REPORTABLE DISEASE: A health care provider should report any suspected or diagnosed case within 24 hours of diagnosis, or a laboratory manager should report any probable or confirmed isolate of Mycobacterium tuberculosis within 72 hours to the Tuberculosis Program, New Jersey Department of Health and Senior Services, 609-588-8092 .

CLINICAL DESCRIPTION

Tuberculosis is a chronic bacterial infection caused by Mycobacterium tuberculosis, which starts as a pulmonary infection and is characterized pathologically by the formation of granulomas.

Clinical status is based mainly on the presence or absence of tubercule bacilli in the sputum and chest radiographs. Abnormal radiographic densities indicative of pulmonary infiltration, cavitation and fibrosis can occur before clinical manifestations. Fatigue, fever, night sweats and weight loss may occur early, while localizing symptoms of cough, chest pain, hemoptysis and hoarseness become prominent in advanced stages. From infection to demonstrable primary lesion or significant tuberculin reaction, about 2-10 weeks. While the subsequent risk of progressive pulmonary or extrapulmonary TB is greatest within the first year or two after infection, latent infection may persist for a lifetime. HIV infection appears to increase the risk greatly and shorten the interval for the development of TB disease.

Early lung lesions commonly heal, and leave no residual changes except occasional pulmonary or tracheobronchial lymph node calcifications. In approximately 5% of apparently normal hosts and as many as 50% of persons with advanced HIV infection, the initial infection may progress directly to pulmonary, miliary, meningeal or other extrapulmonary involvement. Serious outcomes of initial infection are more frequent in infants, adolescents, young adults and the immunosuppressed.

Extrapulmonary TB occurs less commonly than pulmonary TB. Children and persons with immunodeficiencies, such as from HIV infection, have a higher proportion of extrapulmonary TB, but pulmonary disease remains the most common type of TB disease worldwide, even in those more susceptible groups. TB disease may affect any organ or tissue such as the lymph nodes, pleura, pericardium, kidneys, bones and joints, larynx, middle ear, skin, intestines, peritoneum and eyes.

Progressive pulmonary TB arises from exogenous reinfection or endogenous reactivation of a latent focus remaining from the initial infection. If untreated, about half the patients will die within 5 years, a majority of these within 18 months.

NOTE: A case should not be counted twice within any consecutive 12-month period. However, cases in which the patients had previously had verified disease should be reported again if the patients were discharged from treatment. Cases also should be reported again if patients were lost to supervision for greater than 12 months and disease can be verified again. Mycobacterial diseases other than those caused by Mycobacterium tuberculosis complex should not be counted in tuberculosis morbidity statistics unless there is concurrent tuberculosis.

CASE CLASSIFICATION

1. CONFIRMED
   
   • A positive Mantoux tuberculin test; however, those with immunocompromised illnesses or those very sick with advanced pulmonary disease may have a negative tuberculosis test, AND
   • Other signs and symptoms compatible with tuberculosis (e.g., an abnormal, unstable [i.e., worsening or improving] chest radiograph, or clinical evidence of current disease), AND
   • Treatment with two or more antituberculosis medications (If there is only clinical evidence of disease, the individual must be on treatment with two or more antituberculosis medications.), AND/OR
   • Laboratory criteria:
     • Isolation of M. tuberculosis from a clinical specimen (including rapid identification techniques, e.g. DNA probes and mycolic acids HPLC), OR
     • Demonstration of M. tuberculosis from a clinical specimen by nucleic acid amplification test, OR
     • Demonstration of acid-fast bacilli in a clinical specimen when a culture has not been or cannot be obtained.
   
   
2. PROBABLE

   Any suspect case that meets some of the above requirements, but not all, and is under further evaluation.

   
   

3. POSSIBLE
   
   Not used

What should I know about Tuberculosis?