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.
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.
The doctor will complete the following tests to diagnose tuberculosis. You may not be hospitalized for either the initial tests or the beginning of treatment.
Chest X-ray: The most common diagnostic test that leads to the suspicion of infection is a chest X-ray.
In primary TB, an X-ray will show an abnormality in the mid and lower lung fields, and lymph nodes may be enlarged.
Reactivated TB bacteria usually infiltrate the upper lobes of
the lungs.
Miliary tuberculosis exhibits diffuse nodules at different locations in the body.
The Mantoux skin test also known as a tuberculin skin test (TST or PPD
test): This test helps identify people infected with M. tuberculosis but who have no symptoms. A doctor must read the test.
The doctor will inject 5 units of purified protein
derivative (PPD) into your skin. If a raised bump of more than 5 mm (0.2 in) appears at the site 48 hours later, the test may be positive.
This test can often indicate disease when there is none (false positive). Also, it can show no disease when you may in fact have TB (false negative).
QuantiFERON-TB Gold test: This is a blood test that is an aid in the diagnosis of TB. This test can help detect active and latent tuberculosis. The body responds to the presence of the tuberculosis bacteria. By special techniques, the patient's blood is incubated with proteins from TB bacteria. If the bacteria is in the patient, the immune cells in the blood sample respond to these proteins with the production of a substance called interferon-gamma (IFN-gamma). This substance is detected by the test. If someone had a prior BCG vaccination (a vaccine against TB given in some countries but not the U.S.) and a positive skin test due to this, the QuantiFERON-TB Gold test will not detect any IFN-gamma.
Sputum testing:
Sputum testing for acid-fast bacilli is the only test that confirms a TB
diagnosis. If sputum (the mucus you cough up) is available, or can be induced,
a lab test may give a positive result in up to 30% of people with active disease.
Sputum or other bodily secretions such as from your
stomach or lung fluid can be cultured for growth of mycobacteria to confirm the diagnosis.
It may take one to three weeks to detect growth in a culture, but eight to 12 weeks to be certain
of the diagnosis.
and ethambutol (Myambutol) or streptomycin added
until your drug sensitivity is known (from the results of bacterial cultures).
Treatment takes that long because the disease organisms grow very slowly and, unfortunately, also die very slowly. (Mycobacterium tuberculosis is a very slow-growing organism and may take up to six weeks to grow in a culture media.)
Doctors use multiple drugs to reduce the likelihood of resistant organisms emerging.
Often the drugs will be changed or chosen based on
the laboratory results.
If doctors doubt that you are taking your medicine, they may have you come to the office for doses. Prescribing doses twice a week helps assure compliance.
The most common cause of treatment failure is people's failure to comply with the medical regimen. This may lead to the emergence of drug-resistant organisms. You must take your medications as directed, even if you are feeling better.
Another important aspect of tuberculosis treatment is
public health. This is an area of community health for which mandated treatment can occur. In some cases, the local health department will supervise administration of the medication for the entire course of therapy.
Doctors likely will contact or trace your relatives and friends.
Your relatives and friends may need to undergo appropriate skin tests and chest X-rays.
