Challenges Persist in Diagnosing Tuberculosis in the U.S. Amid Rising Cases
While tuberculosis (TB) may seem like a relic of the past, it remains a significant health issue today, with cases in the United States gradually increasing. The complexity of diagnosing TB often leads to delayed treatment, as illustrated by Kate O’Brien’s experience in New York City.
O’Brien, who was expecting her second child, initially believed she had a severe cold. “I was going to all these different doctors, and I was trying to just figure out what was wrong with me,” she recalled. She received various diagnoses such as mononucleosis and acid reflux, yet none of the prescribed treatments provided relief.
“It had just been like months and months and months of being very sick, the disease was progressing very quickly, and I was losing weight. I had no appetite,” O’Brien shared. After a series of misdiagnoses and growing concerns from her loved ones, she finally sought help at an urgent care center. A chest x-ray during her hospital stay eventually led to the correct diagnosis of tuberculosis, but only after four months of symptoms.
Tuberculosis, often associated with historical imagery of Victorian-era maladies, continues to be the deadliest infectious disease worldwide. According to Tasha Pascal from Northern Nevada Public Health, TB is notoriously complex. “There’s two types of tuberculosis,” she explained. “One that is latent tuberculosis infection, or what we also call inactive TB. So it’s like the bacteria is sleeping in the body, most people won’t even know they have the bacteria in the body.”
While latent TB may not cause immediate symptoms, it requires treatment to prevent progression to active TB. Active TB is contagious and can affect various body parts, most commonly the lungs, but also bones and lymph nodes.
Today, TB is treatable with medications, primarily pills, with services like those offered by the Washoe County TB Clinic available at no cost to curb outbreaks. Treatment for active TB typically spans four to nine months, depending on factors like drug resistance. Despite effective treatments, as O’Brien’s situation demonstrates, diagnosis can present more challenges than treatment itself.
Pascal noted that the issue of delayed diagnosis is prevalent beyond the East Coast, extending to areas like Nevada. “People with TB will get diagnosed over and over and over again with pneumonia until they’re really, really sick, and they have a big what we call cavity, or big kind of hole in their lung,” she revealed. “And then finally at that point, once they’re unfortunately pretty sick, then it’s caught.”
In April, the tuberculosis clinic of Northern Nevada Public Health relocated to a larger facility, moving from a cramped basement to a more spacious environment. Pascal emphasized that the new clinic underscores the seriousness with which they approach TB cases.
A significant issue is that many healthcare providers do not consider TB in their initial assessments, a problem rooted in a lack of education. For instance, hospitals in Washoe County may send samples to labs that do not automatically perform rapid TB tests, delaying diagnoses despite the state lab’s ability to provide quick results.
O’Brien’s experience highlights the long-term consequences of such delays. “I’ll have long-term lung damage for the rest of my life, really only one good lung, because of how long it took and how long the disease had a chance to kind of grow,” she said. She now supports others through We Are TB, an organization aiding TB patients and survivors.
Pascal advocates for increased awareness regarding TB. “We need more education out there for TB,” she asserted. “I think that’s the most important thing that we can do to change that.” According to the CDC, symptoms of active TB include a persistent cough lasting over three weeks, coughing up blood, and loss of appetite. Those suspecting TB should consult with healthcare providers or visit the Washoe County TB Clinic.
