Tuberculosis Basics

Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attacks the lungs, however TB can attack any part of the body such as the kidney, spine, and brain. Not everyone infected with the TB bacteria will become sick. As a result, two TB-related conditions exist: latent TB infection (LTBI) and TB disease. TB disease can be fatal.  Of the 289 persons with TB in Winnipeg between 2013 to 2016, 7 died as a result to their TB and TB disease contributed to the cause of death in 9 others.  

Transmission

Respiratory (pulmonary or laryngeal) tuberculosis is infectious. It is spread by person-to-person airborne transmission. An infected person releases TB bacteria when they cough, sneeze, laugh or sing. TB can also be spread when individuals with TB disease have aerosolizing medical procedures such as intubation, bronchoscopy or sputum production. 
Non-respiratory TB cannot  be spread to others, except in rare situations where body fluids are aerosolized by medical procedures.

Active TB vs. Latent TB

Tuberculosis is either active or latent (commonly referred to as “sleeping”).

  • Active TB means that the TB bacteria are growing and causing symptoms.
  • Latent TB means that the TB bacteria is in the body, however the body's defenses (immune system) are keeping it from turning into active TB. This means that there are no symptoms of TB disease and the TB bacteria cannot be spread to others. People with latent TB have a 5 to 10% lifetime risk of progressing to active TB disease.

Treatment

Tuberculosis is treatable. TB treatment usually takes 6 to 9 months. Some forms of TB disease may need to be treated for 2 years or longer.

Treatment of TB disease always requires a combination of three or more antibiotics. TB disease is never treated with only one antibiotic. The Canadian Tuberculosis Standards recommends that individuals suspected of having, or diagnosed with active TB disease, be referred to a physician who specializes in the treatment of TB disease. Almost all people are cured if they take their medicine as prescribed. There can be a 3% lifetime relapse risk after treatment. People who live or work in communities where TB rates are prevalent can be repeatedly exposed and re-infected.

Directly observed therapy (DOT) means a health-care worker watches the person with TB take every dose of their TB medication. DOT ensures that individuals follow their treatment plan throughout  the long TB treatment.

Contact Investigations

All newly diagnosed active TB cases are reportable under The Public Health Act of Manitoba. Latent TB is not reportable. Respiratory TB is an infectious, communicable disease. In Manitoba, Public Health is responsible for contact investigations for every new case of infectious TB. The primary purpose of a contact investigation is to actively search for undiagnosed secondary cases and quickly refer them for treatment. A contact investigation also aims to identify contacts with latent TB infection, in order to offer preventative treatment. 

If a person presents to a primary care provider concerned that they may have been exposed to someone with TB, please refer them to Public Health (contact information below).

Care Management in Manitoba

TB care and treatment is a shared responsibility. Primary care providers play an integral role in the early diagnosis of TB and timely referral to TB specialists.

The WRHA provides consultative services for cases and contact identification and management to all RHAs as follows:

  • Providing consultation for identification and medical management, by WRHA Specialist TB Clinicians for adult and pediatric cases of TB disease, LTBI or request for admission to a WRHA facility.
    • For clients 17 years of age or older – Adult Chest Medicine at the Health Sciences Centre: page 204-787-2071, 24 hours a day, seven days a week (if non-urgent, fax 204-787-2420 or page 204-787-2071, Monday to Friday).
    • For clients younger than 17 years of age – Pediatric Infectious Diseases at the Health Sciences Centre: page 204-787-2071, 24 hours a day, seven days a week (if non-urgent, tel.  204-787-4697 or fax 204-787-4503).
  • Providing consultation for population and public health case and contact management; TB case transfer (within Manitoba); TB issues involving correctional centers – WRHA Population and Public Health: tel. 204-940-2274; fax 204-957-0884.

  
In or near Brandon:
Infectious Diseases on-call (Dr. Bookatz): page 204-578-4000
or call office 204-727-6451 ext.2202

In or near Thompson:
Dr. Shadi Mahmoud: cell 204-939-6076
If cell phone unavailable, page HMO on call:   204-677-2381

Outside of WRHA, each regional health authority (RHA) is responsible for the provision of public health case and contact management for TB. The contact numbers can be found in http://www.gov.mb.ca/health/publichealth/offices.html