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Medical Author:

George Schiffman, MD, FCCP

George Schiffman, MD, FCCP

Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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All cases of TB are passed from person to person via droplets. When someone with TB infection coughs, sneezes, or talks, tiny droplets of saliva or mucus are expelled into the air, which can be inhaled by another person.

• Once infectious particles reach the alveoli (small saclike structures in the air spaces in the lungs), another cell, called the macrophage, engulfs the TB bacteria.
• Then the bacteria are transmitted to the lymphatic system and bloodstream and spread to other organs occurs.
• The bacteria further multiply in organs that have high oxygen pressures, such as the upper lobes of the lungs, the kidneys, bone marrow, and meninges -- the membrane-like coverings of the brain and spinal cord.
• When the bacteria cause clinically detectable disease, you have TB.
• People who have inhaled the TB bacteria, but in whom the disease is controlled, are referred to as infected. Their immune system has walled off the organism in an inflammatory focus known as a granuloma. They have no symptoms, frequently have a positive skin test for TB, yet cannot transmit the disease to others. This is referred to as latent tuberculosis infection or LTBI.
• Risk factors for TB include the following:
• HIV infection,
• low socioeconomic status,
• alcoholism,
• homelessness,
• crowded living conditions,
• diseases that weaken the immune system,
• migration from a country with a high number of cases,
• and health-care workers.

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