuberculosis. And so there are a variety of risk factors for that. One is actually being exposed in the household. Like if someone in the family or in the household has active tuberculosis and you're living in that close setting, that could put someone at risk because of that fact. Group homes or congregate settings can be places where people can be exposed, such as being in a jail or a homeless shelter or a nursing home or a group home. So that's for those reasons. Usually nursing homes and group homes, for instance, will screen new residents when they come to the facility to make sure they don't have active tuberculosis and spread it to others. [00:07:38] Speaker B: But they might have latent. [00:07:41] Speaker A: Yes, people could have latent tb, you're right. But latent TB itself is not contagious. Some of the other risk factors for tuberculosis are actually in this country, the largest group of people with tuberculosis cases are born outside the united states. So non u. S born people. And they're at higher risk because the country they were born in or lived in in their early years has higher rates of active tuberculosis. So they were more likely to have been exposed, and then because of that, they're more likely to be at risk later for reactivation disease. [00:08:36] Speaker B: What kind of long term complications can TB lead to? [00:08:43] Speaker A: Well, it can make people very ill. And if someone has what we call active pulmonary disease, that means it's reactivated in the lungs, which is the most common site, then it really presents with cough. And usually we consider it a chronic cough. That means it goes on for several weeks, it could go on for months, it just doesn't clear up. And people have progressive cough, they might have fevers or night sweats, they can lose weight, they just don't have a good appetite. And if it goes untreated, it can progress and it can be very serious and even life threatening. [00:09:32] Speaker B: All right, so I'm just curious, so my understanding is then latent is not contagious, but when you get to the infectious, can latent turn into infectious, then active? I guess I should be calling it active, right? [00:09:50] Speaker A: Right. I think it's easiest to say latent, which means it's in a resting phase, not an active phase, or active, which means it's actively replicating or making new bacteria and making the person sick. And so someone who has latent disease can later on go on to develop active disease. And there are certain things that we know put people at higher risk for reactivating, and those are other underlying chronic health conditions that might make their immune system compromised or weaker. [00:10:32] Speaker B: Such as? [00:10:33] Speaker A: Well, one of the things is HIV disease. It could also be someone who's on immunosuppressive disease therapies for a variety of reasons, such as they're on prednisone for autoimmune disease, or they're on medicines to prevent rejection of a transplanted organ, for instance. Also, people who have heavy alcohol intake or drug use, they can also have compromised immune systems that, that put them at higher risk for reactivation. Also, young children, their immune systems just aren't as strong. So babies and children less than five in particular are at risk for having a greater likelihood of developing active TB if they are exposed to tuberculosis. [00:11:33] Speaker B: So young kids can get it. So I want to step back and talk about, how would you know if you did have it? Like, could you get it from being exposed but not realize that you had it? Or does it pop up with some symptoms right away and then they might just settle down? [00:11:57] Speaker A: Actually, most people who are exposed and go on to develop latent TB have no symptoms. So latent TB itself, people won't know they have it unless you actively test for it. And one way to test for it is to do what we call a tuberculin skin test. And that's where they inject a small amount of the bacteria, just a killed portion under the skin. And if someone's been exposed to that TB bacteria before, they will react to it and get a large red swelling or lump on their arm. Usually it's in the forearm where they give that skin test. [00:12:49] Speaker B: We talked a little bit about this before, and you said that healthcare workers are pretty much required to get tested before. I mean, when they're going into being healthcare people. [00:13:05] Speaker A: Right, right. Usually, especially if someone's starting to work in a hospital, for instance, or a nursing home or a healthcare facility, usually there is screening before they start the job to see if they do have latent TB or do they have symptoms of active tb. [00:13:30] Speaker B: So if they come up with latent tb, not active, what happens? [00:13:37] Speaker A: So usually they do either that skin test that I was telling you about, or now there's a new blood test that can be done. And that blood test also checks your body's immune reaction to the TB bacteria. So if the skin test or the blood test come back positive, that means that person has been exposed to the TB bacteria in the past and it's in their body then potentially. And so that's why their immune system reacts to it. So at that point, you have to determine, is it active or is it latent? So usually the next step is to get a chest X ray, since pulmonary or lung TB is what we really worry about. Because that's the most contagious with all. [00:14:32] Speaker B: The coughing and stuff. [00:14:34] Speaker A: Exactly. And then we ask people questions if they have a positive test, like, are you coughing, are you having fevers, have you lost weight? Or are there other symptoms that are suggestive of active tuberculosis? [00:14:52] Speaker B: So if they have, if they don't have active, if it's just latent, can they still practice? [00:14:59] Speaker A: Yes. Yes. We would not limit someone from working if they have latent tuberculosis. And we do recommend, however, that they be treated for latent tuberculosis because treating it can decrease the risk of that person going on to develop active tuberculosis. [00:15:21] Speaker B: So. Okay, we'll come back to that then. I'm wondering then if they, if they do that, how does, when we're doing, when we're talking about chronic tb, like infection or, you know, active, how does that affect the respiratory? What happens to the lungs then? [00:15:50] Speaker A: Well, in that setting with active tuberculosis, what happens is that the disease starts to cause pneumonia in the lungs. And if you do a chest X ray, you can see what we call an infiltrate. That means you see some abnormal shadows in the lung tissue, which are signs of the Pneumonia developing. The other thing that TB can do is if that infection progresses, it can actually eat away at some of the lung tissue and cause what we call a cavity, which is actually like a hole in the lung tissue. [00:16:33] Speaker B: Oh, wow. So hearing about this, I'm a little bit, you know, I'm one of these people that did mask during COVID and I felt like I was always carrying hand sanitizer around. I still do. It always makes me nervous a little bit. When I was doing some research on this, I'm like, it feels like people could have it and not know they have it because it's in the latent stage. So how worried should people be? [00:17:05] Speaker A: Well, if they feel perfectly well, I don't think they have to be particularly worried about having latent tuberculosis. However, I would say if someone's feeling ill, especially if they're having a chronic, unexplained cough that is, you know, a cough that's been going on three weeks or longer and they just don't feel well, then those people should definitely go to the doctor and get checked out. And like I said, there are high risk people in this country for being exposed to tb. And those people, like healthcare workers, for instance, should be screened to see if they have latent tb. But also, newly arrived immigrants or refugees in this country are screened to see if they have latent tb. And if they do, then it's recommended they take treatment for latent TB as well. [00:18:02] Speaker B: What would the treatment for latent TB be? [00:18:06] Speaker A: Well, the traditional treatment is with a drug called isoniazid, and you just take one pill a day for six to nine months. And there are some newer drugs that can be used in shorter courses or in combinations. But it's not as intensive a treatment as treating someone with active tuberculosis, where they take three to four drugs for six months and sometimes longer, depending on where the disease is. [00:18:41] Speaker B: So, you know, I know people who have chronic coughs for like, a long time, and they. And I think one time, I'm sure I went to the doctor once because I had a cough for a prolonged period and never did I ever hear them say, well, maybe we should test you for tb. What would kind of go off in a physician's brain to think, say, you know, maybe this should be done. Like, are there anything special that they look at? [00:19:15] Speaker A: Well, I think if it's going on for quite a long time, like a month or so, people are having fevers, they're having night sweats, they're losing weight, or they've already been through standard courses of Antibiotics that would treat most common respiratory infections, and they're just not improving. At that point, we should really start thinking about tuberculosis. And we do know, because there are certain populations that are at higher risk, we usually ask about those types of exposures. You know, have you ever been exposed to anybody that you know of with active TB or lived with someone who was diagnosed with TB or been in jail or a homeless shelter? Were you born outside the U.S. you know, we'll ask those questions, and if they're in one of those higher risk groups, that will heighten our suspicion that they could be at risk for tb. Active tb. [00:20:21] Speaker B: That's interesting because, I mean, I guess I feel like you may know if you live with somebody if they have tb, because they might tell you if they know. But in general, I would guess that most people aren't gonna walk up and say, hey, I just want know I've got latent tb. I mean, I'm guessing they're not going to do that, but they may not know either. Nicknames Latent. [00:20:45] Speaker A: You're right. But remember, latent TB isn't contagious. Isn't contagious. So if you lived with someone with latent tb, that doesn't mean you're at risk. [00:20:57] Speaker B: Ah, okay. [00:20:58] Speaker A: For tb. [00:20:59] Speaker B: So I'm curious because I work at least a couple times a week at the. At a library, and it's a large library, and there are significant amounts of homeless people that sit in the hallways and talk. And, you know, they're looking for a place to be warm, you know, and they. So it's very peaceful and they sit and talk or they're able to go in and use the computer. But you hear coughing and, you know, somebody's sick all the time. So I, for me, I'm always masking in there. How effective is an N95 mask in protecting oneself with, you know, against things like that? [00:21:43] Speaker A: It's actually very effective. In fact, that's what we use in hospitals or clinics if. If we see a patient who we think has active tuberculosis, because it does filter the air so that the bacteria do not get inhaled. So the N95 mask is a very effective way to filter TB. The other thing that we do in the healthcare setting, like the hospital or clinic, if we're seeing a patient who we think has active tb, is we put them in what we call an airborne isolation room. Because TB can be airborne. We put them in a room where the air is pulled out of the room, like a negative airflow, and then vented outside the facility. So it doesn't recirculate. That's another way of protecting others that are in that building. [00:22:48] Speaker B: Ah, okay. So let's talk a little bit. I know you did touch on testing, and we talked about a blood test and a skin test. If someone gets a skin test, you said they generally might develop a lump on their arm. That would be the reaction to telling you maybe that they did have tb. [00:23:19] Speaker A: Right. [00:23:20] Speaker B: And then what would the blood test come back with? And I think you said the blood test is more accurate. How much more accurate? And. Yeah. Tell us a little bit about the differences. [00:23:34] Speaker A: Well, the biggest. There's a couple advantages to the blood test. One is that you can just sample the blood at one point in time and send it to a lab and get the answer sent back. When you put on the skin test, what you do is you inject a little bit of this killed bacterial protein under the skin, and then the patient has to come back in two days and you can see if they reacted. Because we're really looking for a delayed reaction which takes 48 to 72 hours to develop. So it requires an extra trip back. And then at that point point we look at the spot where it was injected. We look to see if it's raised, if it's red, and if there is a red raised area, we'll actually measure it and see how big it is to help determine if that's a positive reaction or not. [00:24:32] Speaker B: Ah, because they might just react, but they wouldn't necessarily be infected. [00:24:38] Speaker A: Well, there can be what we call, like cross reactivity with other mycobacteria, which are not Mycobacterium tuberculosis, although that's less common. Also, there are vaccines called the BCG vaccine that are given in some countries where there are higher rates of tuberculosis. We don't use it in this country anymore. But that BCG vaccine, say you got that in childhood, and then you come here when you're a young adult or something, you might have a positive skin reaction from that prior vaccination. So that's a little harder to sort out with the skin test, but with the blood test, even if you had that vaccination, that should not make the blood test positive. [00:25:32] Speaker B: So I am curious about the vaccine and why. How high do the rates have to be in order for one to have the vaccine? So, like, what country might have that vaccine and how high would the rates be in order for them to be doing that? [00:25:51] Speaker A: That's a good question. Well, there are several countries outside the US that vaccinate. I don't know all the countries that do. One country, for instance, is India. There are high rates of tuberculosis in that country. And what you really worry about is babies being exposed to somebody with active tb. And so primarily they focus on vaccinating babies to help protect them until their immune system is stronger. There are some countries in Europe where there are higher rates of of TB that also give the BCG vaccine. [00:26:35] Speaker B: We've had some breakouts here, and it's my understanding that every year we have some amount of TB breakouts. What are the statistics in Minnesota? Do we have that? [00:26:49] Speaker A: Well, in Minnesota, last year there were 195 active tuberculosis cases. And that was actually an increase from the last few years. But we've had that many cases per year in the past, say, going back 20 years or so. And so the rates change a little bit up and down from year to year. But last year we did see more active cases. [00:27:21] Speaker B: And just to be clear, people do die from this, right? [00:27:25] Speaker A: They can, yes. You know, fortunately, it's not the majority of people. It's a small number. But the important thing is treating people when they have active infection and trying to diagnose it and treat them early on when you have a better chance of curing it before it's too advanced. [00:27:49] Speaker B: Dr. Kleina, you talked briefly about if they have latent TB, that they could have a treatment that would presumably lessen their chances much more from getting active tb. That would be the idea, right? [00:28:07] Speaker A: Right, that's correct. So usually what we tell people, if they're diagnosed with latent tb, that from the time they were infected and then developed latent TB over the rest of their life, there's about a 10% chance they could develop active TB. The highest risk is actually in the first couple of years. There's about a 5% risk then. And then if you don't go on to develop active TB in those first couple of years, then over the rest of your life, it's about a 5% risk. But if you treat somebody with preventative treatment with the medicine that I mentioned, for instance, isoniazid, you can lower their risk of getting active TB by about 90%. [00:29:00] Speaker B: Oh, wow. Let's talk about the active TB. If somebody gets active TB and they don't go through treatment, does it stay active or can it go back to latent? [00:29:16] Speaker A: It's most likely to stay active. And so, you know, I think we all heard stories in the past about people with TB who died of TB at young ages, and that's because we didn't used to have effective treatment. And there were some people that got cured of TB just because their own immune system was able to contain it. But that's not something we would rely on anymore because the risk of it progressing is quite high, actually. And so we would always recommend treating active tuberculosis. [00:30:01] Speaker B: If you have latent, is it still doing damage to your lungs? [00:30:06] Speaker A: No, it's not. It's just resting there. Usually the body walls it off, like in a little nodule you might see on the chest X ray. But it's not making them sick or damaging the lungs. [00:30:28] Speaker B: So the body builds some kind of protective thing around it. Do we know what that's made out of? Like what it is that? [00:30:35] Speaker A: Yes, it's actually white blood cells. And they form what we call a granuloma, which is the white blood cells just form like a little seal around it almost, and wall it off from the rest of the body. [00:30:54] Speaker B: So if somebody goes into active tb, somehow that seal has broken, Right? [00:31:00] Speaker A: Right. So the immune system, for whatever reason, has weakened and those white blood cells can no longer contain it. [00:31:12] Speaker B: Tell us about side effects. Everything always has side effects. So side effects with the medication that or the treatment that you may get with latent as opposed to active tb. [00:31:30] Speaker A: Okay, so with the latent tb, with the isoniazid, for instance, or another drug that we sometimes use called rifampin. One of the major side effects we worry about is in some people, it can affect the liver and cause inflammation in the liver. And so we always warn people about that. And also before we start it, usually we'll check their liver tests by doing a blood test to make sure their liver tests look normal. We'll ask if they've ever had problems with their liver, like infectious hepatitis or if they drink a large amount of alcohol, because that can put people at increased risk of developing liver problems if they take these meds. The other thing that we worry about is sometimes these drugs can cause what is a neuropathy, meaning it can be damaging to the nerves. We usually give a vitamin to help prevent against that, but those are some of the common side effects. [00:32:42] Speaker B: This sounds like chemo that we watch for. [00:32:45] Speaker A: It's not as severe as chemo, but in certain people, especially people whose nutrition is not good, it can cause this tingling in the nerves. [00:32:59] Speaker B: What's the vitamin you give? [00:33:01] Speaker A: Vitamin B6. [00:33:03] Speaker B: Ah, interesting. Okay, so and are the side effects for the treatment you would give with. I presume they'd be different if somebody has an active case of tuberculosis. [00:33:20] Speaker A: Well, with active tb, we use some of the same medicines, like the isoniazid the rifampin, but usually we add one to two other medicines. And so once you start adding multiple medicines, you know, there's increased risk of combination drugs causing more side effects. So we have to monitor more closely for those side effects. We'll do frequent blood tests, for instance. We also have to collect follow up sputum samples. And you know, usually when we diagnose TB we have to collect cultures. [00:33:57] Speaker B: Right. [00:33:58] Speaker A: That's the way to confirm if someone has tb. And then we can test that culture against a panel of antibiotics, anti TB meds, antibiotics, to make sure we choose medications that will be effective. [00:34:14] Speaker B: If you find that somebody does have it and they're living with, you know, a family of whomever, do you go back and test their whole family? [00:34:26] Speaker A: Yes, we do. In fact, we get public health involved and each county has a public health clinic and then they get notified and either the county or the state health department help arrange testing for family members because they have been exposed and look for other people who might have latent TB or even active tb. [00:34:56] Speaker B: Are you concerned about all the public health cuts that you're seeing and are they affecting things that you see and are you worried that they will affect, you know, treatments or us knowing about contagious diseases that are having that are happening? [00:35:18] Speaker A: Well, I do worry that, yes, if public health resources are cut, that we might lose some of those essential services to do this type of contact investigation in communities and also to make sure that all those people who have been exposed get proper follow up testing and that people with latent or active TB can all get the proper treatment. [00:35:50] Speaker B: When you have patients that are diagnosed, what kind of psychological impact on those diagnosed, do you that what happens? [00:36:01] Speaker A: Well, I think, you know, no one wants to have active TB because they feel quite ill. But also I think there is some social stigma attached with it, you know, that they worry they put other people at risk and so they might be embarrassed. [00:36:22] Speaker B: Right, right. And I expect that, you know, maybe most people don't even hear latent or active, they hear TB and then it's freak out, you know, that they're thinking, who, who do I have to be worried about? I've, you know, been around a lot of people, what do I do? And so how does that work? If somebody had an active case and they had been, you know, in a fairly large social group, how would you do? [00:37:01] Speaker A: Well, that's really where public health gets involved. You know, they actually need to speak to the person who has active tb, find out their living situation. [00:37:15] Speaker B: Right. [00:37:16] Speaker A: You know, do they have other roommates or housemates or family members that were exposed. Exposed and then notify those people. Or if they have other close social contacts where they could have exposed other people, the health departments can work to find those people and notify them they were exposed and recommend that they get tested to find out if they have developed latent tb. [00:37:47] Speaker B: And do you actually, are you actually teaching classes yourself on infectious diseases or are you mostly in the hospital? [00:37:59] Speaker A: I do some teaching, but mostly I work in the clinic and the hospital and then also with the infection prevention department. We are responsible in the hospital for doing what we call contact investigations. So for instance, if there was a patient who was admitted to the hospital and then diagnosed with tb, we have to determine were they isolated appropriately the whole time, were they wearing a mask when they were in common waiting areas, or were any other patients or any other healthcare workers exposed to to them. And then if there are exposures, then we have to notify those people to get tested for tb. [00:38:50] Speaker B: So I think I told you that I mask when I'm on my way through the library until I get outside, but I also mask on mass transit. Assuming that you don't know really who you're sitting by or who you're around. And I'm now thinking I'm pretty smart for doing that. I'm wondering how long does you know if it's airborne, is it a direct thing or can it linger in the air for a while? If somebody has active tv, how does it work? [00:39:27] Speaker A: Yes, you're right, it can linger in the air. And if it's a closed setting that doesn't have good ventilation, for instance, it might linger in the air more frequently. If it's in a setting where there's more air exchange or open air type of situation, then it's less likely to linger in the air a long time. [00:39:56] Speaker B: You talked about other countries having a vaccine. If somebody's going to a country that has a higher rate of tb, might they get the vaccine? Do they get notified that maybe you should get this particular vaccine because they have a higher rate of tb? [00:40:13] Speaker A: No, we don't do that for travelers. We don't recommend it for travelers because usually just traveling to another country isn't high risk in and of itself. Those countries usually vaccinate babies because they might have more intense exposure in the household, for instance, or school age kids or in a daycare. [00:40:39] Speaker B: What kind of side effects does the vaccine itself have? [00:40:44] Speaker A: The vaccine doesn't have too many side effects either really. It's usually pretty contained reaction, like at the site of the infection or the inoculation. I should say there are rare case reports of people who get BCG exposure for other reasons. If they're very immunocompromised, it could actually disseminate or develop more of an active infection because the vaccine is a live bacteria, it's not tb, but it's like an attenuated version of a bacteria that's similar to Mycobacterium tuberculosis. [00:41:41] Speaker B: You used to hear about if somebody got tuberculosis a long time ago, they were put in, you know, places that they were away from everyone. Now if somebody gets active tb, how does that work? Like if they're working in a job where they have to encounter people or things like that, or if they're a school age child even. [00:42:09] Speaker A: Right. So now that we have good treatment for active tb, we don't really send people to TB sanitariums, for instance, to isolate them, but we do keep them isolated in the hospital, for instance, until we're sure they're on effective treatment and they're no longer infectious or contagious to other people. Usually that requires at least two weeks of combination antibiotic treatment. And you want to see that the patient's feeling better. If they had fever that is gone, or their cough's improving or their other symptoms are getting better before they would be released to go back to the home setting, for instance, or if they live in a nursing home or group home or they're in school, then usually there are longer restrictions until their treating doctor or public health people are no longer concerned they're infectious and they'll actually collect sputum samples on multiple occasions to show that the previous bacterias is no longer there. [00:43:40] Speaker B: So do you find that certain segments, I'm thinking homeless or poverty, people in poverty have more difficulty getting treatment or testing for tb? [00:43:55] Speaker A: Not necessarily, I would say, because I think in this country at least if, if you're in a shelter, for instance, you can still get access to get the tests and the treatment for TB through public health clinics that are funded specifically for that reason. Hennepin county, for instance, has a very good tuberculosis clinic. So you know, if someone's identified in a homeless shelter, for instance, and they don't have access to care, they can go to that clinic and get treatment. But if someone never seeks care or they're living, you know, outside, like in a camp or something, they may, may not seek care and then they may not have access to care. [00:45:00] Speaker B: So what advice would you tell somebody who maybe has recently been diagnosed with tuberculosis? [00:45:10] Speaker A: Well, I would Say once they're diagnosed with tb, really the most important thing is to complete the full treatment course and not miss doses. And so the recommendation is now actually from medical professionals and public health authorities is that you do something called directly observed therapy. And that means the county can actually send a healthcare worker out to meet with someone every day and give them their medicines and verify or ensure that they're taking them. And so taking the combination of prescribed drugs every day that they're supposed to on their treatment regimen is really the most important thing to get control of the infection and not cause development of resistance. [00:46:10] Speaker B: So it sounds like the general first step when somebody's diagnosed regardless is if it's latent or active, that they're put on some type of medication. [00:46:24] Speaker A: Right. If it's latent, we Recommend Usually just one pill a day for 6 to 9 months. If it's combination treatment for active disease, usually we start out with three to four medicines for at least the first two months and then two medicines for an additional four months. [00:46:46] Speaker B: So. And then if it's latent after they've completed the medicine course. Yeah, after they've completed the treatment, then they don't have, there's nothing really more to do because they'll still have latent tb, but theoretically it's just that's the end of the course and that should lessen your chance to go on to active much more. [00:47:12] Speaker A: Exactly. Yep. And then they don't need additional follow up, unless they were to develop some illness to suggest they had developed active TB and then they would need to be reevaluated by a healthcare provider. [00:47:33] Speaker B: I presume if somebody has gone through the treatment, but they've also had cancer later and gone through a bunch of chemo or immunotherapy, that that could increase their chances of it becoming active, Is that not correct? [00:47:50] Speaker A: No, that is correct. That's exactly right. And so that's one of the reasons to screen people actually for latent TB before they get started on certain immunosuppressive medications. [00:48:06] Speaker B: So if they do that, and when they're done with those, the chemo and whatnot, would it be beneficial for them to take another course of the medicine for the latent tb? [00:48:21] Speaker A: Not really. The best time to take it is before they actually have to undergo immunosuppressive therapy. If that's an option. [00:48:32] Speaker B: Right. Of course, oftentimes it may not be because theoretically when you get diagnosed, you do want treatment as soon as you can get it. [00:48:42] Speaker A: Well, that's true. So it all depends on what disease they have and what the therapy is. So it's hard to make. You know, it's not one size fits. [00:48:52] Speaker B: All right, Charlene, I want to check to see if there's anything you wanted to add. [00:49:00] Speaker C: Actually, no, you guys kind of. [00:49:03] Speaker B: I know you talked and said that you had an uncle that had it. [00:49:07] Speaker C: I did. And he was back in the late 60s, early 70s, when they were putting people in camps and you stayed there for a year and then they let you go. That's what, that's how they cured, I guess, back then. [00:49:26] Speaker B: Well, and I'm sure, I mean, I'm sure there was more to that. I'm guessing. How long has the different medicines been out for treatment for TB? [00:49:38] Speaker A: Well, I'm thinking back that you mentioned the 60s and 70s. I think some of the, the first TB medications actually came out in the 1950s, but the treatment options were more limited back then. They didn't have all the options that we had now. And I will say that's before my time in medicine. So I don't know exactly what those treatments were. [00:50:06] Speaker B: That's okay. [00:50:07] Speaker A: But I think because the treatments were less effective and people were more likely to be contagious for longer periods of time, that's part of the reason why they had these TB sanitariums. So that the person who did have active disease could get treatment and also that they didn't expose their other family members that were in their household, for instance. [00:50:34] Speaker B: So are there any new studies or research going on in regards to tuberculosis that people should know about or can they get involved in studies about tb? [00:50:48] Speaker A: Well, right now I would say the biggest issue going on in the field is development of new medications that will actually treat drug resistant tb. So drug resistant TB is a problem around the world? It's less of a problem in our state, fortunately, but there are some countries around the world that have what's called extremely drug resistant tb. So the TB bacteria has become resistant to most of the first line treatments for tb. And so now they're. One of the big areas of research is development of newer drugs that will treat these drug resistant strains. [00:51:43] Speaker B: So presumably if somebody has a drug resistant tb, I'm trying to figure out where this falls in the two camps that we discussed of latent or active, that it's primarily active TB cases that they're looking at that's resisting. [00:51:59] Speaker A: Exactly. Yep. [00:52:01] Speaker B: Okay. [00:52:02] Speaker A: Because the only way you can really know if it's this drug resistant TB is to have a sample of the bacteria and actually be able to grow it or test it directly for drug. [00:52:17] Speaker B: Resistance and the drug resistant tb. Is this like a recent thing? [00:52:24] Speaker A: Well, it's been going on for, I'd say, quite a few years. But these extremely drug resistant strains is a more recent development over the last ten years or so. [00:52:38] Speaker B: So what happens then to that person? [00:52:41] Speaker A: Well, what happens is they have to get more intensive treatment, usually with more medications, medications that might have more side effects. And it's usually a longer treatment course. So it becomes a more complicated treatment course. [00:52:59] Speaker B: Presumably they're isolated. [00:53:02] Speaker A: Yes, and you're right, they need to be isolated for a longer period of time as well, you know, to make sure that when they're released outside of isolation, they are no longer contagious. [00:53:18] Speaker B: Dr. Klein, thank you so much for coming in and giving us your time. Is there anything else we should know about tuberculosis? [00:53:27] Speaker A: I think we covered most of the. [00:53:29] Speaker B: We covered a lot. [00:53:30] Speaker A: The one thing we didn't really have time to talk about is what we call extra pulmonary tb. And we mostly talked about pulmonary tb, and that's the contagious type. But people can also develop active TB in other parts of their body. [00:53:47] Speaker B: How does that work? [00:53:48] Speaker A: Well, one of the most common sites is in the lymph nodes in the neck, like under the jawline. And people can develop a very swollen lymph node there. That, again, is quite chronic. It can go on for weeks or months. It could progress to even open up like an abscess and start draining. [00:54:10] Speaker B: Oh, wow. [00:54:12] Speaker A: People can also develop TB and lymph nodes in other parts of their body, like by the lungs or in the abdomen. People sometimes get TB in their joints. It can also affect the kidney, sometimes it can affect the genital urinary tract. So it can also sometimes go to the brain. So it can disseminate. It can go widespread through the body. [00:54:44] Speaker B: Can it just sit and be in one lymph node, or does it always spread? [00:54:51] Speaker A: It could just sit and be in one lymph node, but it has a tendency to spread, at least locally. But then if it goes widely throughout the body, then that's what's called disseminated tb. [00:55:04] Speaker C: So that's not as common, though. [00:55:07] Speaker A: Well, that's not as common. But, you know, I recently reviewed the statistics for Minnesota in the last year, and they had 195 active cases. Of those, 99. [00:55:19] Speaker B: Oh, my. [00:55:20] Speaker C: Okay. [00:55:21] Speaker A: Were pulmonary, but 67 of those were extra pulmonary, meaning at sites outside the lung. And there were 29 patients who had both types. So they had it in their lungs, plus at other sites. [00:55:36] Speaker B: Guess I should have jumped in with this one for a while. Well, I'm sure that, you know, I've been watching the different cases happening. I just somebody interview somebody named John Green about a book called Everything tv. So if you're interested in reading that, I hope to have you back. And I'll be watching the TV things. So I'm sure we'll revisit and talk about more of this again. [00:56:08] Speaker A: Okay. Thank you. [00:56:10] Speaker B: Thank you so much for your time. I really appreciate it. This has been Disability in Progress. The views expressed on this show are not necessarily those of kfei. My name is Sam. I'm the board of directors. Charlene Dahl is my research PR person. Erin is my podcaster. We've been speaking with Dr. Susan Klein. Dr. Klein is a professor of medicine and the division of Infectious diseases and in internal medicine at the University of Minnesota. This is KFAI 90.3 FM, Minneapolis, and KFAI.org we podcast. Please listen to our podcasts and if you want to be on the email list, you can email me at disabilityandprogressamjasmin.com Fresh fruit is up next. Thanks so much for listening. [00:57:07] Speaker A: KPI dot dot org.